alfacalcidol: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
alfacalcidol: clinical details
Prescribing considerations
- Confirm the licensed indication, intended formulation and relevant excipient allergies before prescribing.
- Assess baseline calcium and phosphate balance, kidney function, parathyroid hormone, alkaline phosphatase and vitamin D status.
- Review calcium, vitamin D, antacid, laxative and complementary products to reduce avoidable toxicity.
- Use particular caution with nephrolithiasis, granulomatous disease, renal impairment and cardiac glycoside treatment.
Contraindications and cautions
- Hypercalcaemia
- Metastatic calcification
- Hypersensitivity to alfacalcidol or product excipients
- Peanut allergy for selected capsules; people with soya allergy should also avoid this formulation
Monitoring
- Corrected serum calcium and serum phosphate throughout treatment
- Renal function and electrolytes
- Parathyroid hormone and alkaline phosphatase
- Serum magnesium where clinically relevant
- Symptoms of hypercalcaemia, hypercalciuria, nephrolithiasis or soft-tissue calcification
Clinical pharmacology
Alfacalcidol is a prodrug rapidly hydroxylated in the liver to calcitriol. It bypasses renal 1-alpha hydroxylation and regulates intestinal calcium and phosphate absorption, renal handling of minerals and parathyroid hormone activity.
Formulation and product differences
- Selected soft capsules contain arachis oil and small quantities of sorbitol and ethanol.
- Oral drops use an integral dropper and contain sorbitol, methylparahydroxybenzoate and macrogolglycerol hydroxystearate; they require refrigerated storage.
- The intravenous formulation contains ethanol and propylene glycol and requires refrigerated, light-protected storage; consider cumulative excipient exposure in neonates.
alfacalcidol preparations and strengths
Capsule
Route: Oral
Strengths: 0.25 micrograms, 0.5 micrograms, 1 micrograms, 1.0 micrograms
alfacalcidol interactions
Check prescribed, purchased and complementary products for these clinically relevant interactions.
Other vitamin D products or analogues
Additive effects increase the risk of hypercalcaemia; concurrent use generally requires specialist oversight.
Calcium-containing products and thiazide diuretics
These can further increase blood calcium, requiring closer biochemical monitoring.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.