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Calcimimetic (Calcium-sensing Receptor Agonist)

Cinacalcet

Brand names: Mimpara

Cinacalcet is a calcimimetic that lowers parathyroid hormone in secondary hyperparathyroidism in patients on dialysis, and in hypercalcaemia due to parathyroid carcinoma or primary hyperparathyroidism where parathyroidectomy is unsuitable.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Cinacalcet tablets should be taken with food or shortly after a meal ( 2.1 ). Tablets should always be taken whole and not divided ( 2.1 ) Secondary HPT in patients with CKD on dialysis ( 2.2 ): Starting dose is 30 mg once daily. Titrate dose no more frequently than every 2 to 4 weeks through sequential doses of 30, 60, 90, 120, and 180 mg once daily as necessary to achieve targeted intact parathyroid hormone (iPTH) levels. iPTH levels should be measured no earlier than 12 hours after most recent dose. Hypercalcemia in patients with PC or hypercalcemia in patients with primary HPT ( 2.3 ): Starting dose is 30 mg twice daily. Titrate dose every 2 to 4 weeks through sequential doses of 30 mg …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-12-12. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It increases the sensitivity of the calcium-sensing receptor on parathyroid cells to extracellular calcium, suppressing parathyroid hormone secretion and lowering serum calcium.

Prescribing in practice

  • It causes hypocalcaemia, so monitor serum calcium and watch for paraesthesia, muscle cramps, seizures and QT prolongation; do not start if calcium is below the normal range.
  • Nausea and vomiting are common and may limit tolerability or affect adherence.
  • Use caution in significant hepatic impairment, as exposure is increased.

Monitoring

Monitor serum calcium (and corrected calcium) closely, especially after initiation and dose changes, together with phosphate and parathyroid hormone; be alert for QT prolongation when calcium falls.

Counselling the patient

  • Take it with food or shortly after a meal.
  • Report tingling around the mouth or fingers, muscle cramps, twitching or fits, which may indicate low calcium.
  • Nausea is common, particularly at first.

Evidence & guidelines

Recommended in selected dialysis patients with secondary hyperparathyroidism and in hypercalcaemia of parathyroid carcinoma or primary hyperparathyroidism (NICE TA117).

Reference: NICE TA117 (Cinacalcet in CKD); KDIGO CKD-MBD Guidelines 2017; EVOLVE Trial (NEJM 2012); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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