How does this medication work? What will it do for me?
Cinacalcet belongs to the class of medications called calcimimetic agents. Cinacalcet is used to treat overactive parathyroid glands for people with chronic kidney disease who are receiving dialysis for the kidney disease. Cinacalcet is also used to reduce high calcium in the blood for people with parathyroid cancer and hyperparathyroidism that cannot have surgery.
The parathyroid glands work to control the levels of calcium, phosphorus, and parathyroid hormone in the body. If the parathyroid glands produce too much parathyroid hormone, the amount of calcium in the blood increases. This calcium often comes from the bones, causing the bones to weaken if it is allowed to continue for long periods of time.
When the kidneys aren't working properly, such as in chronic kidney disease, the parathyroid glands become overactive, causing an imbalance in the calcium and phosphorus levels in the blood. Cinacalcet works to control the parathyroid hormone, regulating calcium and phosphorus levels in the blood.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each light green, film-coated, oval-shaped tablet, printed with "AMG" on one side and "30" on the other side, contains 30 mg of cinacalcet. Nonmedicinal ingredients: pre-gelatinized starch, microcrystalline cellulose, povidone, crospovidone, colloidal silicon dioxide, magnesium stearate, water, opadry II green colour, clear film-coat (opadry clear), and carnauba wax.
Each light green, film-coated, oval-shaped tablet, printed with "AMG" on one side and "60" on the other side, contains 60 mg of cinacalcet. Nonmedicinal ingredients: pre-gelatinized starch, microcrystalline cellulose, povidone, crospovidone, colloidal silicon dioxide, magnesium stearate, water, opadry II green colour, clear film-coat (opadry clear), and carnauba wax.
Each light green, film-coated, oval-shaped tablet, printed with "AMG" on one side and "90" on the other side, contains 90 mg of cinacalcet. Nonmedicinal ingredients: pre-gelatinized starch, microcrystalline cellulose, povidone, crospovidone, colloidal silicon dioxide, magnesium stearate, water, opadry II green colour, clear film-coat (opadry clear), and carnauba wax.
How should I use this medication?
To treat overactive parathyroid glands for people with chronic kidney disease receiving dialysis, the recommended starting dose of cinacalcet is 30 mg once daily. Your doctor may adjust the dose gradually to a maximum of 180 mg daily, based on lab tests and how well the medication works for you.
To reduce high calcium in the blood for people with parathyroid cancer and hyperparathyroidism who cannot have surgery, the recommended starting dose of cinacalcet is 30 mg twice daily. Your doctor may adjust the dose gradually to a maximum of 90 mg twice daily, based on lab tests and how well the medication works for you.
The tablets must be swallowed whole with fluids. Do not crush, chew, or split this medication. It should be taken with food or soon after eating, at approximately the same time each day.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to cinacalcet or any ingredients of the medication
- have low levels of calcium in your blood
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- abdominal pain
- loss of appetite
- muscle or back pain
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- blood clots at the dialysis port
- infection at the dialysis port
- severe dizziness
- signs of low blood pressure (e.g., dizziness, lightheadedness, fatigue)
- symptoms of chest (respiratory tract) infections (e.g., fever or chills, severe shortness of breath, prolonged dizziness, cough)
- symptoms of too little calcium in the blood (e.g., muscle aches, cramps, tingling sensation in the hands and feet, fast or pounding heartbeat)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- chest pain
- signs of an allergic reaction (e.g., difficulty breathing, coughing or wheezing, hives, itchy skin rash)
- signs of worsening heart failure (e.g., increased difficulty breathing; swelling of legs, ankles, and feet; increased fatigue)
- signs of angioedema (e.g., swelling of the face, lips, mouth, tongue, or throat)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Abnormal heart rhythms: This medication can cause abnormal heart rhythms when there are low blood calcium levels. Contact your doctor immediately if you develop an unusually fast or pounding heartbeat. If you have heart disease and abnormal heart rhythms, or are taking certain medications (e.g., verapamil, atazanavir), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Heart failure: Cinacalcet has been reported to cause worsening heart failure for people who have poor heart function or heart disease. If you have heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Report any signs of worsening heart failure such as difficulty breathing, swelling in the ankles or hands, cough, or chest pain to your doctor as soon as possible.
Low blood calcium levels: This medication helps to reduce the level of calcium in the blood. Occasionally, it may cause the level to become too low. Your doctor will monitor the amount of calcium in your blood. Report any signs of extremely low blood calcium such as muscle aches, cramps, or tingling in the hands and feet to your doctor immediately.
Low blood pressure: Blood pressure may occasionally drop when taking cinacalcet. Be alert for any lightheadedness, dizziness, or a faster-than-normal heart rate. Move slowly when moving from a lying to an upright position. If your blood pressure drops too low, your doctor may adjust your dose or try another medication.
Liver disease: Decreased liver function or liver disease may cause this medication to build up in the body, causing side effects. If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Seizures: Cinacalcet may increase the possibility of seizures occurring, particularly if you have a history of seizures. If you have a seizure disorder or a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if cinacalcet passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children.
What other drugs could interact with this medication?
There may be an interaction between cinacalcet and any of the following:
- amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
- antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
- azole antifungal medications (e.g., fluconazole, ketoconazole, itraconazole)
- beta-adrenergic blockers (e.g., carvedilol, metoprolol, propranolol, timolol)
- grapefruit juice
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- macrolide antibiotics (e.g., clarithromycin, erythromycin,)
- narcotic pain relievers (e.g., codeine, hydrocodone, methadone)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine)
- tricyclic antidepressants (e.g., amitriptyline, desipramine, nortriptyline)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
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