Doxercalciferol vs. Paricalcitol for Kidney Disease and Hyperparathyroidism: Important Differences and Potential Risks.

Hectorol

(doxercalciferol)

Paricalcitol

(Zemplar)

Summary for Doxercalciferol

Prescription only

Hectorol (doxercalciferol) is a lab-made form of vitamin D2. It's a medication that's used to lower parathyroid hormone (PTH) levels in people with chronic kidney disease (CKD), including those on dialysis. Hectorol (doxercalciferol) is available as lower-cost generic capsules and an injection through the vein (intravenous or IV). Side effects include infection, constipation, runny nose, and cough.

Indications for Doxercalciferol

High PTH levels (secondary parathyroidism) in adults with stage 3 or stage 4 chronic kidney disease (CKD) - capsules only
High PTH levels in adults with CKD and on dialysis - capsules and IV injection

Pros and Cons for Doxercalciferol

Pros

Capsules are taken once per day
Can help lower PTH levels
Available as a lower-cost generic

Cons

Interacts with a lot of medications, such as calcium- or vitamin-D containing products and digoxin (Lanoxin)
Risk of high calcium levels
Requires frequent lab monitoring

Common Side Effects for Doxercalciferol

Stage 3 or 4 CKD:

Infection (30%)
Constipation (26%)
Runny nose (22%)
Cough (19%)
Shortness of breath (19%)
"Pin and needles" feeling in arms or legs (15%)
Weakness (15%)

CKD on dialysis:

Swelling (34%)
Not feeling well (28%)
Headache (28%)
Nausea or vomiting (21%)
Dizziness (12%)
Shortness of breath (12%)

Warnings for Doxercalciferol

High blood calcium levels
Serious allergic reaction
Broken bones (fractures)

Summary for Paricalcitol

Prescription only

Paricalcitol (Zemplar) lowers parathyroid hormone (PTH) levels in people with chronic kidney disease. It works just as well as calcitriol (Rocaltrol) and has similar side effects. Paricalcitol (Zemplar) only needs to be taken once per day or three times a week but you'll need to have lab work done regularly while taking this medication.

Indications for Paricalcitol

Prevention and treatment of high parathyroid hormone levels for people with chronic kidney disease (CKD) stages 3, 4, or 5

Pros and Cons for Paricalcitol

Pros

Works well at lowering PTH levels
Convenient dosing where it's taken either once per day or three times per week
Available in a lower-cost, generic form

Cons

Requires you to have blood work done regularly
Can cause high calcium levels, which can be dangerous and require emergency treatment
You might need to change your diet to lower the risk of side effects.
Can interact with many medications