Calcitonin is a nasal spray medicine used for treating women with postmenopausal osteoporosis. These are women whose bones became weak and brittle, especially following menopause. The medicine is the man-made version of the protein hormone called “calcitonin,” released by the thyroid gland of mammals, including human, birds, and fish.
Osteoporosis is a condition in which the bones become weak and brittle due to the loss of bone mineral density (BMD) and bone mass. This reduces the quality and strength of bones. It is commonly seen in women who are past the stage of menopause, typically over 50 years of age.
Common effects of osteoporosis are curved spine, loss of height, and rounded shoulders. More significantly, it increases the risk for fractures of the spine, hip, and wrist. Calcitonin treatment is significant as it effectively increases bone mass and reduces the risk of spinal fractures.
Patients must be postmenopausal for at least 5 years prior to treatment and unable to be treated other than with Calcitonin. The medication is most effective when used with sufficient calcium and vitamin D. Its use is not recommended for preventing osteoporosis-related fractures in early postmenopausal women.
As with all medicinal treatments, patients should weigh the benefits against the risks of using Calcitonin. A discussion with your doctor may help you decide if this medicine is safe for you. Your doctor may consider your age, symptoms, and any medical condition (such as pregnancy), and family history before deciding to treat you.
Disclose all prescription and over-the-counter (OTC’s) medicines you may be taking or plan to take. These include herbal products, vitamin supplements, and nutritional supplements. This is important as Calcitonin is known to interact with the drug, lithium, and other medical problems. It may also interact with other agents such as those found in foods, alcohol, and tobacco.
Tell your doctor if you are allergic to this medicine. A pre-treatment test should be done to rule out an allergic reaction once you start taking the medicine.
This medicine should be used cautiously in pregnant and breastfeeding women. No adequate studies were done to determine the safety and efficacy of use.
Similarly, the safety and efficacy of use in children is not established. Therefore, it is not recommended for use in pediatrics.
Although it may be safe to use in the treatment of elderly patients, unwanted side effects, e.g., irritation or redness of the nose, are more likely to occur when using the nasal spray.
The medicine is intended to be used along with a daily recommended dose of at least 1000 mg of calcium and 400 I.U. of vitamin D. Your doctor may prescribe these supplements if you are not getting enough of them in your daily diet.
A number of side effects are possible when using this medicine. Patients over 65 more commonly experience an increase in nasal symptoms that are mild but do not usually require medical attention. Side effects range from being more common to rare. The effects may not occur all at once, and the occurrence of one or more of them may require medical attention.
Some side effects are more common and will require medical attention. Call your doctor right away if you experience any of the following symptoms:
Other side effects may occur, but the frequency and level of severity with which they do are unknown. If they occur, call your doctor right away. They include fainting, seizure, irregular heartbeat, confusion and blurry vision, in addition to the following:
The following is a list of other side effects that may occur but the frequency and level of severity with which they do are unknown:
Side effects that may not need medical attention usually go away on their own as the body adjusts to the medicine. If they persist or become bothersome, talk with your doctor. You can ask for information on ways to reduce or prevent side effects from occurring.
Other side effects not listed may occur. Call your doctor if you notice unusual symptoms or changes in your health after taking Calcitonin, or side effects do not go away or become worse. Side effects can also be reported to the FDA at 1-800-FDA-1088.
Carefully read all directions given by the doctor, pharmacist, and the patient information leaflet that may come with the medicine. The leaflet comes with step-by-step instructions and diagrams for prepping and activation of the spray. You may ask your pharmacist to demonstrate the use of the nasal spray or to assemble and prime it for you.
If the nasal spray unit was not already primed by your pharmacist, prime it before use as follows:
Each bottle of Calcitonin nasal spray usually contains 30 doses of the medicine. One glass bottle and a screw-on pump are provided. These must be assembled and primed before the first dose. Each spray delivers a dosage strength of 200 I.U. (0.09 mL).
