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. [4]
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.
Parathyroid Hormone Analogs
Class Summary
Recombinant human parathyroid hormone may be required in addition to calcium and vitamin D supplementation for hypocalcemia.
Human parathyroid hormone, recombinant (Natpara, rhPTH)
Parathyroid hormone raises serum calcium by increasing renal tubular calcium reabsorption, increasing intestinal calcium absorption, and increasing bone turnover. rhPTH is indicated as an adjunct to calcium and vitamin D to control hypocalcemia in patients with hypoparathyroidism.
