calcitonin (salmon): clinical use

Prescribing considerations

• Confirm a restricted licensed indication; calcitonin is not licensed for treating osteoporosis.
• Consider the increased malignancy risk associated with long-term exposure.
• Use in people under 18 is not recommended because supporting evidence is insufficient.
• Suspected calcitonin sensitivity warrants assessment and skin testing before treatment.

Contraindications and cautions

• Hypersensitivity to calcitonin or any excipient.
• Hypocalcaemia.

Monitoring

• Serum calcium and clinical response, particularly in malignancy-associated hypercalcaemia.
• In Paget’s disease, appropriate bone-remodelling markers may help assess response.
• Watch for hypersensitivity, symptomatic hypocalcaemia and reduced response associated with neutralising antibodies.
• Clearance is reduced in end-stage renal failure, although the clinical relevance is uncertain.

Clinical pharmacology

Synthetic salmon calcitonin acts at calcitonin receptors on osteoclasts. It inhibits bone resorption and reduces renal tubular calcium reabsorption; it is mainly degraded by proteolysis in the kidneys.

Formulation and product differences

• The product is a clear, colourless aqueous solution in single-use glass ampoules for subcutaneous, intramuscular or intravenous administration.
• Infusions should be prepared immediately in soft PVC bags; glass or hard-plastic intravenous containers are incompatible.
• The formulation contains sodium, which may matter when strict sodium restriction is required.