What happens if I overdose Calcijet?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local, or emergency room immediately. Symptoms may include dizziness; headache; irregular heartbeat; loss of appetite; mental or mood changes; nausea; stomach pain or cramps; vomiting; weakness.
Proper storage of Calcijet solution:
Store Calcijet solution as directed on the prescription label. Keep Calcijet solution out of the reach of children and away from pets.
Overdose of Calcijet in details
Administration of Calcijet (Calcijet) to patients in excess of their daily requirements can cause hypercalcemia, hypercalciuria, and hyperphosphatemia. Since Calcijet is a derivative of vitamin D, the signs and symptoms of overdose are the same as for an overdose of vitamin D. High intake of calcium and phosphate concomitant with Calcijet (Calcijet) may lead to similar abnormalities. The serum calcium times phosphate (Ca x P) product should not be allowed to exceed 70 mg. High levels of calcium in the dialysate bath may contribute to the hypercalcemia.
Treatment of Hypercalcemia and Overdosage in Dialysis Patients and Hypoparathyroidism Patients
General treatment of hypercalcemia (greater than 1 mg/dL above the upper limit of the normal range) consists of immediate discontinuation of Calcijet (Calcijet) therapy, institution of a low-calcium diet and withdrawal of calcium supplements. Serum calcium levels should be determined daily until normocalcemia ensues. Hypercalcemia frequently resolves in 2 to 7 days. When serum calcium levels have returned to within normal limits, Calcijet (Calcijet) therapy may be reinstituted at a dose of 0.25 mcg/day less than prior therapy. Serum calcium levels should be obtained at least twice weekly after all dosage changes and subsequent dosage titration. In dialysis patients, persistent or markedly elevated serum calcium levels may be corrected by dialysis against a calcium-free dialysate.
Treatment of Hypercalcemia and Overdosage in Predialysis Patients
If hypercalcemia ensues (greater than 1 mg/dL above the upper limit of the normal range), adjust dosage to achieve normocalcemia by reducing Calcijet (Calcijet) therapy from 0.5 mcg to 0.25 mcg daily. If the patient is receiving a therapy of 0.25 mcg daily, discontinue Calcijet (Calcijet) until patient becomes normocalcemic. Calcium supplements should also be reduced or discontinued. Serum calcium levels should be determined 1 week after withdrawal of calcium supplements. If serum calcium levels have returned to normal, Calcijet (Calcijet) therapy may be reinstituted at a dosage of 0.25 mcg/day if previous therapy was at a dosage of 0.5 mcg/day. If Calcijet (Calcijet) therapy was previously administered at a dosage of 0.25 mcg/day, Calcijet (Calcijet) therapy may be reinstituted at a dosage of 0.25 mcg every other day. If hypercalcemia is persistent at the reduced dosage, serum PTH should be measured. If serum PTH is normal, discontinue Calcijet (Calcijet) therapy and monitor patient in 3 months' time.
Treatment of Hyperphosphatemia in Predialysis Patients
If serum phosphorus levels exceed 5.0 mg/dL to 5.5 mg/dL, a calcium-containing phosphate-binding agent (ie, calcium carbonate or calcium acetate) should be taken with meals. Serum phosphorus levels should be determined as described earlier. Aluminum-containing gels should be used with caution as phosphate-binding agents because of the risk of slow aluminum accumulation.
Treatment of Accidental Overdosage of Calcijet (Calcijet)
The treatment of acute accidental overdosage of Calcijet (Calcijet) should consist of general supportive measures. If drug ingestion is discovered within a relatively short time, induction of emesis or gastric lavage may be of benefit in preventing further absorption. If the drug has passed through the stomach, the administration of mineral oil may promote its fecal elimination. Serial serum electrolyte determinations (especially calcium), rate of urinary calcium excretion, and assessment of electrocardiographic abnormalities due to hypercalcemia should be obtained. Such monitoring is critical in patients receiving digitalis. Discontinuation of supplemental calcium and a low-calcium diet are also indicated in accidental overdosage. Due to the relatively short duration of the pharmacological action of Calcijet, further measures are probably unnecessary. Should, however, persistent and markedly elevated serum calcium levels occur, there are a variety of therapeutic alternatives which may be considered, depending on the patient's underlying condition.
