Calcimimetic (IV)

Etelcalcetide

Brand names: Parsabiv

Adult dose

Dose: 5mg IV at end of haemodialysis 3× weekly; titrate by 2.5–5mg increments q4 weeks (max 15mg per dose)

Route: IV (end of dialysis)

Frequency: 3× weekly

Clinical pearls

NICE TA448: option for secondary hyperparathyroidism in adults on haemodialysis when surgical parathyroidectomy not appropriate
KDIGO CKD-MBD guideline framework
Administered by dialysis nurse — improves adherence vs oral cinacalcet

Contraindications

Hypocalcaemia (corrected calcium <2.1 mmol/L)
Hypersensitivity

Side effects

Hypocalcaemia (often symptomatic — paraesthesia, muscle spasm, QT prolongation, seizures)
Nausea/vomiting
Diarrhoea
Headache
Hyperkalaemia
Hypophosphataemia

Interactions

QT-prolonging drugs
Other agents lowering calcium

Monitoring

Corrected calcium (before each dose initially, then weekly–monthly)
Phosphate
PTH
ECG (QT) if risk factors

Reference: BNF; NICE TA448; KDIGO CKD-MBD 2017 guidelines; SmPC; https://bnf.nice.org.uk/drugs/etelcalcetide/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways