etelcalcetide hydrochloride: clinical use

Prescribing considerations

• Confirm corrected serum calcium is not below the laboratory's lower normal limit before initiation or reinitiation.
• Review current or recent cinacalcet use and other treatments that can reduce serum calcium.
• Use caution with previous seizures, heart failure, QT prolongation, or other ventricular-arrhythmia risk factors.
• Avoid sustained excessive PTH suppression because adynamic bone may develop.

Contraindications and cautions

• Hypersensitivity to etelcalcetide or an excipient.
• Initiation when corrected serum calcium is below the lower limit of normal.

Monitoring

• Monitor corrected serum calcium and PTH.
• Increase monitoring when hypocalcaemia symptoms or seizure, heart-failure or QT-prolongation risks are present.
• Consider potassium and phosphate trends during dialysis biochemical monitoring.

Clinical pharmacology

Etelcalcetide is a synthetic peptide agonist of the calcium-sensing receptor. It is not metabolised through CYP450 enzymes, undergoes reversible disulphide exchange with endogenous thiols and is substantially removed by haemodialysis.

Formulation and product differences

• Clear, colourless, preservative-free solution for intravenous injection in single-use vials.
• Vial presentations differ in fill volume and total active ingredient but have the same concentration.
• The product is essentially sodium-free and must not be diluted or mixed with other medicines.