Calcimimetic (IV) Pregnancy: There are no available data on use in pregnant women. In animal reproduction studies, effects were seen at doses associated with maternal toxicity that included hypocalcaemia: in a rat pre- and post-natal study there was a slight increase in perinatal pup mortality, delay in parturition and transient effects on pup growth at exposures 1.8 times the human exposure for the clinical dose of 15 mg three times per week; reduced fetal growth was observed in rats and rabbits at exposures 2.7 and 7 times the clinical exposure respectively.

Etelcalcetide

Brand names: Parsabiv

Etelcalcetide is an intravenous calcimimetic used to treat secondary hyperparathyroidism in adults with chronic kidney disease on haemodialysis.

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: 5 mg by intravenous bolus injection three times per week at the end of haemodialysis (recommended starting dose). Maintenance dose is individualised by titration; the dose range is 2.5 mg to 15 mg three times per week

Route: Intravenous bolus injection into the venous line of the dialysis circuit after haemodialysis, during rinse back, or intravenously after rinse back. Do not mix or dilute prior to administration. Administer a sufficient volume of saline (e.g. 150 mL of rinse back) after injection into the dialysis tubing; if given after rinse back, follow with at least 10 mL of saline flush

Frequency: Three times per week, at the end of each haemodialysis treatment only

Max: 15 mg three times per week (highest maintenance dose)

Indication in this label: secondary hyperparathyroidism in patients with chronic kidney disease on haemodialysis. BEFORE DOSING: ensure corrected serum calcium is at or above the lower limit of normal prior to initiation, a dose increase, or re-initiation after a dosing interruption. TITRATION: titrate on parathyroid hormone (PTH) and corrected serum calcium response; increase in 2.5 mg or 5 mg increments no more frequently than every 4 weeks, up to a maximum of 15 mg three times per week, in patients with corrected serum calcium within the normal range and PTH above the recommended target range. MONITORING: corrected serum calcium 1 week after initiation or dose adjustment and every 4 weeks during maintenance; PTH 4 weeks after initiation or dose adjustment, then per clinical practice. DOSE REDUCTION/HOLD: decrease or temporarily discontinue in patients with PTH below the target range; in patients with corrected serum calcium below the lower limit of normal but at or above 7.5 mg/dL without symptoms of hypocalcaemia, consider decreasing or temporarily discontinuing, or use concomitant therapies to increase corrected serum calcium; stop and treat hypocalcaemia if corrected serum calcium falls below 7.5 mg/dL or the patient reports symptoms of hypocalcaemia. RE-INITIATION: when corrected serum calcium is within normal limits, symptoms have resolved and predisposing factors have been addressed, re-initiate at a dose 5 mg lower than the last administered dose (if the last dose was 2.5 mg or 5 mg, re-initiate at 2.5 mg); if the dose was stopped for low PTH, re-initiate at a lower dose once PTH is within target and hypocalcaemia is corrected. MISSED DOSES: if a scheduled haemodialysis treatment is missed, do not administer the missed dose - resume at the end of the next haemodialysis treatment at the prescribed dose; if doses are missed for more than 2 weeks, re-initiate at the starting dose of 5 mg (or 2.5 mg if that was the patient's last dose). Available presentations in this label: 2.5 mg/0.5 mL, 5 mg/mL and 10 mg/2 mL single-dose vials. PAEDIATRIC: safety and efficacy have not been established in paediatric patients. SOURCE: no UK SPC (eMC) record was retrieved in this bundle - the dose above is from US prescribing information (PARSABIV, Amgen, label date 2026-03-08, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=52286976-a97a-4b77-b678-f40ab5aa7133) and must be verified against UK labelling.

Dose auto-extracted from 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 etelcalcetide or any of its excipients (hypersensitivity reactions, including face oedema and anaphylactic reaction, have occurred)

Side effects

Blood calcium decreased / hypocalcaemia (can be severe, causing paraesthesias, myalgias, muscle spasms, seizures, QT prolongation and ventricular arrhythmias)
Muscle spasms
Diarrhoea, nausea and vomiting
Headache and paraesthesia
Worsening heart failure and upper gastrointestinal bleeding are labelled warnings; adynamic bone may develop if PTH is chronically suppressed

Clinical monograph

How it works

It binds to and allosterically activates the calcium-sensing receptor on parathyroid cells, increasing the receptor's sensitivity to extracellular calcium and thereby lowering parathyroid hormone secretion.

Prescribing in practice

It commonly causes hypocalcaemia, which can be symptomatic and precipitate QT prolongation and seizures, so calcium must be corrected before and monitored during treatment.
It is administered intravenously at the end of haemodialysis and is intended for dialysis patients only.
Concurrent use with other agents that lower calcium or prolong the QT interval increases risk and warrants caution.

Monitoring

Monitor corrected serum calcium and parathyroid hormone regularly, with closer calcium monitoring after initiation or dose changes.

Counselling the patient

Report tingling, muscle cramps, spasms or palpitations, which may indicate low calcium.
This injection is given by the dialysis team at the end of your dialysis session.
Do not stop prescribed calcium or vitamin D supplements without advice.

Evidence & guidelines

Etelcalcetide is licensed for secondary hyperparathyroidism in haemodialysis patients, with trials demonstrating reductions in parathyroid hormone versus placebo.

Reference: NICE TA448; KDIGO CKD-MBD 2017 guidelines; SmPC; 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).

Curated clinical cross-links plus same-class fallbacks.

Pathways