Calcitonin: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 31, 2023.

1. How it works

• Calcitonin may be used to treat postmenopausal osteoporosis in some women.
• Calcitonin acts on calcitonin receptors in bone and possibly also the kidney and gastrointestinal tract, preventing the breakdown of bone and increasing its density. Calcitonin is a human hormone that is also found in salmon, however, man-made calcitonin is made using DNA recombinant technology and does not use salmon.
• Calcitonin may be known as calcitonin-salmon.
• Calcitonin belongs to the class of medicines known as calcitonin receptor agonists.

2. Upsides

• May be used for the treatment of postmenopausal osteoporosis in women that are at least five years postmenopause, when other treatments (such as estrogens) are contraindicated, not tolerated, or not desired.
• Available as a spray to be used in the nose.
• Once-daily use (alternate nostrils every day).
• May be used off-label (meaning it is not an FDA-approved use but is a recognized use) short-term for Paget's disease, a bone disorder; for acute bone loss due to sudden immobilization; and with excess blood calcium levels caused by cancer.
• Has few drug interactions although may reduce blood levels of lithium because it increases the clearance of lithium via the kidneys.
• Generic calcitonin is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Use of calcitonin nasal spray may result in adverse reactions related to the nose such as rhinitis and nosebleeds. Back pain and a headache have also been reported.
• Serious, sometimes fatal, allergic reactions (including swelling of the tongue or throat, bronchospasm, and anaphylaxis) have been reported in people receiving calcitonin.
• Very low blood calcium levels (hypocalcemia) may occur, associated with muscle cramps and twitching, and occasionally seizure activity. Hypocalcemia must be corrected before starting calcitonin, and blood calcium levels monitored throughout treatment. Calcitonin nasal spray should be used in conjunction with an adequate intake of calcium and vitamin D.
• Has also been associated with cardiovascular side effects (such as high blood pressure, and chest pain), tinnitus, shortness of breath, and other side effects.
• The effectiveness of calcitonin for reducing the risk of bone fractures has not been proven.
• Calcitonin treatment has been associated with an increased risk of cancer (risk of 4.1% with calcitonin compared with 2.9% in placebo-treated patients).
• In some people, antibodies may develop to calcitonin which inhibits its effectiveness.
• May cause changes in urine in bedridden people.
• Has not been shown to increase bone mineral density in early postmenopausal women, which is why use is restricted to women who are at least five years postmenopausal. It should never be used in women with reproductive potential.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Calcitonin is reserved for the treatment of postmenopausal osteoporosis in women when other treatments for osteoporosis are ineffective, not tolerated, or not desired. The FDA discourages its use, saying its risks (of malignancy) outweigh its benefits. Nasal side effects are common and blood calcium levels must be within the normal range before treatment begins.

5. Tips

• Take exactly as directed by your doctor. Do not overuse this medication.
• Store unopen calcitonin nasal spray in the refrigerator at a temperature between 36°F to 46°F (2°C to 8°C). Calcitonin that is in use may be kept at room temperature, between 68°F to 77°F (20°C to 25°C). When using calcitonin for the first time, allow it to warm to room temperature before using. Prime the pump several times to ensure a full spray is released, before self-administering. This only needs to be done once.
• Do not shake the bottle. When self-administering the nasal spray, keep your head in an upright position and firmly depress the pump. You do not need to breathe in or inhale while you are giving your dose and you may not feel the spray inside your nose. Use a different nostril to spray your medicine into each day. Even if some spray drips out of your nose, you will still be receiving the correct dose. Each spray delivers 0.09mL (200 USP calcitonin salmon units) per actuation.
• Wipe the tip of the nose spray pump with a clean damp cloth once or twice a week. The 2mL bottle should be discarded after 14 doses and the 3.7mL bottle after 30 doses, even if they do not look empty.
• Your doctor will talk to you about taking calcium and vitamin D with calcitonin nasal spray. Follow his/her recommendations and maintain good dietary levels of calcium and vitamin D.
• Call your doctor if you experience any untoward reactions such as muscle cramps or twitching, rhinitis, nose bleeds, or there is no change in your bone density measurements. Be aware that the use of calcitonin can increase your risk of developing a malignancy (a risk of 4.1% with calcitonin compared with 2.9% in people who do not take calcitonin).
• Seek emergency medical help if you develop any symptoms of an allergic reaction such as swelling of the tongue, throat, or facial features, difficulty breathing, or collapse).
• Tell your doctor if you are pregnant or intend to become pregnant while taking calcitonin. Calcitonin is not recommended during pregnancy and there is no data about its effects on the breastfeeding infant. Calcitonin is only recommended in postmenopausal women.

6. Response and effectiveness

• Calcitonin nasal spray is rapidly absorbed with a maximum time-to-peak effect of 13 minutes. It has a short half-life (18 minutes); however, its effects are long-lasting, and once-daily dosing is effective for the treatment of osteoporosis.
• Research has not shown calcitonin to be effective at reducing the incidence of fractures. The nasal spray should be reserved for people intolerant of or with contraindications to other treatments.
• The FDA has ruled that the benefits of calcitonin-containing medicines do not outweigh their risks for the treatment of osteoporosis and they should no longer be used for this condition.

7. Interactions

Medicines that interact with calcitonin may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with calcitonin. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with calcitonin include:

• etelcalcetide
• foscarnet
• lithium
• sincalide
• zoledronic acid.

Note that this list is not all-inclusive and includes only common medications that may interact with calcitonin You should refer to the prescribing information for calcitonin for a complete list of interactions.

References

• Calcitonin-Salmon Injection. 11/2021. Par Pharmaceutical, Inc. https://www.drugs.com/pro/calcitonin-salmon-injection.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use calcitonin only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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