Vitamin D Analogue
Pregnancy: C
Calcitriol
Brand names: Rocaltrol, Calcijex
Adult dose
Dose: 0.25–2 micrograms once daily
Route: Oral or IV
Frequency: Once daily
IV: 0.5–4 micrograms three times weekly post-dialysis. Titrate based on PTH and calcium.
Clinical pearls
- Active form of vitamin D — bypasses renal hydroxylation (essential in CKD)
- Target PTH: 2–9× upper normal limit in dialysis patients
- Monitor calcium × phosphate product — should remain <4.4 mmol²/L²
- Alfacalcidol is an alternative (requires hepatic activation, intact in CKD)
Contraindications
- Hypercalcaemia
- Vitamin D toxicity
- Hypercalciuria
Side effects
- Hypercalcaemia
- Hypercalciuria
- Nausea
- Weakness
- Metastatic calcification
Interactions
- Thiazide diuretics — increased hypercalcaemia risk
- Digoxin — hypercalcaemia potentiates toxicity
- Cholestyramine — reduces absorption
Monitoring
- Serum calcium (weekly initially)
- Serum phosphate
- Serum PTH (monthly)
- Urinary calcium (oral use)
Reference: KDIGO CKD-MBD Guidelines 2017. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.