Cinacalcet lowers parathyroid hormone by sensitising the calcium-sensing receptor, and in doing so lowers serum calcium. Hypocalcaemia is common, can be symptomatic — paraesthesia, cramps, seizures — and prolongs the QT interval.
Check serum calcium within about a week of starting or changing the dose, and PTH within one to four weeks. Hold or reduce the dose if calcium falls below the normal range, and consider calcium or vitamin D adjustment. Gastrointestinal upset is the commonest reason patients stop it; taking it with food helps.
- Check calcium within about a week of starting or changing cinacalcet.
- Recheck PTH one to four weeks after a dose change.
- Hold or reduce cinacalcet if calcium falls below normal.
- Advise taking it with food to reduce nausea.
Why it matters
Cinacalcet-related hypocalcaemia is predictable and easily missed between dialysis bloods.
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