Last updated on RxList: 5/3/2021
Paricalcitol Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 02/27/2017

Zemplar (paricalcitol) Injection is a man-made active form of vitamin D used in patients with long-term kidney disease to treat or prevent high levels of parathyroid hormone. Too much parathyroid hormone can cause serious problems such as bone disorders. This medication is available in generic form. Common side effects include:

  • headache,
  • nausea,
  • chills, or
  • fever.

The recommended initial dose of Zemplar is 0.04 mcg/kg to 0.1 mcg/kg (2.8 – 7 mcg) administered as a bolus dose no more frequently than every other day at any time during dialysis. Zemplar may interact with products that contain aluminum/magnesium (e.g., certain antacids, phosphate binders), corticosteroids, digoxin, calcium supplements, other products that contain vitamin D or phosphate, nefazodone, telithromycin, azole antifungals, antibiotics, protease inhibitors, thiazide diuretics, or drugs that cause drowsiness (antihistamines, anti-seizure drugs, medicine for sleep or anxiety, muscle relaxants, narcotics, psychiatric medicines). Tell your doctor all medications and supplements you use. During pregnancy, Zemplar should be used only when prescribed. It is unknown if Zemplar passes into breast milk. Consult your doctor before breastfeeding.

Our Zemplar (paricalcitol) Injection Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


The only purpose of the kidneys is to filter blood. See Answer
Paricalcitol Consumer Information

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Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • fast, slow, or pounding heartbeats;
  • fever, flu symptoms, mouth and throat ulcers;
  • new or worsening cough, fever, trouble breathing;
  • a seizure; or
  • high calcium levels--nausea, vomiting, loss of appetite, constipation, increased thirst or urination, confusion, weight loss, tiredness.

You may be more likely to have a broken bone if your parathyroid hormone levels get too low. Talk with your doctor about how to avoid the risk of fractures.

Common side effects may include:

  • nausea, vomiting;
  • swelling in your hands or feet;
  • dizziness or spinning sensation;
  • joint pain; or
  • runny nose.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Paricalcitol (Paricalcitol Tablets)


Kidney Stones: Symptoms, Causes, and Treatment See Slideshow
Paricalcitol Professional Information


The following serious adverse reactions are described below and elsewhere in the labeling:

  • Hypercalcemia [see WARNINGS AND PRECAUTIONS]
  • Adynamic Bone Disease [see WARNINGS AND PRECAUTIONS]

Clinical Trials Experience

Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice.

Four placebo-controlled, double-blind, multicenter studies were conducted in 113 patients (51% male, 10% Caucasian, 81% African-American and 9% Hispanic, ranging in age from 18 to 90 years). Sixty-two patients were exposed to ZEMPLAR and the average dose at the end of treatment was 0.12 mcg/kg/dose with a mean number of 55 days of dosing across the studies. Discontinuation of therapy due to any adverse reaction occurred in 6.5% of patients treated with ZEMPLAR and 2.0% of patients treated with placebo. Adverse reactions occurring with greater frequency in the ZEMPLAR group and at a frequency of 2% or greater are presented in Table 3.

Table 3: Adverse Reactions Occurring at a Rate of 2% or Greater in Patients with CKD on Dialysis in Four Placebo-Controlled Studies

Adverse Reaction Placebo
(n = 51) %
(n = 62) %
Nausea 8 13
Vomiting 6 8
Edema 0 7
Gastrointestinal Hemorrhage 2 5
Chills 2 5
Pyrexia 2 5
Pneumonia 0 5
Sepsis 2 5
Influenza 4 5
Arthralgia 4 5
Palpitations 0 3
Dry Mouth 2 3
Malaise 0 3

Other Adverse Reactions

The following adverse reactions occurred in less than 2% of the ZEMPLAR treated patients in the above mentioned studies and in additional double-blind, active-controlled and open-label studies:

