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Cinacalcet GI Side Effects Limiting — ESENeph MCQ

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EasyHaemodialysisCinacalcet GI Side Effects LimitingESENeph

A 60-year-old man with CKD G5D on HD develops severe secondary hyperparathyroidism (PTH 180 pmol/L). His calcium is 2.3 mmol/L and phosphate 2.0 mmol/L. He is started on Cinacalcet 30 mg daily. What is the most common side effect limiting Cinacalcet use?

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Correct answer: A — Gastrointestinal intolerance (nausea, vomiting) – occurs in 20-30% of patients and is the most common reason for discontinuation; taking with food reduces symptoms; dose titration from 30 mg helps tolerability

Cinacalcet causes GI side effects (nausea, vomiting, loss of appetite) in 20-30% of patients, which is the most common reason for dose reduction or discontinuation. The mechanism involves calcium-sensing receptor activation in GI mucosa. Strategies to improve tolerability: take with food or after meals, start at 30 mg with gradual titration (every 4 weeks), and consider switching to IV Etelcalcetide (avoids GI absorption and associated GI side effects) for patients who cannot tolerate oral Cinacalcet. Other side effects include hypocalcaemia (common, monitor) and QT prolongation.

Reference: KDIGO 2017 – CKD-MBD; BNF – Cinacalcet