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Cinacalcet PTH Oversuppression — ESENeph MCQ

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HardHaemodialysisCinacalcet PTH OversuppressionESENeph

A haemodialysis patient taking cinacalcet 90 mg daily develops cramps and paraesthesia. Corrected calcium is 1.86 mmol/L despite calcium and vitamin-D adjustment. What does the UK SmPC direct?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Withhold cinacalcet until calcium and symptoms recover, then restart lower

Explanation lettering: D = shown as A · A = shown as C · C = shown as D

D is correct. At corrected calcium at or below 1.9 mmol/L—or with persistent symptomatic hypocalcaemia when vitamin D cannot be increased—the cinacalcet SmPC directs withholding treatment until calcium reaches at least 2.0 mmol/L and symptoms resolve, then restarting at the next lower dose. Hypocalcaemia can prolong QT and cause ventricular arrhythmia or seizures. More calcimimetic exposure worsens the mechanism. Calcium, phosphate, PTH, dialysate calcium, vitamin-D therapy and the original indication are reviewed rather than treating the PTH value in isolation.

Reference: UK cinacalcet Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/11795/smpc