"The US Food and Drug Administration (FDA) has approved soluble ferric pyrophosphate (Triferic, Rockwell Medical) to replace iron and maintain hemoglobin in adults with chronic kidney disease who are undergoing dialysis.
Administration of Hectorol (doxercalciferol liquid filled capsule) to patients in excess doses can cause hypercalcemia, hypercalciuria, hyperphosphatemia, and oversuppression of PTH secretion leading in certain cases to adynamic bone disease. High intake of calcium and phosphate concomitant with Hectorol (doxercalciferol liquid filled capsule) may lead to similar abnormalities. High levels of calcium in the dialysate bath may contribute to hypercalcemia.
Treatment of Hypercalcemia and Overdosage
General treatment of hypercalcemia (greater than 1 mg/dL above the upper limit of the normal range in dialysis patients; > 10.7 mg/dL in pre-dialysis patients) consists of immediate suspension of Hectorol (doxercalciferol liquid filled capsule) therapy, institution of a low calcium diet, and withdrawal of calcium supplements. Serum calcium levels should be determined at least weekly until normocalcemia ensues. Hypercalcemia usually resolves in 2 to 7 days. When serum calcium levels have returned to within normal limits, Hectorol (doxercalciferol liquid filled capsule) therapy may be reinstituted at a dose that is lower (at least 2.5 mcg in dialysis patients and 0.5 mcg in pre-dialysis patients) than prior therapy. In dialysis patients, serum calcium levels should be obtained weekly after all dosage changes and during subsequent dosage titration. Persistent or markedly elevated serum calcium levels may be corrected by dialysis against a reduced calcium or calcium-free dialysate.
Treatment of Accidental Overdosage of Doxercalciferol
The treatment of acute accidental overdosage of Hectorol (doxercalciferol liquid filled capsule) should consist of general supportive measures. If drug ingestion is discovered within a relatively short time (10 minutes), induction of emesis or gastric lavage may be of benefit in preventing further absorption. If drug ingestion is discovered later than 10 minutes post-ingestion, the administration of mineral oil may promote its fecal elimination. Serial serum electrolyte determinations (especially calcium), 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 institution of a low calcium diet are also indicated in accidental overdosage. If persistent and markedly elevated serum calcium levels occur, treatment with standard medical care should be followed, as needed. Based on similarities between Hectorol (doxercalciferol liquid filled capsule) and its active metabolite, lα,25-(OH)2D2, it is expected that Hectorol (doxercalciferol liquid filled capsule) is not removed from the blood by dialysis.
Hectorol (doxercalciferol liquid filled capsule) should not be given to patients with a tendency towards hypercalcemia or current evidence of vitamin D toxicity.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 4/12/2011
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