The information below represents the average dosage for adults. Your doctor will determine your specific dose and the duration of treatment. Follow all directions given, including those stated on the prescription label.
Adults - 1 spray into one nostril per day (200 I.U./0.09 mL). To avoid nasal irritation and other symptoms of side effects, you may spray into the other nostril each time you take your dose. For example, if you took your dose in the right side of the nose today, take your dose in the left side nostril tomorrow. Continue to alternate.
Children - Because its safety and efficacy are not established for use in pediatrics, this medicine is not recommended for children unless determined by a doctor.
After the nasal spray is assembled and primed for use, administer your dosage using the following directions, or as directed by a doctor or pharmacist.
If you miss a dose of your medicine, take it as soon as possible. If the time is too close to your next dose, skip the missed dose and take the next scheduled dose on time.
Serious side effects or the risk of overdose are not known to occur when the nasal spray is taken in high doses. Single doses of the nasal spray, each with a maximum strength of 1600 I.U., were tested and considered safe, producing no serious adverse effect. However, take only the dose prescribed for you.
If an overdose does occur, call the poison control center right away at 1-800-222-1222 and seek urgent medical care. Stop using the medicine after the period of treatment is complete, as directed by your healthcare professional.
Some medicines may require the use of other medicines for it to work as it should. In such cases, any interaction that occurs is expected and required. Some unwanted interactions may also occur with these or other drugs being taken by the patient during treatment.
Care should be taken to tell your doctor about all medicines (prescription, non-prescription, vitamin or nutritional supplements, or herbal products) you are taking or plan to take during treatment. This can help your doctor take the necessary precautions when prescribing your dosage.
Lithium may interact with Calcitonin and cause an increase in the risk of side effects. These two drugs should not be used together. If both drugs are prescribed during treatment, your doctor may change how often you can use one or both of them. He/she may also change your dose altogether. No other significant interaction is shown to occur with other drugs.
The nasal spray should be used with caution in patients with Paget’s Disease. Certain medicines used to treat this condition, such as etidronate, risedronate or alendronate, may interact and prevent the nasal spray from working effectively.
Patients who have Hypocalcemia (low calcium levels) or a vitamin D deficiency must be treated first before beginning treatment with Calcitonin. It is important to let your doctor know if you have any of these medical conditions as they may interact with the nasal spray treatment.
Also ask your doctor for information on the possible interaction of this drug with foods, tobacco, or alcohol.
All unopened and unused medicine should be kept refrigerated between 2°C-8°C (36°F-46°F). Do not freeze. Any bottle of medicine in use should be kept at room temperature between 15°C-30°C (59°F-86°F), in an upright position, for up to 30-35 days.
Each bottle contains at least 30 doses. Throw away the spray bottles as soon as they are empty in the manner directed by your pharmacist, healthcare professional or local waste disposal company.
Due to the pain, risk of fractures, disability, and other effects of postmenopausal osteoporosis, an effective treatment was needed. Calcitonin therapy became a preferred and effective treatment for the condition. Its significance in bone health in postmenopausal women is acknowledged in medicine.
This hormone is particularly suitable for treatment in patients who have been postmenopausal for at least five years prior to treatment and for whom other treatments, such as with estrogen, is not possible. Its efficacy is based on signs of increase in spinal bone mineral density and improvement in bone strength.
One of the notable limitations of the drug is its inability to be used for bone care in the prevention of postmenopausal osteoporosis. The hormonal medicine is not recommended for preventative treatment in early postmenopausal women either, since there is no evidence that it increases bone mineral density in these women.
There is also no evidence that the medicine increases bone mass in the hip.
Like most medication, Calcitonin Nasal Spray has its side effects. Its safety and efficacy are well established, and most of the common side effects affect the nasal cavity and usually require medical attention. There appears to be no serious side effects even among the list of side effects with incidence unknown.
Adverse interaction is seen only with the drug lithium, and the medical conditions Paget’s Disease, Hypocalcemia (low calcium levels), and Vitamin D deficiency.