CALCIUM REGULATING DRUGS›BONE
RESORPTION INHIBITORS
Calcitonin (salmon)
(Salcatonin)
lINDICATIONS AND DOSE
Hypercalcaemia (limited experience in children)
(specialist use only)
▶BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR
INJECTION
▶Child: 2. 5 – 5 units/kg every 12 hours (max. per dose
400 units every 6 – 8 hours), adjusted according to
response, no additional benefit with doses over
8 units/kg every 6 hours
▶BY INTRAVENOUS INFUSION
▶Child: 5 – 10 units/kg, to be administered by slow
intravenous infusion over at least 6 hours
Osteoporosis (specialist use only)
▶BY INTRAMUSCULAR INJECTION, OR BY SUBCUTANEOUS
INJECTION
▶Child:Refer for specialist advice, experience very
limitedlUNLICENSED USENot licensed in children.
lCONTRA-INDICATIONSHypocalcaemia
lCAUTIONSHeart failure.history of allergy (skin test
advised).risk of malignancy—avoid prolonged use (use
lowest effective dose for shortest possible time)
lINTERACTIONS→Appendix 1 : calcitonin (salmon)
lSIDE-EFFECTS
▶Common or very commonAbdominal pain.arthralgia.
diarrhoea.dizziness.fatigue.flushing.headache.
musculoskeletal pain.nausea.secondary malignancy
(long term use).taste altered.vomiting
▶UncommonHypersensitivity.hypertension.influenza like
illness.oedema.polyuria.skin reactions.visual
impairment
▶Rare or very rareBronchospasm.throat swelling.tongue
swelling
▶Frequency not knownHypocalcaemia.tremor
lPREGNANCYAvoid unless potential benefit outweighs risk
(toxicity inanimalstudies).
lBREAST FEEDINGAvoid; inhibits lactation inanimals.
lRENAL IMPAIRMENTUse with caution.
lMONITORING REQUIREMENTSMonitor bone growth.
lDIRECTIONS FOR ADMINISTRATION
▶With intravenous useForintravenous infusion, dilute
injection solution (e.g. 400 units in 500 mL) with Sodium
Chloride 0. 9 % and give over at least 6 hours; glass or hard
plastic containers should not be used; some loss of
potency on dilution and administration—use diluted
solution without delay.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Calcitonin (salmon) (Non-proprietary)
Calcitonin (salmon) 50 unit per 1 mlCalcitonin (salmon)
50 units/ 1 ml solution for injection ampoules| 5 ampouleP
£ 167. 50
Calcitonin (salmon) 100 unit per 1 mlCalcitonin (salmon)
100 units/ 1 ml solution for injection ampoules| 5 ampouleP
£ 220. 00
Calcitonin (salmon) 200 unit per 1 mlCalcitonin (salmon)
400 units/ 2 ml solution for injection vials| 1 vialP£ 352. 00
5 Gonadotrophin responsive
conditions
PITUITARY AND HYPOTHALAMIC HORMONES
AND ANALOGUES›GONADOTROPIN-RELEASING
HORMONESGoserelin
lDRUG ACTIONAdministration of gonadorelin analogues
produces an initial phase of stimulation; continued
administration is followed by down-regulation of
gonadotrophin-releasing hormone receptors, thereby
reducing the release of gonadotrophins (follicle
stimulating hormone and luteinising hormone) which in
turn leads to inhibition of androgen and oestrogen
production.lINDICATIONS AND DOSE
ZOLADEX LA®
Gonadotrophin-dependent precocious puberty
▶BY SUBCUTANEOUS INJECTION
▶Child: 10. 8 mg every 12 weeks, to be administered into
the anterior abdominal wall, injections may be required
more frequently in some cases
ZOLADEX®
Gonadotrophin-dependent precocious puberty
▶BY SUBCUTANEOUS INJECTION
▶Child: 3. 6 mg every 28 days, to be administered into the
anterior abdominal wall, injections may be required
more frequently in some caseslUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSUndiagnosed vaginal bleeding
lCAUTIONSDepression.patients with metabolic bone
disease (decrease in bone mineral density can occur)
lSIDE-EFFECTSAsthma.body hair changes.breast
abnormalities.depression.headache.hypersensitivity.
mood altered.ovarian cyst (may require withdrawal).
paraesthesia.skin reactions.vaginal haemorrhage.visual
impairment.weight change.withdrawal bleed
lCONCEPTION AND CONTRACEPTIONNon-hormonal, barrier
methods of contraception should be used during entire
treatment period. Pregnancy should be excluded before
treatment, thefirst injection should be given during
menstruation or shortly afterwards or use barrier
contraception for 1 month beforehand.
lPREGNANCYAvoid.
lBREAST FEEDINGAvoid.
lMONITORING REQUIREMENTSMonitor bone mineral
density.
lDIRECTIONS FOR ADMINISTRATIONRotate injection site to
prevent atrophy and nodule formation.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Implant
▶Zoladex(AstraZeneca UK Ltd)
Goserelin (as Goserelin acetate) 3.6 mgZoladex 3. 6 mg implant
SafeSystem pre-filled syringes| 1 pre-filled disposable injectionP
£ 65. 00 DT = £ 65. 00
▶Zoladex LA(AstraZeneca UK Ltd)
Goserelin (as Goserelin acetate) 10.8 mgZoladex LA 10. 8 mg
implant SafeSystem pre-filled syringes| 1 pre-filled disposable
injectionP£ 235. 00 DT = £ 235. 00BNFC 2018 – 2019 Gonadotrophin responsive conditions 471
Endocrine system6