Pediatric Hypercalcemia Medication

Updated: Aug 11, 2017
  • Author: Pisit (Duke) Pitukcheewanont, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Medication

Calcimimetic agents

Class Summary

These agents increase sensitivity of the calcium-sensing receptor to extracellular calcium by changing the configuration.

Cinacalcet (Sensipar in the US, Mimpara in Europe)

Directly lowers iPTH levels by increasing sensitivity of calcium-sensing receptor on chief cell of parathyroid gland to extracellular calcium. Also results in concomitant decrease of serum calcium levels by affecting renal reabsorption. Indicated for secondary hyperparathyroidism in patients with chronic kidney disease. Pediatric data are limited.

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Loop diuretics

Class Summary

These augment urinary elimination.

Furosemide (Lasix)

Used to induce calciuresis. First line for hypercalcemia with concomitant intense hydration. For IV dosing, diuretic effect begins within 5 min and peaks at 2 h.

Administer IV for emergency treatment of hypercalcemia.

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Bone-resorption inhibitors

Class Summary

These agents decrease serum calcium levels. They inhibit bone resorption and, thus, have a hypocalcemic effect. Used in the treatment of conditions associated with increased bone resorption, such as osteoporosis, Paget disease of bone, and management of hypercalcemia (especially that associated with malignancy). Recent reports have linked these medications with osteonecrosis of the jaw, delayed oral wound healing, and renal compromise. [14]

Etidronate (Didronel)

Bisphosphonate that inhibits formation, growth, and dissolution of hydroxyapatite crystals by chemisorption to calcium phosphate surfaces; can be used IV short term or PO long term.

Pamidronate (Aredia)

A bisphosphonate. Same mechanism as etidronate. Inhibits formation, growth, and dissolution of hydroxyapatite crystals by chemisorption to calcium phosphate surfaces. Only IV use is approved, although a few studies have attempted PO.

Gallium nitrate (Ganite)

A naturally occurring heavy metal. The mechanism by which it inhibits calcium resorption from bone is unclear but may involve reducing increased bone turnover.

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Calcium-lowering hormones

Class Summary

These are secreted by the thyroid gland and help maintain calcium homeostasis by increasing calcium mineral stores in bone and increasing calcium renal excretion.

Calcitonin (Calcimar, Miacalcin)

Acts primarily on bone but also on the kidney and GI tract to decrease serum calcium levels. Also lowers serum alkaline phosphatase levels by inhibiting bony turnover. Calcium-lowering effect begins 2 h after the first injection and lasts 6-8 h. The effect is maintained for 5-8 d.

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