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Administration of CALCIJEX® (calcitriol injection) to patients in excess of their daily requirements can cause hypercalcemia, hypercalciuria and hyperphosphatemia. Conversely, high intake of calcium and phosphate concomitantly with therapeutic doses of CALCIJEX® may cause similar abnormalities (see WARNINGS and PRECAUTIONS and ADVERSE REACTIONS). In dialysis patients, high levels of calcium in the dialysis bath may contribute to hypercalcemia.
Treatment Of Hypercalcemia In Patients Undergoing Hemodialysis
General treatment of hypercalcemia (more than 1 mg/dL or 0.25 mmol/L above the upper limit of the normal range) consists of immediate discontinuation of calcitriol therapy, institution of a low calcium diet and withdrawal of calcium supplements. Decreasing calcium concentration in the dialysate solution may be considered. Serum calcium levels should be determined daily until normocalcemia ensues. Hypercalcemia frequently resolves in two to seven days. When serum calcium levels have returned to within normal limits, CALCIJEX® therapy may be reinstituted at a dose of 0.5 mcg less than prior therapy. Serum calcium levels should be carefully monitored (at least twice weekly) during this period of dosage adjustment and subsequent dosage titration.
Persistent or markedly elevated serum calcium levels may be corrected by dialysis against a calcium-free dialysate.
Treatment Of Accidental Overdosage
The treatment of acute accidental overdosage with CALCIJEX® should consist of general supportive measures. Serial serum electrolyte determinations (especially calcium ion), rate of urinary calcium excretion, and assessment of electrocardiographic abnormalities due to hypercalcemia should be obtained. Such monitoring is critical in patients receiving digitalis. Discontinuation of supplemental calcium and low calcium diet are also indicated in accidental overdosage. Due to the relatively short pharmacological action of calcitriol, further measures are probably unnecessary. Should, however, persistent and markedly elevated serum calcium levels occur, there are a variety of therapeutic alternatives which may be considered, depending on the patient's underlying condition. These include the use of drugs such as phosphates, corticosteroids, bisphosphonates, mithramycin, calcitonin, glucocorticoids, and galium nitrate as well as measures to induce an appropriate forced saline diuresis. The use of peritoneal dialysis against a calcium-free dialysate has also been reported.
- CALCIJEX® (calcitriol injection) is contraindicated in patients with previous hypersensitivity to vitamin D or its analogues and derivatives
- CALCIJEX® is contraindicated in patients with hypercalcemia or evidence of vitamin D toxicity
- CALCIJEX® is contraindicated in patients with previous hypersensitivity to calcitriol or to any ingredient in the formulation or component of the container. For a complete listing of components/excipients, see the Dosage Forms, Composition And Packaging section of the Product Monograph.
Last reviewed on RxList: 2/23/2016
Additional Calcijex Injection Information
- Calcijex Injection Drug Interactions Center: calcitriol iv
- Calcijex Injection Side Effects Center
- Calcijex Injection Overview including Precautions
- Calcijex Injection FDA Approved Prescribing Information including Dosage
Report Problems to the Food and Drug Administration
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