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Cinacalcet（Sensipar®）

臨床用途：

Treatment of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) on dialysis; treatment of hypercalcemia in patients with parathyroid carcinoma

對於副甲狀腺亢進且伴隨慢性腎臟疾病進行血液透析的病患

治療副甲狀腺腫瘤引起的血鈣過高

外觀：

機轉：

Increases the sensitivity of the calcium-sensing receptor on the parathyroid gland thereby, concomitantly lowering PTH and serum calcium levels.

用法：

Note: Do not titrate dose more frequently than every 2-4 weeks.

Secondary hyperparathyroidism: Oral: Initial: 30 mg once daily (maximum daily dose: 180 mg); increase dose incrementally (60 mg, 90 mg, 120 mg, 180 mg once daily) as necessary to maintain iPTH level between 150-300 pg/mL.

Parathyroid carcinoma: Oral: Initial: 30 mg twice daily (maximum daily dose: 360 mg daily as 90 mg 4 times/day); increase dose incrementally (60 mg twice daily, 90 mg twice daily, 90 mg 3-4 times/day) as necessary to normalize serum calcium levels.

另外，他還需要監測：

Hyperparathyroidism: Serum calcium and phosphorus levels prior to initiation and within a week of initiation or dosage adjustment; iPTH should be measured 1-4 weeks after initiation or dosage adjustment. After the maintenance dose is established, monthly calcium and phosphorus levels and iPTH every 1-3 months are required. Wait at least 12 hours after dose before drawing PTH levels.

Parathyroid carcinoma: Serum calcium levels prior to initiation and within a week of initiation or dosage adjustment; once maintenance dose is established, obtain serum calcium level every 2 months.

Reference Range

CKD K/DOQI guidelines definition of stages; chronic disease is kidney damage or GFR <60 mL/minute/1.73 m² for ≥3 months:

Stage 2: GFR 60-89 mL/minute/1.73 m² (kidney damage with mild decrease GFR)

Stage 3: GFR 30-59 mL/minute/1.73 m² (moderate decrease GFR)

Stage 4: GFR 15-29 mL/minute/1.73 m² (severe decrease GFR)

Stage 5: GFR <15 mL/minute/1.73 m² or dialysis (kidney failure)

Target range for iPTH: Adults:

Stage 3 CKD: 35-70 pg/mL

Stage 4 CKD: 70-110 pg/mL

Stage 5 CKD: 150-300 pg/mL

Serum phosphorus: Adults:

Stage 3 and 4 CKD: ≥2.7 to <4.6 mg/dL

Stage 5 CKD: 3.5-5.5 mg/dL

Serum calcium-phosphorus product: Adults: Stage 3-5 CKD: <55 mg²/dL²