Salmcalcitonin

Products

Salmcalcitonin is commercially available as a nasal spray and solution for injection (Miacalcic). It has been approved in many countries since 1976.

Structure and properties

The drug does not contain the human thyroid hormone calcitonin, but salmon calcitonin, also known as salmcalcitonin. It is a synthetic polypeptide consisting of 32 amino acids (C145H240N44O48S2, Mr = 3432 g/mol). It exists as a white powder that is readily soluble in water. Unlike mammalian calcitonin, salmcalcitonin has a higher binding affinity and a longer duration of action. It has the following sequence, which differs from human calcitonin at 16 positions: Cys-Ser-Asn-Leu-Ser-Thr-Cys-Val-Leu-Gly-Lys-Leu-Ser-Gln-Glu-Leu-His-Lys-Leu-Gln-Thr-Tyr-Pro-Arg-Thr-Asn-Thr-Gly-Ser-Gly-Thr-Pro

Effects

Salmcalcitonin (ATC H05BA01) has bone-stabilizing and analgesic properties and decreases elevated calcium concentrations. The effects are mainly due to inhibition of osteoclast activity. Salmcalcitonin reduces bone resorption and and normalizes bone turnover.

Indications

  • Osteoporosis prevention in acute bone loss due to sudden immobilization.
  • Paget’s disease (osteitis deformans)
  • Algodystrophy or Sudeck’s syndrome
  • Hypercalcemia

For the treatment of postmenopausal osteoporosis, salmcalcitonin is no longer indicated in many countries since 2013. This because a small increase in the incidence of malignancy was found with long-term use when clinical trials were evaluated.

Dosage

According to the SmPC. When used intranasally, the active ingredient enters the bloodstream through the nasal mucosa. If multiple sprays are prescribed, they are administered alternately into both nostrils.

Contraindications

  • Hypersensitivity

For complete precautions, see the drug label.

Interactions

Calcitonin may reduce plasma concentrations of lithium.

Adverse effects

With nasal spray, the most common possible adverse effects include local discomfort such as nasal congestion, inflammation of the nasal mucosa, dry nose, nosebleeds, and irritation. Other common side effects include: