• Calcitonin IM will be formulary restricted to 2 doses in patients with symptomatic hypercalcemia and uncorrected 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  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