Hypoparathyroidism Medication
- Author: Joseph Michael Gonzalez-Campoy, MD, PhD, FACE; Chief Editor: George T Griffing, MD more...
Medication Summary
Calcium and vitamin D are the mainstays of treatment.
Calcium salts
Class Summary
Without PTH, the ionized calcium levels in the plasma drop. Bone becomes an inefficient source of calcium for plasma, and kidneys waste calcium. Calcium helps maintain the ionized calcium level close to the reference range.
Calcium carbonate (Tums Extra Strength, Cal-Plus, Caltrate, Os-Cal 500)
Moderates nerve and muscle performance and facilitates normal cardiac function. Many commercially available preparations exist. Titrate total daily dose of elemental calcium to minimize the daily dose of vitamin D and to keep patients asymptomatic. Ionized calcium is absorbed best in an acidic environment; 400 mg elemental calcium equals 1 g calcium carbonate.
Calcium citrate (Citracal, Cal-Citrate 250)
Moderates nerve and muscle performance and facilitates normal cardiac function; 210 mg of elemental calcium equals 1 g calcium citrate.
Calcium gluconate (Kalcinate)
Moderates nerve and muscle performance and facilitates normal cardiac function. Available for IV use. Infuse slowly over 5-10 min; 10 mL calcium gluconate contains approximately 90 mg elemental calcium; 1000 mg of calcium gluconate equals 90 mg elemental calcium.
Vitamin D preparations
Class Summary
Vitamin D is synthesized by the kidneys, and the synthesis of 1,25-dihydroxy vitamin D is PTH dependent. In most patients with chronic hypoparathyroidism, treatment with the active vitamin D form is necessary.[8]
Ergocalciferol (Calciferol, Drisdol)
Stimulates absorption of calcium and phosphate from small intestine and promotes release of calcium from bone into blood.
Dihydrotachysterol (DHT, Hytakerol)
Synthetic analog of vitamin D. Stimulates calcium and phosphate absorption from small intestine and promotes secretion of calcium from bone to blood. Promotes renal tubule resorption of phosphate.
Calcifediol (Calderol)
Promotes absorption of calcium and phosphorus in the small intestine. Promotes renal tubule resorption of phosphate. Increases rate of accretion and resorption in bone minerals.
Calcitriol (Rocaltrol, Calcijex)
Promotes absorption of calcium in intestines and retention at kidneys to increase calcium levels in serum. Decreases excessive serum phosphatase levels and parathyroid levels. Decreases bone resorption.
Bhadada SK, Bhansali A, Upreti V, Subbiah S, Khandelwal N. Spectrum of neurological manifestations of idiopathic hypoparathyroidism and pseudohypoparathyroidism. Neurol India. Jul-Aug 2011;59(4):586-9. [Medline].
Assfaw Z, Assefa G. Basal ganglia calcification with hypoparathyroidism: a case report. Ethiop Med J. Jul 2011;49(3):273-7. [Medline].
Goswami R, Goel S, Tomar N, et al. Prevalence of clinical remission in patients with sporadic idiopathic hypoparathyroidism. Clin Endocrinol (Oxf). Jun 22 2009;[Medline].
Rubin MR, Dempster DW, Zhou H, et al. Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res. Dec 2008;23(12):2018-24. [Medline].
Ebrahimi H, Edhouse P, Lundgren CI, et al. Does autoimmune thyroid disease affect parathyroid autotransplantation and survival?. ANZ J Surg. May 2009;79(5):383-5. [Medline].
Brown EM. Anti-parathyroid and anti-calcium sensing receptor antibodies in autoimmune hypoparathyroidism. Endocrinol Metab Clin North Am. Jun 2009;38(2):437-45, x. [Medline].
Goltzman D, Cole DEC. Hypoparathyroidism. In: Favus MJ, ed. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. Philadelphia, Pa: Lippincott-Raven; 1996:220-3.
Cheung M. Drugs used in paediatric bone and calcium disorders. Endocr Dev. 2009;16:218-232. [Medline].
Brown EM, Harris HW, Vassilev PM. The biology of the extracellular Ca2+-sensing receptor. In: Bilezikian JP, ed. Principles of Bone Biology. San Diego, Calif: Academic Press; 1996:243-62.
Cole DEC, Hendy GN. Hypoparathyroidism and pseudohypoparathyroidism. Endotext.com. 2005, Available at. [Full Text].
Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med. Dec 21 2000;343(25):1863-75. [Medline].
Thakker RV. Molecular basis of PTH underexpression. In: Bilezikian JP, et al, eds. Principles of Bone Biology. San Diego, Calif: Academic Press; 1996:837-51.
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