Medical Professional Home Page About Rocaltrol Important Safety Information Dosing and Administration Physician and Patient Checklist Representative Guidelines to Consider Prescribing Information
 
Dosing: Dialysis Patients
Dosing and Administration
The optimal daily dose of Rocaltrol must be carefully determined for each patient. Rocaltrol can be administered orally either as a capsule (0.25 mcg or 0.50 mcg) or as an oral solution (1 mcg/ml). Rocaltrol therapy should always be started at the lowest possible dose and should not be increased without careful monitoring of serum calcium.

The effectiveness of Rocaltrol therapy is predicated on the assumption that each patient is receiving an adequate but not excessive daily intake of calcium. Patients are advised to have a dietary intake of calcium at a minimum of 600 mg daily. The U.S. R.D.A. for calcium in adults is 800 mg to 1200 mg. To ensure that each patient receives an adequate daily intake of calcium, the physician should either prescribe a calcium supplement or instruct the patient in proper dietary measures.

Because of improved calcium absorption from the gastrointestinal tract, some patients on Rocaltrol may be maintained on a lower calcium intake. Patients who tend to develop hypercalcemia may require only low doses of calcium or no supplementation at all.

During the titration period of treatment with Rocaltrol, serum calcium levels should be checked at least twice weekly. When the optimal dosage of Rocaltrol has been determined, serum calcium levels should be checked every month (or as given below for individual indications). Samples for serum calcium estimation should be taken without a tourniquet.

Adult RECOMMENDED DOSE: The recommended initial dose of Rocaltrol is 0.25 mcg/day. If a satisfactory response in the biochemical parameters and clinical manifestations of the disease state is not observed, dosage may be increased by 0.25 mcg/day at 4 to 8 week intervals. During this titration period, serum calcium levels should be obtained at least twice weekly, and if hypercalcemia is noted, the drug should be immediately discontinued until normocalcemia ensues (see full prescribing information PRECAUTIONS: General). Phosphorus, magnesium, and alkaline phosphatase should be determined periodically.

Patients with normal or only slightly reduced serum calcium levels may respond to Rocaltrol doses of 0.25 mcg every other day. Most patients undergoing hemodialysis respond to doses between 0.5 and 1 mcg/day.

Oral Rocaltrol may normalize plasma ionized calcium in some uremic patients, yet fail to suppress parathyroid hyperfunction. In these individuals with autonomous parathyroid hyperfunction, oral Rocaltrol may be useful to maintain normocalcemia, but has not been shown to be adequate treatment for hyperparathyroidism.

The safety and effectiveness of Rocaltrol in pediatric patients undergoing dialysis have not been established.
References:
1. Rocaltrol [package insert]. Parsippany, NJ: Validus Pharmaceuticals; 2009.
 
Important Safety Information for Rocaltrol® (calcitriol) Capsules and Oral solution
Rocaltrol should not be given to patients with hypercalcemia or evidence of vitamin D toxicity. If hypercalcemia develops in a patient receiving Rocaltrol, treatment should be immediately discontinued. In treating chronic hypocalcemia and resultant metabolic bone disease in patients undergoing chronic dialysis, the optimal dose must be carefully determined for each patient. During the titration period of treatment with Rocaltrol, serum calcium levels should be checked at least twice daily. Reassessment and correction of dosage may be necessary.

Since Rocaltrol is believed to be the active hormone which exerts vitamin D activity in the body, adverse effects are, in general, similar to those encountered with excessive vitamin D intake, ie, hypercalcemia syndrome or calcium intoxication (depending on the severity and duration of hypercalcemia). Normalization of elevated serum calcium occurs within a few days of treatment withdrawal (ie, faster than in treatment with vitamin D3 preparations). Chronic hypercalcemia may lead to generalized calcification, nephrocalcinosis and other soft tissue calcification. The serum calcium times phosphate (Ca X P) product should not exceed 70 mg2/dL2. Overdose may require immediate medical attention.

Use with caution in patients receiving digitalis, as this may cause cardiac arrhythmias.

The information on this site is intended for reference only. It should not be used for prescribing or dispensing products; consult the attached full prescribing information.