Calcitonin
Kelas obat: Agen Antineoplastik
Panganggone Calcitonin
Penyakit Paget Balung
Pengobatan Penyakit Paget Balung. Coba perawatan karo calcitonin utawa bisphosphonate (contone, alendronate, etidronate, pamidronate, risedronate) ing pasien kanthi marker biokimia sing nuduhake paningkatan remodeling balung, sing duwe gejala, lan sing duwe risiko komplikasi ing mangsa ngarep saka penyakit kasebut (contone, sing kanthi lesi pagetic ing wilayah bobot utawa ing jejere sendi).
Hiperkalsemia
Perawatan awal darurat hiperkalsemia (karo agen liyane sing cocog) yen perlu nyuda konsentrasi kalsium serum kanthi cepet.
Osteoporosis Postmenopause
Pengobatan osteoporosis postmenopausal ing wanita>5 taun postmenopause.
Saliyane asupan kalsium/vitamin D sing nyukupi lan modifikasi gaya urip liyane (umpamane, olahraga, ngindhari panggunaan alkohol lan rokok sing berlebihan), para ahli nyaranake supaya terapi farmakologis kanggo osteoporosis dianggep ing wanita postmenopausal kanthi risiko dhuwur. fraktur (umume sing wis ngalami hip utawa fraktur vertebral sadurunge utawa sing duwe BMD kurang); terapi farmakologis uga bisa dianggep ing wanita postmenopausal karo massa balung kurang, sanajan ana bukti kurang ndhukung nyuda resiko fraktur sakabèhé ing patients kuwi.
Disaranake nggunakake obat kanthi khasiat antifraktur; ahli umume nyaranake calcitonin minangka therapy baris pungkasan nalika obatan liyane ora efektif utawa ngejarke.
Pilihan terapi individu adhedhasar keuntungan potensial (babagan pengurangan risiko patah tulang) lan efek samping terapi, preferensi pasien, komorbiditas, lan faktor risiko.
Glucocorticoid-induced Osteoporosis
Wis digunakake ing perawatan saka glucocorticoid-induced osteoporosis† [off-label]; Nanging, terapi liyane (contone, bisphosphonates oral) luwih disenengi.
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Carane nggunakake Calcitonin
Umum
Penyakit Paget Tulang
Postmenopausal Osteoporosis
Administrasi
Administrasi kanthi sub-Q utawa injeksi IM (penyakit Paget balung, hiperkalsemia, osteoporosis postmenopause) utawa intranasal (osteoporosis postmenopause).
Administrasi IM
Injeksi IM luwih disenengi nalika volume injeksi >2 mL.
Gunakake sawetara situs injeksi nalika volume >2 mL.
Administrasi Sub-Q
Injeksi Sub-Q luwih disenengi kanggo administrasi mandiri pasien.
Administrasi Intranasal
Administrasi sapisan dina (minangka semprotan siji ing 1 bolongan irung ) nggunakake pompa semprotan dosis meter sing diwenehake dening pabrikan. Ganti bolongan irung saben dina.
Allow solusi kanggo tekan suhu kamar sadurunge priming pump lan administering dosis pisanan.
Pompa perdana sadurunge dosis pisanan; aja prima sadurunge saben dosis.
Miacalcin: Kanggo pompa prima, tahan botol kanthi vertikal lan tekan 2 lengen sisih putih pompa menyang botol nganti semprotan lengkap.
Fortical: Kanggo pompa utama, tahan botol kanthi vertikal lan tekan 2 lengen sisih putih pompa menyang botol paling sethithik 5 kaping nganti semprotan lengkap diprodhuksi.
Administrasi dosis kanthi nempatake nozzle ing bolongan irung kanthi sirah ing posisi jejeg lan depressed pompa menyang botol.
Buang pompa semprotan sawise 30 aktuasi, amarga dosis obat sing bener saben aktuasi ora bisa dijamin yen digunakake kanggo dosis tambahan.
Dosis
Aktivitas salmon kalsitonin ing babagan Unit Internasional (unit).
Pompa semprotan intranasal ngirimake 0,09 ml larutan saben aktuasi; saben 0,09-mL semprotan ngirim 200-unit dosis.
Dewasa
Penyakit Paget Tulang Sub-Q utawa IMDosis awal: 100 unit (0,5 mL) saben dina.
Mantenance: 50 unit (0,25 mL) saben dina utawa saben dina liyane; dosis sing luwih dhuwur (100 unit saben dina) cocok kanggo pasien kanthi deformitas serius utawa keterlibatan neurologis.
Dosis >100 unit saben dina biasane ora ngasilake respon sing luwih apik ing pasien sing kambuh nalika nampa calcitonin.
