Parenteral Manual

Calcitriol

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Alternate Name(s): 
CALCIJEX®, 1-25-dihydroxycholecalciferol
Classification: 
Vitamin D3 Metabolite
Original Date: 
August 2005
Revised Date: 
September 2011
Indications: 
  • Management of hypocalcemia in patients undergoing chronic renal hemodialysis
  • Treatment of hypocalcemic tetany in premature infants
Reconstitution and Stability: 
  • Available as 1 mcg/mL injection
  • Store at room temperature
  • Protect from light and excessive heat in original container
Compatibility: 

- Solutions Compatible: D5W, NS, Sterile Water for Injection

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

- Incompatible: do not mix with any other drug

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

YES
Usual dilution: 1 mcg/mL
Infusion rate: over 15 seconds or through catheter at end of hemodialysis

IV Intermittent Infusion YES
Usual dilution: 1 mcg/mL
Infusion time: 15 minutes
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatrics:

  • Hemodialysis patients: 0.01-0.05 mcg/kg/dose three times weekly

Adults:

  • Hemodialysis patients: 0.5 mcg (0.1 mcg/kg) IV 3 times/week; may increase dosage by 0.25 - 0.5 mcg increments at 2-4 week intervals until optimal response is achieved. [Range 0.5-3 mcg]
Potential hazards of parenteral administration: 
  • Mild pain at site of injection    
  • Hypercalcemia
  • Vitamin D intoxication
  • Excessive dosage induces hypercalcemia which can lead to generalized vascular calcification, nephrocalcinosis, calcifications of cornea or other soft tissues
Notes: 
  • Early and late signs of vitamin D intoxication and hypercalcemia:
    - Early:  weakness, headache, somnolence, nausea, vomiting, thirst,
    dry mouth, constipation, muscle and bone pain, metallic taste,
    cardiac arrhythmias

    Late: polyuria, polydipsia, anorexia, conjunctivitis, nocturia, pancreatitis,
    photophobia, rhinorrhea, pruritus, hyperthermia, decreased libido,
    ectopic calcification, cardiac arrhythmias and hypertension

  • Treatment of hypercalcemia includes discontinuation of calcitriol, institution of a low calcium diet and withdrawal of calcium supplementation
  • Do not use in combination with magnesium containing antacids, as hypermagnesemia may develop       
  • Monitor serum calcium and phosphorus levels
References: 

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