Calcitonin, Salmon

Class and Category

Pharmacologic class: Hormone
Therapeutic class: Antihypercalcemic, Anti-osteoporitic

Indications and Dosages

To treat an early hypercalcemic emergency.
I.M or Subcutaneous Injection
Initial: 4 international units/kg every 12 hr. Increased after 1 or 2 days, if needed, to 8 international units/kg every 12 hr and then 8 international units/kg every 6 hr after 2 more days, if needed. Maximum: 8 international units/kg every 6 hr.

To treat postmenopausal osteoporosis in women who are at least 5 years postmenopausal.
I.M or Subcutaneous Injection
Initial: 100 international units daily.

Nasal Spray
Adults: 200 international units (1 spray) daily, alternating nostrils.

To treat symptomatic Paget’s disease of the bone
I.M or Subcutaneous Injection
Adults: Initial: 100 international units daily.

Mechanism of Action
Directly inhibits bone resorption. Besides reducing the serum calcium level, this action slows bone metabolism (a major factor in the development of Paget’s disease) and calcium loss from the bone (a major factor in the development of osteoporosis).

Hypersensitivity to calcitonin salmon or its components.

lithium: Possibly decreased lithium level

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Adverse Reactions
CNS: Agitation, anxiety, CVA, dizziness, fatigue, headache, insomnia, neuralgia, paresthesia, tremor, vertigo.
CV: Bundle branch block, hypertension, MI, palpitations, peripheral edema, tachycardia, thrombophlebitis
EENT: Blurred vision; dry mouth; earache; epistaxis; eye pain; hearing loss; nasal irritation or ulceration (nasal spray), lesions, or redness; pharyngitis; rhinitis; salty taste; sinusitis; taste perversion; tinnitus; vitreous floaters
ENDO: Goiter, hyperthyroidism
GI: Abdominal pain, anorexia, cholelithiasis, diarrhea, epigastric discomfort, flatulence, gastritis, hepatitis, increased appetite, nausea, thirst, vomiting
GU: Hematuria, nocturia, polyuria, pyelonephritis, renal calculi
HEME: Anemia
MS: Arthralgia, arthrosis, back or musculoskeletal pain, joint stiffness, polymyalgia rheumatica
RESP: Bronchitis, bronchospasm, cough, dyspnea, pneumonia, upper respiratory tract infection
SKIN: Alopecia, diaphoresis, eczema, flushing of face or hands, pruritus of earlobes, rash, ulceration, urticaria
Other: Anaphylaxis, anaphylactic shock, angioedema, antibody formation, feverish sensation, hypocalcemia, influenza-like symptoms, injection-site inflammation, lymphadenopathy, malignancies, mild tetanic symptoms.

Childbearing Considerations
  • It is not known if drugs can cause fetal harm.
  • Use with caution only if the benefit to the mother outweighs the potential risk to the fetus.

  • It is not known if drug is present in breast milk.
  • Drug is not recommended for women who are or wish to breastfeed because drug action may interfere with lactation.

Nursing Considerations
  • Expect to perform a skin test before giving drug if sensitivity to drug is suspected. Prepare a mixture of 10 international units/ml by withdrawing 0.05 ml from a 200-international unit solution in a tuberculin syringe and filling the syringe to 1 ml with sodium chloride for injection. Mix well, discard 0.9 ml, and inject 0.1 ml intradermally on the inner forearm. Observe the site for 15 minutes after injection. If you detect evidence of sensitivity, such as more than mild erythema or a wheal, notify the prescriber.
WARNING: Monitor all patients for hypersensitivity reactions, which could be severe. Have appropriate equipment and drugs present to treat a hypersensitivity reaction if it occurs. Notify prescriber, expect drug to be discontinued, and provide supportive care, as directed by prescriber.
  • Monitor serum calcium level, as ordered, if patient receives calcitonin for hypercalcemia. During first several doses, keep parenteral calcium available in case the calcium level is inadvertently overcorrected.
  • Know that if prescribed calcitonin dose exceeds 2 ml, expect to use I.M. route and multiple injection sites.
  • Know that for patient receiving calcitonin for postmenopausal osteoporosis, know that hypocalcemia and other mineral metabolism disorders, such as vitamin D deficiency, must be corrected before calcitonin therapy begins. These patients should also be monitored during therapy for signs and symptoms of hypocalcemia such as muscle cramps, twitching, and seizures. Also, expect to give 1.5 g of supplemental calcium carbonate and at least 400 units of vitamin D daily. Plan to provide a balanced diet that includes foods high in calcium and vitamin D.
  • Periodically examine patient using nasal spray for nasal ulcers. If severe ulceration of the nasal mucosa occurs (ulcers greater than 1.5 mm, ulcers penetrating below the mucosa, or ulcers causing heavy bleeding), notify prescriber and expect nasal spray form to be discontinued. Also, know that nasal spray should be discontinued for smaller or less severe ulcers until healing occurs.
  • Assess for nausea, especially with the first dose. Nausea tends to decrease or disappear with continued use.
  • Be aware if patient with Paget’s disease relapses after treatment, check for antibody formation, as ordered.

  1. Tell patient to refrigerate injection or unopened nasal spray container.
  2. Teach patient to self-administer injections.
  3. Be aware that if patient has postmenopausal osteoporosis, teach her about dietary needs, including foods rich in calcium and vitamin D.
  4. Teach patient how to administer nasal spray, if ordered. Explain how to activate nasal pump by holding the bottle upright and depressing two white side arms toward the bottle six times. When bottle emits a faint spray, pump is activated. Tell patient to store activated nasal pump upright at room temperature and to discard it after 30 days.
  5. Instruct patient to place nozzle firmly into one nostril while holding head upright. Tell her to then depress the pump toward the bottle. 
  6. Remind patient that she doesn’t need to reactivate the pump before each dose. 
  7. Instruct patient to report nasal symptoms to prescriber.


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