Which medications in the drug class Calcium Metabolism Modifiers are used in the treatment of Vitamin Toxicity?

Updated: Jun 01, 2020
  • Author: Mark Rosenbloom, MD, MBA; Chief Editor: Michael A Miller, MD  more...
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Calcium Metabolism Modifiers

Calcitonin analogues may be used if the patient is severely hypercalcemic following the diuretic therapy. These agents directly inhibit osteoclastic bone resorption and have significant analgesic effects on bone.

Salmon calcitonin (Miacalcin, Fortical)

This agent is a peptide hormone that binds to calcitonin receptors on osteoclasts and rapidly inhibits bone resorption. Osteoclasts do not induce cytotoxic effects in bone cells.

Salmon calcitonin induces reductions in urinary hydroxyproline and serum alkaline phosphatase levels. Serum alkaline phosphatase begins to decline 4 weeks after initiation of treatment. Levels of urinary hydroxyproline may decrease quickly, indicating inhibition of bone resorption. These laboratory markers slowly increase back to pretreatment levels if treatment is stopped.

Restoration of more normal bone can be seen radiographically, especially after long-term calcitonin treatment. Bone biopsy samples also reflect reduced disease activity because decreased bone cells, marrow fibrosis, and woven bone are present. Improvement of neurologic deficits and stabilization of hearing have been noted. A dosage of 4-8 IU/kg IM/SC q6-12h may be administered.

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