Route of administration for calcitonin in hypercalcemia

Q: To treat severe symptomatic hypercalcemia, calcitonin should be given intranasally to have immediate effect.

A) True

B) False

Answer: B

Calcitonin is least effective when given intranasally. In moderate to severe symptomatic hypercalcemia, calcitonin should be given intramuscularly (IM). The Subcutaneous (SQ) route is also effective. 

This should be noted that patients can be either calcitonin sensitive or not. This requires close monitoring of serum or ionized levels of calcium. The initial recommended dose is 4 units/kg every 4-6 hours. If it is effective, the dose can be continued as 8 units/kg every 6 to 12 hours for a total duration of 48 hours. Unfortunately, calcitonin is not very effective after 48 hours due to tachyphylaxis.

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References:

1. Bilezikian JP. Clinical review 51: Management of hypercalcemia. J Clin Endocrinol Metab 1993; 77:1445.

2. Basso SM, Lumachi F, Nascimben F, Luisetto G, Camozzi V. Treatment of acute hypercalcemia. Med Chem. 2012 Jul;8(4):564-8. doi: 10.2174/157340612801216382. PMID: 22571195.