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calcitonin nasal

Generic Name: calcitonin nasal (kal si TOE nin)
Brand Name: Fortical, Miacalcin Nasal

What is calcitonin nasal?

Calcitonin is a man-made form of a hormone that occurs naturally in the thyroid gland.

Calcitonin nasal is used to treat osteoporosis in women who have been in menopause for at least 5 years.

Calcitonin nasal may also be used for purposes not listed in this medication guide.

Important Information

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use this medicine if you are allergic to salmon calcitonin.

To make sure calcitonin nasal is safe for you, tell your doctor if you have:

  • high levels of calcium in your blood (hypercalcemia); or

  • any nasal or sinus problems such as nasal deformities, a chronic infection, or nasal pain.

Using calcitonin nasal may increase your risk of developing certain types of cancer. Ask your doctor about your specific risk.

FDA pregnancy category C. It is not known whether calcitonin nasal will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

It is not known whether calcitonin nasal passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How should I use calcitonin nasal?

To make sure you are not allergic to calcitonin, your doctor may perform an allergy skin test before your first dose of this medicine.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Calcitonin nasal comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Store unopened calcitonin nasal in the refrigerator but do not allow it to freeze.

Once you put the bottle and pump assembly together, you may keep the medicine at room temperature, away from light and heat. Store the bottle upright with the pump attached.

Before your first use of the assembled bottle and pump, you must prime the spray. Allow the medicine to reach room temperature before priming.

To prime calcitonin nasal, press the pump at least 5 times until a fine mist appears. Prime the spray only before your first use of the newly assembled bottle.

To use the nasal spray:

  • Blow your nose gently. Keep your head upright and insert the tip of bottle into one nostril. Hold the nasal spray upright with your first and second fingers on each side of the pump and your thumb on the bottom of the bottle.

  • Pump the spray unit firmly to spray the medicine into your nostril. You do not need to sniff or inhale deeply.

  • Do not blow your nose for at least a few minutes after using the nasal spray.

  • If the spray gets in your eyes or mouth or on your skin, rinse with water.

Calcitonin nasal is usually given as one spray per day into only one of your nostrils. Use the other nostril the next day and continue alternating back and forth for each daily dose.

Calcitonin nasal spray delivers a fine mist into the nose. Even if you do not feel the spray while using it, the medication is still being absorbed by your nasal passages.

Each bottle contains 30 doses of calcitonin nasal. Throw away the medicine after 30 uses, even if there is still medicine left in the bottle.

To be sure this medication is not causing harmful side effects to the inside of your nose, your doctor may want to check your nasal passages often.

Your doctor may have you take extra vitamin D while you are using calcitonin nasal. Take only the amount of vitamin D that your doctor has prescribed.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using calcitonin nasal?

Avoid using any other nasal sprays or nasal medicines at the same time you use calcitonin nasal unless your doctor has told you to.

Calcitonin nasal side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; fast heartbeats; feeling lightheaded; chest pain, difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • severe nasal irritation; or

  • low levels of calcium in your blood--numbness or tingly feeling around your mouth, fast or slow heart rate, muscle tightness or contraction, overactive reflexes.

Common side effects may include:

  • bleeding from your nose;

  • runny or stuffy nose;

  • dryness, itching, tenderness, or general discomfort of your nose; or

  • crusting, scabs, or sores inside your nose.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Calcitonin nasal dosing information

Usual Adult Dose for Paget's Disease:

50 to 100 intl units given subcutaneously or intramuscularly once a day. The dosage may be reduced to 50 to 100 intl units subcutaneously or intramuscularly three times a week when improvement (clinical or biochemical) occurs. Calcitonin is usually not given for more than 6 months unless there are neurological symptoms or extensive lytic lesions in the weight-bearing bones. Biochemical remissions of the illness generally last for under six months. If retreatment is necessary, the same initial and maintenance dosage schedules generally are repeated. Human calcitonin is an orphan drug that may be used in patients that develop resistance or an allergic reaction to calcitionin-salmon.


200 to 400 intl units by intranasal administration once a day may also be used with a slight loss in efficacy (400 intl units nasal dose compared to 100 intl units intramuscular dose) but a decrease in systemic side effects. Studies have demonstrated that intranasal preparations reduced bone turnover by 30% to 40%, compared to the 50% seen with subcutaneous or intramuscular preparations.

Usual Adult Dose for Hypercalcemia:

4 intl units/kg (rounded to the next higher 5 intl units) subcutaneously or intramuscularly every 12 hours. The maximum dosage should not exceed 545 intl units per dose. If a response to the 4 intl units/kg dose is not observed in 1 to 2 days, 8 intl units/kg (rounded to the next higher 5 intl units) may be given subcutaneously or intramuscularly every 12 hours. The dosing frequency may be increased to every 6 hours, if needed. The maximum dosage should not exceed 1090 intl units per dose. Therapy is generally 5 days or fewer. A 2 mg/dl reduction in plasma calcium level is usually noted and maintained for 2 to 4 days. Thereafter, the effect diminishes.

Usual Adult Dose for Osteoporosis:

100 intl units given every other day or 50 intl units given once a day either subcutaneously or intramuscularly. Injectable doses may be increased to 200 or 400 intl units once per day, as required.


200 intl units may be given intranasally once a day, alternating nostrils daily.

Therapy is generally long-term, lasting months or years.

Usual Adult Dose for Osteogenesis Imperfecta Tarda:

50 intl units given subcutaneously three times a week. Dosages may be increased to 100 intl units depending on tolerance of side effects and efficacy of the 50 intl units dose therapy.

Usual Pediatric Dose for Osteogenesis Imperfecta Tarda:

Not a FDA approved indication:
Osteogenesis imperfecta
Children over 6 months of age: 2 international units/kg IM or SQ 3 times/week.

What other drugs will affect calcitonin nasal?

Other drugs may interact with calcitonin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about calcitonin nasal.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 6.01.

Date modified: January 03, 2018
Last reviewed: November 17, 2014