• Calcitonin IM will be formulary restricted to 2 doses in patients with symptomatic hypercalcemia and corrected calcium level of at least 13.

If you receive an order for IM calcitonin, you must ensure the following PRIOR to verifying the order.  

1. Patient has an elevated corrected calcium level that is ≥ 13 mg/dL

2. Patient has documented symptoms of hypercalcemia in the electronic medical record.

   1. Examples: altered mental status, confusion, lethargy, extreme weakness, encephalopathy, and arrhythmias

3. Patient has fluids (Normal Saline continuous infusion) and a bisphosphonate (Zolendronic Acid or Pamindronate x once if NOT contraindicated e.g. AKI) on his/her MAR to start same day as calcitonin. 

   Ensure the IV calcitonin dose is not greater than 4 international units / kg

   1. Max = 2 doses in 48 hours

• UpToDate
• FDA Package Inserts
• Acadiana Market Specific P&T Updates
• Jackson Market Specific P&T Updates