Monitor therapy, Vitamin D Analogs: May enhance the adverse/toxic effect of other Vitamin D Analogs. Secondary hyperparathyroidism associated with stage 5 chronic renal failure (CKD): Children ≥10 years and Adolescents ≤16 years: Initial dose: Calculate based on intact parathyroid hormone (iPTH) serum levels using the following equation. *If patient is taking 1 mcg once daily and further dose reduction is needed, decrease to 1 mcg 3 times/week. For modest dosing adjustments: In situations where monitoring of iPTH, calcium, and phosphorus occurs less frequently than once per week, a more modest initial and dose titration rate may be warranted. Preclinical and in vitro studies have demonstrated that paricalcitol's biological actions are mediated through This unique mechanism of action may be due to a different dose response of paricalcitol and calcitriol on the regulation of intestinal vitamin D receptor (VDR) content, parathyroid gland growth, and bone resorption. Proposed mechanism of action (MOA) Based on preclinical studies, inhibition of FGF23 is thought to restore phosphate homeostasis by promoting renal phosphate reabsorption through increased renal expression of sodium phosphate cotransporters and by increasing the renal expression of 1α-hydroxylase, a vitamin D–metabolizing enzyme involved in vitamin D production. 1. It was patented in 1989 and approved for medical use in 1998. Find medication information including related drug classes, side effects, patient statistics and answers to frequently asked questions. Initial dose: Calculate based on iPTH serum levels using the following equation and administer calculated dose 3 times/week and no more frequently than every other day. Avoid taking aluminum-containing antacids chronically with paricalcitol as there is an increased risk of aluminum toxicity. Paricalcitol (19-nor-1,25-dihydroxyvitamin D2 ), a new vitamin D analogue, recently became available for the treatment of hyperparathyroidism in patients with end-stage renal disease. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. Abbott laboratories pharmaceutical products div, Murfreesboro Pharmaceutical Nursing Supply, Overington JP, Al-Lazikani B, Hopkins AL: How many drug targets are there? Paricalcitol is a synthetic, biologically active vitamin D analog of calcitriol with modifications to the side chain (D2) and the A (19-nor) ring. Synthetic vitamin D analog, reduces parathyroid hormone (PTH) Absorption. The information detailed herein, including that with regard to active pharmaceutical ingredients , their use in treatments and possible mechanism(s) of action, was all obtained from public sources. 2005 Jul-Aug;18(4):315-21. Marta Ruiz-ortega. mechanism of action Paricalcitol reduces parathyroid hormone (PTH) concentrations with only small changes in serum calcium and phosphorus. Modest dose (mcg) = Most recent iPTH level (pg/mL) divided by 100. Although the mechanism of action of paricalcitol is not completely known, it seems to downregulate the expression of vitamin D receptor in the intestine. The therapeutic efficacy of Paricalcitol can be decreased when used in combination with Betamethasone. Monitor serum calcium frequently in high risk patients. Unlike calcitriol, paricalcitol is a selective vitamin D receptor (VDR) activator. IV: Prevention and treatment of secondary hyperparathyroidism in adults and pediatric patients 5 years and older with chronic kidney disease (CKD) on dialysis, Oral: Prevention and treatment in adults and pediatric patients 10 years and older with secondary hyperparathyroidism associated with stage 3 and 4 CKD and stage 5 CKD patients on hemodialysis or peritoneal dialysis, Hypersensitivity to paricalcitol or any component of the formulation; vitamin D toxicity; hypercalcemia. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. Monitor therapy, CYP3A4 Inhibitors (Strong): May increase the serum concentration of Paricalcitol. If you develop a dry, scaly, itchy and red rash you may be left wondering whether you have eczema or psoriasis. Nucleic Acids Res. Monitor therapy, Digoxin: Paricalcitol may enhance the adverse/toxic effect of Digoxin. People with IBS often find the foods they eat can make a real difference to how they feel. Protein Bound: 99.8%. