Alfacalcidol Hypercalcaemia Low PTH — ESENeph MCQ

Correct answer: A — Stop alfacalcidol, then consider half-dose restart

The best answer is “Stop alfacalcidol, then consider half-dose restart”. The SmPC directs interruption when hypercalcaemia occurs. Calcium is monitored to normalisation and, if active vitamin D remains indicated, treatment restarts cautiously at half the previous dose. “Increase alfacalcidol to stimulate PTH secretion” is less appropriate because active vitamin D suppresses PTH and raises calcium, so escalation worsens the problem “Continue the same dose because suppressed PTH excludes vitamin-D toxicity” is less appropriate because suppressed PTH is the expected physiological response to treatment-related hypercalcaemia “Add a thiazide to increase urinary calcium excretion” is less appropriate because thiazides reduce urinary calcium and can aggravate hypercalcaemia “Switch immediately to calcitriol at an equivalent active dose” is less appropriate because another active vitamin-D analogue can perpetuate hypercalcaemia

Reference: Alfacalcidol Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/101564/smpc