Calcimimetic
Pregnancy: C
Cinacalcet
Brand names: Sensipar, Mimpara
Adult dose
Dose: 30mg once daily
Route: Oral
Frequency: Once daily with food
Titrate every 2–4 weeks to max 180mg/day based on PTH. Target PTH 2–9× upper normal in dialysis.
Clinical pearls
- Activates calcium-sensing receptor on parathyroid gland — suppresses PTH secretion
- Used for secondary hyperparathyroidism in dialysis patients and primary HPT if surgery contraindicated
- Check calcium before each dose titration — hold if Ca <2.1 mmol/L
- Not recommended in CKD stages 3–5 not on dialysis
Contraindications
- Hypocalcaemia (Ca <2.1 mmol/L)
- Hypersensitivity
Side effects
- Hypocalcaemia
- Nausea
- Vomiting
- Diarrhoea
- Myalgia
- Seizures (if hypocalcaemia)
Interactions
- CYP3A4 inhibitors (ketoconazole) — increase cinacalcet levels
- CYP2D6 substrates (flecainide, amitriptyline) — inhibited by cinacalcet
Monitoring
- Serum calcium (within 1 week of starting/dose change)
- Serum phosphate
- Serum PTH (every 1–3 months)
Reference: EVOLVE trial; KDIGO CKD-MBD 2017. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.