Blood and Lymphatic System Disorders: Anemia, lymphadenopathy

Cardiac Disorders: Arrhythmia, atrial flutter, irregular heart rate, cardiac arrest, chest discomfort, chest pain, edema peripheral

Ear and Labyrinth Disorders: Ear discomfort

Endocrine Disorders: Hypoparathyroidism

Eye Disorders: Conjunctivitis, glaucoma, ocular hyperemia

Gastrointestinal Disorders: Abdominal discomfort, constipation, diarrhea, dysphagia, gastritis, intestinal ischemia, rectal hemorrhage

General Disorders: Asthenia, condition aggravated, fatigue, feeling abnormal, pain, swelling Infections: Nasopharyngitis, upper respiratory tract infection, vaginal infection

Injection site reactions: Injection site extravasation, injection site pain

Laboratory abnormalities: Hypercalcemia, hyperkalemia, hyperphosphatemia, hypocalcemia, increased aspartate aminotransferase, prolonged bleeding time

Metabolism and Nutrition Disorders: Decreased appetite, thirst, decreased weight

Musculoskeletal and Connective Tissue Disorders: Joint stiffness, muscle twitching, myalgia

Neoplasms Benign, Malignant and Unspecified: Breast cancer

Nervous System Disorders: Cerebrovascular accident, dizziness, dysgeusia, headache, hypoesthesia, myoclonus, paresthesia, syncope, unresponsive to stimuli, gait disturbance

Psychiatric Disorders: Agitation, confusional state, delirium, insomnia, nervousness, restlessness

Reproductive System and Breast Disorders: Breast pain, erectile dysfunction

Respiratory, Thoracic and Mediastinal Disorders: Cough, dyspnea, orthopnea, pulmonary edema, wheezing

Skin and Subcutaneous Tissue Disorders: Alopecia, blister, hirsutism, night sweats, rash pruritic, pruritus, skin burning sensation

Vascular Disorders: Hypertension, hypotension

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of ZEMPLAR. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Allergic reactions, such as rash, urticaria, and angioedema (including laryngeal edema) have been reported.


Table 4 includes clinically significant drug interactions with ZEMPLAR.

Table 4: Clinically Significant Drug Interactions with ZEMPLAR

Drugs that May Increase the risk of Hypercalcemia
Clinical Impact Concomitant administration of high doses of calcium-containing preparations or other vitamin D compounds may increase the risk of hypercalcemia. Thiazide diuretics are known to induce hypercalcemia by reducing excretion of calcium in the urine.
Examples Calcium-containing products, other vitamin D compounds or thiazide diuretics
Intervention Monitor calcium more frequently and adjust ZEMPLAR dose as needed [see WARNINGS AND PRECAUTIONS].
Digitalis Compounds
Clinical Impact ZEMPLAR can cause hypercalcemia which can potentiate the risk of digitalis toxicity.
Intervention Monitor patients for signs and symptoms of digitalis toxicity and increase frequency of serum calcium monitoring when initiating or adjusting the dose of ZEMPLAR in patients receiving digitalis compounds [see WARNINGS AND PRECAUTIONS].
Strong CYP3A Inhibitors
Clinical Impact ZEMPLAR is partially metabolized by CYP3A. Exposure of ZEMPLAR will increase upon coadministration with strong CYP3A inhibitors [see CLINICAL PHARMACOLOGY].
Examples Boceprevir, clarithromycin, conivaptan, grapefruit juice, indinavir, itraconazole, ketoconazole, lopinavir/ritonavir, mibefradil, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telithromycin, and voriconazole
Intervention If a patient initiates or discontinues therapy with a strong CYP3A4 inhibitor, dose adjustment of ZEMPLAR may be necessary. Monitor intact PTH and serum calcium concentrations closely.

Read the entire FDA prescribing information for Paricalcitol (Paricalcitol Tablets)

© Paricalcitol Patient Information is supplied by Cerner Multum, Inc. and Paricalcitol Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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