Cinacalcet
SENSIPAR
What it isCalcium-sensing receptor agonist; secondary hyperparathyroidism in dialysis and parathyroid carcinoma.
Why this oneIt lowers PTH without raising calcium and phosphate, which vitamin D analogues cannot do.
What limits itHypocalcemia, which lengthens QT and can cause seizures. Nausea limits titration; it inhibits CYP2D6.
FDA-approved for
- hyperparathyroidism (2004)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Secondary hyperparathyroidism in CKD on dialysis | Adults | 30 mg QD | Titrate to iPTH 150–300 pg/mL | 180 mg QD |
| Hypercalcemia in parathyroid carcinoma / severe primary HPT | Adults | 30 mg BID | Titrate to normalize serum calcium | 90 mg TID–QID |
Titration Titrate no more frequently than every 2–4 weeks
Renal Undefined
Hepatic Undefined
Instructions
- Take with food or shortly after a meal
- Swallow whole — do not chew, crush, or divide
- iPTH measured no earlier than 12h after most recent dose
Contraindications
- Serum calcium below the lower limit of normal (do not initiate)
Cautions
- Hypocalcemia — life-threatening/fatal events reported; can prolong QT, lower seizure threshold, cause hypotension/heart failure/arrhythmia; monitor serum calcium
- Upper GI bleeding in patients with risk factors
- Hypotension, worsening heart failure and/or arrhythmias in impaired cardiac function
- Adynamic bone disease if iPTH <100 pg/mL
- Not established/indicated in pediatric patients (fatal hypocalcemia reported)
Adverse reactions
- Nausea and vomiting (≥25%)
- Diarrhea, myalgia
- Dizziness, hypertension, asthenia, anorexia
- Seizures (1.4%)
Pregnancy Limited human data insufficient; animal studies show pup loss/reduced weight with maternal hypocalcemia
Lactation No human data; excreted in rat milk — consider benefits vs. risks
NO BOXED WARNINGS
Principal riskHypocalcemia, which lengthens QT
Cost, est. cash$20–$1,500/month
Generic entry2018
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Cinacalcet ballicule
Open Cinacalcet in the interactive console ↗
Memory aids: mascots and interaction avatars
