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.
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
Hectorol (doxercalciferol) is a vitamin D analog. It acts like vitamin D, which has a complex relationship with calcium and parathyroid hormone (PTH) levels in your body. By acting like vitamin D, Hectorol (doxercalciferol) raises calcium absorption, which in turn blocks the production of PTH in the body. This helps lower PTH levels.
Source: DailyMed
Side effects that you should report to your care team as soon as possible:
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Capsules are taken once per day
Can help lower PTH levels
Available as a lower-cost generic
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
Take Hectorol (doxercalciferol) with or without food. If it's hurting your stomach, try taking it with food to help.
Mark your calendar with your appointments to see your provider and to get any blood work done during treatment with Hectorol (doxercalciferol). Your provider will keep track of your kidney health and measure your blood levels of calcium, vitamin D, and PTH. This helps you and your provider see how well the medication is working for you.
Make sure to keep a healthy diet while you're taking Hectorol (doxercalciferol). This includes having a balanced and consistent diet of vitamin D-containing and calcium-containing foods so your calcium levels don't get too high or too low.
Hectorol (doxercalciferol) interacts with a lot of medications. These interactions can affect how safe your medications are for you or how well they work. Some of these interactions include with magnesium-containing products like Milk of Magnesia, calcium-containing products, phenobarbital, and certain diuretics. Tell your providers about all of the medications you're taking before starting Hectorol (doxercalciferol). Don't start any new medications while taking Hectorol (doxercalciferol) without asking your pharmacist or provider if it's okay to take together.
Let your provider and pharmacist know if you're taking a heart medication called digoxin (Lanoxin). Your provider will want to check your blood calcium levels more closely. This is because Hectorol (doxercalciferol) can cause your blood calcium levels to rise, which can make you more sensitive to the effects of digoxin. This raises your risk of digoxin side effects.
Hectorol (doxercalciferol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Conditions that cause high calcium levels | Taking too much vitamin D | Taking too much calcium | Taking thiazide diuretics
Hectorol (doxercalciferol) can sometimes lead to high calcium levels in the blood, which can be serious. High levels of calcium can raise your risk of heart, blood vessel problems, and seizures. You're at risk of having very high calcium levels if you're taking Hectorol (doxercalciferol) with high doses of calcium-containing products (e.g., supplements), certain diuretics ("water pills"), or other vitamin D products. For this reason, don't take additional vitamin D- or calcium-containing foods or supplements unless your provider said it's safe for you to do so.
To make sure your blood calcium levels are safe, you'll need to get blood work done during treatment (more often at the start of treatment or when the dose changes, then eventually once every 3 months). Depending on your calcium levels, your provider might adjust your Hectorol (doxercalciferol) dose. Let your provider know if you notice any signs of high blood calcium levels, such as tiredness, problems thinking clearly, loss of appetite, nausea, vomiting, constipation, and muscle weakness.
Some people have had a serious and sometimes life-threatening allergic reaction to Hectorol (doxercalciferol). These reactions can include anaphylaxis; swelling of the face, lips, or airways; chest discomfort; and shortness of breath. Get medical help or call 911 if you experience an allergic reaction at any time while you're taking Hectorol (doxercalciferol).
It's possible for Hectorol (doxercalciferol) to lower your PTH levels too much. This can cause your bones to weaken, which raises your risk of fractures. Your provider will check your PTH levels closely through blood work while you're taking Hectorol (doxercalciferol). They'll adjust your dose to make sure your PTH levels are healthy.
Capsules
Stage 3 or 4 CKD: The typical starting dose is 1 mcg by mouth once a day. The maximum dose is 3.5 mcg once a day.
CKD on dialysis: The typical starting dose is 10 mcg by mouth three times a week at dialysis appointments. The maximum dose is 20 mcg three times a week at dialysis appointments.
Injection
CKD on dialysis: The medication is given by a healthcare provider at the end of your dialysis appointment. The typical starting dose is 4 mcg injected to the veins (IV) three times a week. The maximum dose is 18 mcg per week.
Your provider will adjust your dose based on your PTH and calcium levels.
High calcium levels in the blood (hypercalcemia)
Vitamin D toxicity
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
Hypoparathyroidism (low parathyroid hormone levels)
Familial hypophosphatemia (genetic condition causing low phosphate levels)
Vitamin D-resistant rickets (weakening of the bones caused by low vitamin D)
Low calcium in people on dialysis
Secondary hyperparathyroidism in people not yet on dialysis
Low calcium in people with hypoparathyroidism or pseudohypoparathyroidism
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AbbVie Inc. (2021). Zemplar- paricalcitol capsule, liquid filled [package insert]. DailyMed.
MedlinePlus. (2021). Calcium blood test.
National Kidney Foundation. (n.d.). Dialysis.
National Kidney Foundation. (n.d.). Secondary hyperparathyroidism.
Winthrop U.S, a business of sanofi-aventis U.S. LLC. (2023). Doxercalciferol- doxercalciferol capsule [package insert]. DailyMed.
Your and Your Hormones. (n.d.). Parathyroid hormone.
Your and Your Hormones. (n.d.). Vitamin D.
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