Hiperkalsemia Sub-Q utawa IMKaping pisanan, 4 unit/kg saben 12 jam; bisa nambah dosis sawise 1 utawa 2 dina (yen respon ora cukup) nganti 8 unit / kg saben 12 jam; bisa nambah dosis sawise 2 dina (yen respon ora cukup) nganti 8 unit/kg saben 6 jam.
Postmenopausal Osteoporosis Sub-Q utawa IMDosis efektif minimal ora ditetepake; 100 unit saben dina bisa uga efektif kanggo njaga BMD vertebral.
Intranasal200 unit (1 semprotan) saben dina.
Batesan Resep
Dewasa
Hiperkalsemia Sub-Q utawa IMMaksimal 8 unit/kg saben 6 jam.
Pènget
Kontraindikasi
Pènget/PanandhapReaksi Sensitivitas
Reaksi alergi sing serius (bronkospasme, pembengkakan ilat utawa tenggorokan, kejut anafilaksis, paling ora 1 pati amarga anafilaksis) dilaporake ing pasien sing nampa injeksi kalsitonin. Beda reaksi hipersensitivitas saka flushing lan hypotension umum.
Reaksi alergi uga dilapurake ing pasien sing nampa semprotan hidung kalsitonin.
Agen sing cocog kanggo perawatan reaksi hipersensitivitas kudu kasedhiya.
Kanggo pasien sing dicurigai sensitif marang kalsitonin, coba tes kulit sadurunge miwiti terapi.
Pancegahan Umum
Tetani HipokalsemikKemungkinan tetani hipokalsemi sawise administrasi parenteral; duwe injeksi kalsium sing kasedhiya, utamane sajrone sawetara dosis pertama kalsitonin parenteral.
Pemantauan LaboratoriumBahan granular kasar lan gips sing ngemot sel epitel tubular ginjal sing dilapurake ing sawetara sukarelawan diwasa enom ing bedrest sing nampa kalsitonin parenteral ing studi babagan efek ing immobilization osteoporosis. Clcr ora diowahi lan proteinuria ora dilapurake; endapan cipratan bali menyang normal ing 4 dina sawise discontinuation tamba. Efek ora dilapurake dening peneliti liyane.
Pemeriksaan periodik saka sedimen cipratan dianjurake kanggo pasien sing nampa terapi parenteral jangka panjang.
Pemantauan RadiografiIng pasien sing nandhang penyakit Paget, evaluasi kanthi teliti bukti radiografi babagan progresi lesi pagetik sing nyata kanggo ngilangi sarkoma osteogenik (amarga frekuensi tambah ing pasien sing nandhang penyakit Paget).
Pemeriksaan NasalPemeriksaan hidung periodik kanthi visualisasi mukosa hidung, turbinate, septum, lan status pembuluh getih mukosa dianjurake kanggo pasien sing nampa semprotan hidung kalsitonin.
Mungkasi semprotan irung yen ulkus mukosa irung abot (yaiku, ulkus > 1,5 mm diametere utawa tembus ing ngisor mukosa, ulkus sing ana gandhengane karo pendarahan abot). Kanggo ulkus sing luwih cilik, interupsi terapi nganti penyembuhan.
Populasi Tertentu
KandhutanKategori C.
LaktasiNyandhet laktasi ing kewan. Ora dingerteni manawa calcitonin disebarake menyang susu manungsa. Gunakake ora dianjurake.
Panggunaan PediatrikPengalaman karo calcitonin ing bocah-bocah sing nandhang penyakit Paget remaja banget winates; hubungan antarane kelainan iki lan penyakit Paget diwasa ora ditetepake.
Pengalaman karo calcitonin ing bocah-bocah karo osteoporosis juvenile idiopatik banget winates; hubungan antarane kelainan iki lan osteoporosis postmenopausal ora ditetepake.
Data ora cukup kanggo ndhukung panggunaan calcitonin ing bocah-bocah.
Panggunaan GeriatrikEfek irung sing ora becik (yaiku, rhinitis, iritasi, kemacetan) luwih kerep dilapurake ing pasien> 65 taun sing nampa semprotan hidung kalsitonin. Efek irung diterangake minangka entheng.
Efek Sabar sing Umum
Kanthi terapi parenteral, mual, muntah, reaksi ing situs injeksi, rai, kuping, tangan, lan sikil.
Kanthi terapi intranasal, rhinitis, gejala irung, nyeri punggung.
Apa obatan liyane bakal mengaruhi Calcitonin
Bifosfonat
Kamungkinan nyuda respon antiresorptive kanggo calcitonin ing pasien karo penyakit Paget sing sadurunge diobati nganggo bifosfonat.
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