calcitonin is supplied as a 200 units/mL, 2 mL multi-dose vial (400 units/vial)

Dosing Rounding (Adults): Intramuscular calcitonin doses may be automatically rounded to the nearest vial size (200 units) if within 15% of the originally ordered dosage.

August 2022 Update: Only 400 unit vials are available (400 unit and 800 unit rounding described above). Other dosage ranges may be rounded to nearest 10 units until the 200 unit vial is available.

Calcimar --> Interchange to nasal spray if being used for osteoporosis or Paget’s Disease, if patient can take nasal spray. 

Interchange doses are as follows: 

• Approximately 200 units of nasal spray once daily produces similar clinical results as 100 units of injection administered I.M. or SQ every other day. 
• For postmenopausal osteoporosis, calcitonin inj. 100 units every other day should be interchanged to calcitonin nasal spray (Fortical) 200 units (1 spray) in one nostril daily. 
• For Paget’s Disease, 50 units injectable once daily or 100 units injectable every 2-3 days interchanged to nasal spray 200 units in one nostril daily.

Fortical is the formulary calcitonin nasal spray.

Miacalcin is non-formulary, not stocked and should be interchanged to Fortical.

Criteria for calcitonin use in hypercalcemia of malignancy:

• Patients must present with at least one severe symptom (acute kidney injury, altered mental status, or arrhythmias) with hypercalcemia (corrected calcium >/= 10.5 mg/dL).
• Calcitonin dose should not exceed 4 units/kg (TBW) and 4 doses over 48 hours.
• In addition to specialists above, hospitalists may order calcitonin for treatment of hypercalcemia of malignancy if ordered through the PowerPlan, HOSP ADULT Hypercalcemia of Malignancy Orders

Reviewed: June 27, 2008 (FORTICAL)

Updated: 24 January 2017 (Dose Rounding). Jan 2021 (Criteria for calcitonin in hypercalcemia)

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