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. The efficacy of calcipotriol in the treatment of psoriasis was first noticed by the observation of patients receiving various forms of vitamin D in an osteoporosis study. Avoid combination, Orlistat: May decrease the serum concentration of Paricalcitol. Round the calculated dose down to the nearest whole number and administer calculated dose 3 times/week and no more frequently than every other day. In conclusion, our data suggest that the anti-inflammatory actions of paricalcitol in tubular cells could depend on the inhibition of TGF-α/ADAM17/EGFR pathway in response to aldosterone, showing an important mechanism of VDRAs action. iPTH level <150 pg/mL or decreased by >60%: Decrease weekly paricalcitol dose by 0.04 mcg/kg or by 50% if decreased dose is zero. Semin Dial. Preclinical andin vitro studies have demonstrated that paricalcitol's biological actions are mediated through binding of the VDR, which results in the selective activation of vitamin D responsive pathways. Mechanism of Action Paricalcitol is a synthetic, biologically active vitamin D 2 analog. Paricalcitol (a form of vitamin D) works by blocking a signal in the cancer cells that leads to growth and spreading of the tumor. Half-Life: 14-20 hr in ESRD. 1.49 +/- 0.60 L/h [chronic kidney disease Stage 5 with hemodialysis], 1.54 +/- 0.95 L/h [chronic kidney disease Stage 5with peritoneal dialysis]. The serum concentration of Aluminum hydroxide can be increased when it is combined with Paricalcitol. Marta Ruiz-ortega. Circulating TRAF3 levels could be a biomarker of renal damage associated with the inflamm … If dosage reduction is required while receiving 1 mcg 3 times/week, discontinue therapy, resuming when appropriate. Zemplar: 1 mcg, 2 mcg [contains alcohol, usp], Zemplar: 2 mcg/mL (1 mL); 5 mcg/mL (1 mL, 2 mL) [contains alcohol, usp, propylene glycol], Generic: 2 mcg/mL (1 mL); 5 mcg/mL (1 mL, 2 mL). Caution is advised to avoid hypercalcemia or elevated phosphate levels (KDIGO 2017). This information should not be interpreted without the help of a healthcare provider. The risk or severity of ventricular arrhythmias and Cardiac Arrhythmia can be increased when Paricalcitol is combined with Acetyldigitoxin. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21). Paricalcitol was approved by the Food and Drug Administration (FDA) for the prevention and treatment of elevated calcium levels associated with chronic renal failure. Epub 2009 Jun 3. Learn more about the criteria for depression. Paricalcitol is used to help maintain healthy levels of parathyroid hormone in people with chronic kidney disease who are on dialysis. Preclinical andin vitro studies have demonstrated that paricalcitol's biological actions are mediated through binding of the VDR, which results in the selective activation of vitamin D responsive pathways. Consider separating the administration of these agents by several hours to minimize the risk of interaction. Mechanism of Action. Stage 5 CKD: Oral: 38 to 49 L; IV: 31 to 35 L, Hydroxylation and glucuronidation via hepatic and nonhepatic enzymes, including CYP24, CYP3A4, UGT1A4; forms metabolites (at least one active), Healthy subjects: Feces (oral: 70%; IV: 63%); urine (oral: 18%, IV: 19%); 51% to 59% as metabolites, Healthy subjects: Oral: 4 to 6 hours; IV: 5 to 7 hours, Stage 5 CKD (on HD or PD): Oral: 14 to 18 hours; IV: 14 to 15 hours. Here, we evaluated the effect of this vitamin D analog paricalcitol with and without cinacalcet on the genesis of oxyphil cells in uremic patients. However, the mechanism of action on bone has not been fully elucidated. Mechanism of action 3D structure of paricalcitol Like 1,25-dihydroxyergocalciferol, paricalcitol acts as an agonist at the vitamin D receptor and thereby lowers parathyroid hormone levels in the blood. Note: KDIGO guidelines suggest that in children vitamin D analogs may be considered to maintain serum calcium levels in an age-appropriate normal range, which differs from recommendation in adult patients (KDIGO 2017). Mechanism of Action. Elevated serum calcium: Decrease dose by 2 to 4 mcg. 2006 Dec;5(12):993-6. Anchel Schwartz, Alexei Ploutno, Koby Wolfman, "Preparation of paricalcitol." Consider therapy modification, Mineral Oil: May decrease the serum concentration of Vitamin D Analogs. Nat Rev Drug Discov. Minor open wounds such as cuts, grazes and scratches can be easily treated at home with basic first aid items. Note: KDIGO guidelines do not recommend routine use of vitamin D analogs in patients not on dialysis with chronic kidney disease (CKD) stages G3 to G5; it may be reasonable to reserve use for patients with CKD stages G4 or G5 and with severe and progressive hyperparathyroidism.