Secondary hyperparathyroidism or hypocalcemia:
Indications for PARSABIV:
Secondary hyperparathyroidism in adults with chronic kidney disease (CKD) on hemodialysis.
Limitations of Use:
Not recommended in adults with parathyroid carcinoma, primary hyperparathyroidism, or with CKD who are not on hemodialysis.
Give at the end of hemodialysis. Initially 5mg as IV bolus inj 3 times weekly. Maintenance: 2.5mg–15mg 3 times weekly based on PTH target range and corrected serum calcium response within normal range. May increase in 2.5mg or 5mg increments no sooner than every 4 weeks; max 15mg 3 times weekly. Monitoring and dose adjustment: see full labeling. Switching from cinacalcet: initially 5mg.
Hypocalcemia: may increase risk of QT prolongation and ventricular arrhythmias in congenital or family history of long QT syndrome or sudden cardiac death, history of QT prolongation and other predispositions; monitor closely. Seizure disorders. Measure corrected serum calcium prior to initiation; do not start if below lower limit of normal. Monitor serum calcium within 1 week of initiation or dose adjustment and every 4 weeks during treatment (see full labeling). If serum calcium is below lower limit of normal or symptoms of hypocalcemia occurs, initiate or increase calcium supplementation. Monitor for adynamic bone disease; if PTH levels fall below target range, reduce dose (Vit.D sterols and/or etelcalcetide) or discontinue; resume at lower dose. Monitor closely for worsening heart failure. Known gastritis, esophagitis, ulcers, severe vomiting: monitor for worsening GI reactions, bleeding, and ulcerations. Pregnancy. Nursing mothers: not recommended.
See Adults. Risk of severe hypocalcemia with concomitant other oral calcium-sensing receptor agonist. When switching from cinacalcet, discontinue cinacalcet for at least 7 days prior to initiation.
Decreased blood calcium, muscle spasms, diarrhea, nausea, vomiting, headache, hypocalcemia (may be severe), paresthesia.