paricalcitol: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
paricalcitol: clinical details
Prescribing considerations
- Individualise treatment using intact parathyroid hormone, corrected calcium and phosphate results.
- Avoid excessive PTH suppression because hypercalcaemia and low-turnover bone disease may result.
- Review calcium-based phosphate binders if clinically significant hypercalcaemia develops.
- In pre-dialysis patients, serum creatinine may rise and calculated eGFR may fall without a change in true glomerular filtration.
- There is no clinical experience with severe hepatic impairment.
Contraindications and cautions
- Hypercalcaemia
- Evidence of vitamin D toxicity
- Hypersensitivity to paricalcitol or a formulation excipient
Monitoring
- Intact parathyroid hormone
- Corrected serum calcium
- Serum phosphate and calcium–phosphate product
- Clinical and biochemical evidence of PTH oversuppression
- Interactions and mineral-containing supplements, particularly during treatment changes
Clinical pharmacology
Paricalcitol is a synthetic calcitriol analogue and selective vitamin D receptor activator. It suppresses parathyroid-cell proliferation and PTH synthesis and secretion. Oral absorption is not meaningfully affected by food; elimination is predominantly hepatobiliary.
Formulation and product differences
- Soft capsules are licensed for adults with chronic kidney disease stages 3 to 5 and for children aged 10 to 16 years with stages 3 or 4.
- The intravenous solution is licensed for adults with stage 5 chronic kidney disease undergoing haemodialysis and is given through dialysis access.
- Capsules contain gelatin and a small amount of ethanol.
- The injection contains ethanol and propylene glycol and is supplied for single use.
paricalcitol preparations and strengths
Capsule
Route: Oral
Strengths: 1 micrograms, 2 micrograms
Injection
Route: Parenteral
Strengths: 5 micrograms/mL
paricalcitol interactions
Tell the renal team about prescribed, non-prescription and complementary products; mineral-containing preparations are especially relevant.
Other vitamin D or phosphate-containing products
Combined use increases the risk of high calcium, phosphate and calcium–phosphate product.
Calcium supplements or calcium-based phosphate binders
High calcium intake can increase hypercalcaemia risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.