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Vitamin D Analogue Pregnancy: Safety in pregnancy not established; use only if benefits outweigh potential risk to the foetus. May breastfeed while taking calcitriol provided maternal and infant serum calcium are monitored.

Calcitriol

Brand names: Rocaltrol, Calcijex

Calcitriol is the biologically active form of vitamin D, used in renal bone disease, hypocalcaemia and hypoparathyroidism.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 0.25 mcg daily (initial); most patients respond to 0.5-1.0 mcg daily
Route: Oral
Frequency: Once daily (or 0.25 mcg every other day if calcium near-normal)
Max: For pulse therapy in refractory osteodystrophy, a maximum total cumulative dose of 12 mcg per week should not be exceeded
Dose must be individually adjusted to biological response to avoid hypercalcaemia; adequate daily calcium intake required. Renal osteodystrophy: initial 0.25 mcg/day; if no satisfactory response within 2-4 weeks, increase by 0.25 mcg at 2-4 week intervals (monitor serum calcium at least twice weekly). Refractory osteodystrophy pulse therapy: initial 0.1 mcg/kg/week split into two or three doses at end of dialysis. Post-menopausal osteoporosis: 0.25 mcg twice daily. Stop immediately if serum calcium rises 1 mg/100 ml (250 micromol/l) above normal or serum creatinine rises to 120 micromol/l, until normocalcaemia returns. Elderly: adult dosing may be used.

Dose adjustments

Renal

In renal failure, caution due to danger of ectopic calcification; maintain plasma phosphate at normal level with phosphate-binding agents and low-phosphate diet. Discontinue if serum creatinine rises to 120 micromol/l until normocalcaemia returns.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Known hypersensitivity to calcitriol (or drugs of the same class) or any excipient
  • All diseases associated with hypercalcaemia
  • Evidence of metastatic calcification
  • Evidence of vitamin D toxicity

Side effects

  • Hypercalcaemia (most commonly reported)
  • Headache; decreased appetite; abdominal pain, nausea, vomiting, constipation
  • Rash, erythema, pruritus, urticaria (hypersensitivity)
  • Cardiac arrhythmias; muscular weakness, sensory disturbance, somnolence
  • Polyuria, nocturia, urinary tract infection; blood creatinine increased

Interactions

  • Other vitamin D compounds/derivatives and vitamin-D-fortified foodstuffs should be withheld during treatment (risk of hypervitaminosis D)
  • Phosphate-binding agents may be needed to control serum phosphate in renal failure
  • Switching from long-acting vitamin D (ergocalciferol/colecalciferol) increases hypercalcaemia risk for several months
  • See SPC section 4.5 for dose adjustments related to drug interactions

Clinical monograph

How it works

As the active 1,25-dihydroxyvitamin D metabolite, it binds the vitamin D receptor to increase intestinal absorption of calcium and phosphate and to help regulate parathyroid hormone secretion.

Prescribing in practice

  • The principal risk is hypercalcaemia, which can develop with excessive dosing or concurrent calcium supplementation and may impair renal function.
  • It does not require renal hydroxylation, making it suitable in chronic kidney disease where this conversion is impaired.
  • Concurrent thiazide diuretics or calcium-containing preparations increase the risk of hypercalcaemia.

Monitoring

Monitor serum calcium and phosphate regularly, particularly after dose changes, along with parathyroid hormone and renal function as appropriate.

Counselling the patient

  • Regular blood tests are needed to keep your calcium level safe.
  • Report nausea, thirst, constipation or confusion, which can suggest a high calcium level.
  • Do not take additional calcium or vitamin D supplements unless advised.

Evidence & guidelines

Active vitamin D analogues are established in the management of secondary hyperparathyroidism and renal bone disease per NICE guidance.

Reference: KDIGO CKD-MBD Guidelines 2017; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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