Calcitonin (Nasal spray)
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 BRAND NAMES
- Canada: Miacalcin Nasal Spray, Apo-Calcitonin Nasal spray (Calcitonin salmon nasal spray will be withdrawn from the market on October 1st, 2013 because of a newly identified risk of malignancies (cancer), making its benefit-risk profile for the treatment of postmenopausal osteoporosis no longer considered favourable )
- U.S.: Miacalcin Nasal Spray
 MECHANISM OF ACTION
Osteoporosis happens when not enough new bone grows to replace the bone that is naturally broken down. Gradually, the bones become thin and fragile, and more likely to break. Osteoporosis is more common in women after the menopause, when the levels of the female hormone estrogen fall, since estrogen helps to keep bones healthy.
Osteoblasts make bone, while osteoclasts resorb or take away bone.
Calcitonin is a polypeptide hormone secreted by the parafollicular cells of the thyroid gland in mammals and by the ultimobranchial gland of birds and fish.
Calcitonin salmon Nasal Spray, is a synthetic polypeptide of 32 amino acids in the same linear sequence that is found in calcitonin of salmon origin that acts by inhibiting osteoclast bone resorption and promoting renal excretion of Calcium. Calcitonin salmon is approximately 40 to 50 times more potent than human calcitonin.
- Treatment of postmenopausal osteoporosis in females greater than 5 years postmenopause with low bone mass relative to healthy premenopausal females. Calcitonin Nasal Spray should be reserved for patients who refuse or cannot tolerate estrogens or in whom estrogens are contraindicated. Use of Calcitonin Nasal Spray is recommended in conjunction with an adequate calcium (at least 1000 mg elemental calcium per day) and vitamin D (400 I.U. per day) intake to retard the progressive loss of bone mass. The evidence of efficacy is based on increases in spinal bone mineral density observed in clinical trials.
The recommended dose of Calcitonin nasal spray is one spray (200 I.U.) per day administered intranasally, in alternating nostrils.
Drug effect may be monitored by periodic measurements of lumbar vertebral bone mass to document stabilization of bone loss or increases in bone density.
Hypersensitivty to calcitonin-salmon
- Periodic nasal examinations with visualization of the nasal mucosa, turbinates, septum and mucosal blood vessel status are recommended because of the risk of development of mucosal ulcerations or transient nasal conditions. If severe ulceration of the nasal mucosa occurs. Calcitonin Nasal Spray should be discontinued.
- Monitor serum Calcium
- Lithium carbonate: Concomitant use of calcitonin and lithium may lead to a reduction in plasma lithium concentrations due to increased urinary clearance of lithium. The dose of lithium may need to be adjusted.
 PREGNANCY AND LACTATION
- Pregnancy Category C (US). Calcitonin Nasal Spray is not indicated for use in pregnancy.
- Nursing Mothers: It is not known whether this drug is excreted in human milk. As a general rule, nursing should not be undertaken while a patient is on this drug since many drugs are excreted in human milk. Calcitonin has been shown to inhibit lactation in animals.
 SIDE EFFECTS
Most common adverse events include: nasal irritaion, rhinitis, back pain, headache and epistaxis