These include the use of drugs such as phosphates and corticosteroids as well as measures to induce an appropriate forced diuresis. The use of peritoneal dialysis against a calcium-free dialysate has also been reported.
What should I avoid while taking Calcijet?
Avoid exposing treated skin areas to sunlight or tanning beds. Calcijet can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Avoid getting Calcijet in your eyes or mouth, or on your lips. If this does happen, rinse with water.
Overdosage of any form of vitamin D is dangerous. Progressive hypercalcemia due to overdosage of vitamin D and its metabolites may be so severe as to require emergency attention. Chronic hypercalcemia can lead to generalized vascular calcification, nephrocalcinosis and other soft-tissue calcification. The serum calcium times phosphate (Ca x P) product should not be allowed to exceed 70 mg. Radiographic evaluation of suspect anatomical regions may be useful in the early detection of this condition.
Calcijet (Calcijet) is the most potent metabolite of vitamin D available. The administration of Calcijet (Calcijet) to patients in excess of their daily requirements can cause hypercalcemia, hypercalciuria, and hyperphosphatemia. Therefore, pharmacologic doses of vitamin D and its derivatives should be withheld during Calcijet (Calcijet) treatment to avoid possible additive effects and hypercalcemia. If treatment is switched from ergocalciferol (vitamin D) to Calcijet, it may take several months for the ergocalciferol level in the blood to return to the baseline value.
Calcijet increases inorganic phosphate levels in serum. While this is desirable in patients with hypophosphatemia, caution is called for in patients with renal failure because of the danger of ectopic calcification. A non-aluminum phosphate-binding compound and a low-phosphate diet should be used to control serum phosphorus levels in patients undergoing dialysis.
Magnesium-containing preparations (eg, antacids) and Calcijet (Calcijet) should not be used concomitantly in patients on chronic renal dialysis because such use may lead to the development of hypermagnesemia.
Studies in dogs and rats given Calcijet for up to 26 weeks have shown that small increases of Calcijet above endogenous levels can lead to abnormalities of calcium metabolism with the potential for calcification of many tissues in the body.
What should I discuss with my healthcare provider before taking Calcijet?
Some medical conditions may interact with Calcijet solution. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
- if you are pregnant, planning to become pregnant, or are breast-feeding
- if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
- if you have allergies to medicines, foods, or other substances
- if you have heart disease, kidney disease or kidney stones, hardening of the arteries or other blood vessel problems, or a high phosphate level in the blood
- if you are dehydrated, have recently had surgery, or will be confined to a bed or chair for a long period of time
- if you take a phosphate-binding medicine (eg, calcium acetate)
Some MEDICINES MAY INTERACT with Calcijet solution. Tell your health care provider if you are taking any other medicines, especially any of the following:
- Thiazide diuretics (eg, hydrochlorothiazide) because the risk of high blood calcium levels may be increased
- Digoxin because the risk of irregular heartbeat may be increased
- Antacids that contain magnesium because high blood magnesium levels may occur
- Barbiturates (eg, phenobarbital), cholestyramine, corticosteroids (eg, prednisone), hydantoins (eg, phenytoin), or ketoconazole because they may decrease Calcijet solution's effectiveness
This may not be a complete list of all interactions that may occur. Ask your health care provider if Calcijet solution may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Excessive dosage of Calcijet (Calcijet) induces hypercalcemia and in some instances hypercalciuria; therefore, early in treatment during dosage adjustment, serum calcium should be determined twice weekly. In dialysis patients, a fall in serum alkaline phosphatase levels usually antedates the appearance of hypercalcemia and may be an indication of impending hypercalcemia. An abrupt increase in calcium intake as a result of changes in diet (eg, increased consumption of dairy products) or uncontrolled intake of calcium preparations may trigger hypercalcemia.
Should hypercalcemia develop, treatment with Calcijet (Calcijet) should be stopped immediately. During periods of hypercalcemia, serum calcium and phosphate levels must be determined daily. When normal levels have been attained, treatment with Calcijet (Calcijet) can be continued, at a daily dose 0.25 mcg lower than that previously used. An estimate of daily dietary calcium intake should be made and the intake adjusted when indicated. Calcijet (Calcijet) should be given cautiously to patients on digitalis, because hypercalcemia in such patients may precipitate cardiac arrhythmias.
Immobilized patients, eg, those who have undergone surgery, are particularly exposed to the risk of hypercalcemia.
In patients with normal renal function, chronic hypercalcemia may be associated with an increase in serum creatinine. While this is usually reversible, it is important in such patients to pay careful attention to those factors which may lead to hypercalcemia. Calcijet (Calcijet) therapy should always be started at the lowest possible dose and should not be increased without careful monitoring of the serum calcium. An estimate of daily dietary calcium intake should be made and the intake adjusted when indicated.
Patients with normal renal function taking Calcijet (Calcijet) should avoid dehydration. Adequate fluid intake should be maintained.
For dialysis patients, serum calcium, phosphorus, magnesium, and alkaline phosphatase should be determined periodically. For hypoparathyroid patients, serum calcium, phosphorus, and 24-hour urinary calcium should be determined periodically. For predialysis patients, serum calcium, phosphorus, alkaline phosphatase, creatinine, and intact PTH (iPTH) should be determined initially. Thereafter, serum calcium, phosphorus, alkaline phosphatase, and creatine should be determined monthly for a 6-month period and then determined periodically. Intact PTH (iPTH) should be determined periodically every 3 to 4 months at the time of visits. During the titration period of treatment with Calcijet (Calcijet), serum calcium levels should be checked at least twice weekly.
Carcinogenesis, Mutagenesis and Impairment of Fertility
Long-term studies in animals have not been conducted to evaluate the carcinogenic potential of Calcijet (Calcijet). Calcijet (Calcijet) is not mutagenic in vitro in the Ames Test, nor is it genotoxic in vivo in the Mouse Micronucleus Test. No significant effects of Calcijet (Calcijet) on fertility and/or general reproductive performances were observed in a Segment I study in rats at doses of up to 0.3 mcg/kg (approximately 3 times the maximum recommended dose based on body surface area).
Pregnancy Category C. Calcijet (Calcijet) has been found to be teratogenic in rabbits when given at doses of 0.08 and 0.3 mcg/kg (approximately 2 and 6 times the maximum recommended dose based on mg/m) administered on days 7 to 15 of gestation. The offspring of a woman administered 17 mcg/day to 36 mcg/day of Calcijet (Calcijet) (approximately 17 to 36 times the maximum recommended dose), during pregnancy manifested mild hypercalcemia in the first 2 days of life which returned to normal at day 3.
Calcijet from ingested Calcijet (Calcijet) may be excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions from Calcijet (Calcijet) in nursing infants, a mother should not nurse while taking Calcijet (Calcijet).
Safety and effectiveness of Calcijet (Calcijet) in pediatric patients undergoing dialysis have not been established. The safety and effectiveness of Calcijet (Calcijet) in pediatric predialysis patients is based on evidence from adequate and well-controlled studies of Calcijet (Calcijet) in adults with predialysis chronic renal failure and additional supportive data from non-placebo controlled studies in pediatric patients. Dosing guidelines have not been established for pediatric patients under 1 year of age with hypoparathyroidism or for pediatric patients less than 6 years of age with pseudohypoparathyroidism.
Oral doses of Calcijet (Calcijet) ranging from 10 to 55 ng/kg/day have been shown to improve calcium homeostasis and bone disease in pediatric patients with chronic renal failure for whom hemodialysis is not yet required (predialysis). Long-term Calcijet therapy is well tolerated by pediatric patients. The most common safety issues are mild, transient episodes of hypercalcemia, hyperphosphatemia, and increases in the serum calcium times phosphate (Ca x P) product which are managed effectively by dosage adjustment or temporary discontinuation of the vitamin D derivative.
Clinical studies of Calcijet (Calcijet) did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
What happens if I miss a dose of Calcijet?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
- DailyMed. "CALCITRIOL: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DrugBank. "calcitriol". http://www.drugbank.ca/drugs/DB00136 (accessed September 17, 2018).
- MeSH. "Vitamins". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology