paricalcitol
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.
What is Paricalcitol (Zemplar)?
What is Paricalcitol (Zemplar) used for?
- Prevention and treatment of high parathyroid hormone levels for people with chronic kidney disease (CKD) stages 3, 4, or 5
How Paricalcitol (Zemplar) works
Paricalcitol (Zemplar) is a form of vitamin D. It binds to vitamin D receptors, which stops your body from making too much parathyroid hormone (PTH).
Drug facts
Side effects of Paricalcitol (Zemplar)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nausea (5–13%)
- Diarrhea (7–12%)
- Common cold (8%)
- Vomiting (5–8%)
- High blood pressure (7%)
- Swelling (6–7%)
- Dizziness (5–7%)
Less Common Side Effects
- Runny nose
- Infections
- Low blood pressure
- Chills
- Trouble sleeping
- Feeling like you're spinning (vertigo)
- Headache
- Rash
- High fluid in your blood
- Bleeding in your stomach
- Stomach infection
- Constipation
- Urge to urinate
- Flu
- Arthritis or join pain, arthritis
- Weakness
- Pink eye
- Asthma
- Lung infection (pneumonia)
- Fever
Paricalcitol (Zemplar) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reactions: itching, hives, trouble breathing, swelling of your face, lips, tongue, or throat
- High calcium levels: tiredness, trouble thinking clearly, loss of appetite, nausea, vomiting, constipation, more thirst, more urination, weight loss
The following Paricalcitol (Zemplar) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred vision
cough or hoarseness
difficulty with swallowing
dizziness
fever or chills
headache
lower back or side pain
nervousness
painful or difficult urination
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
shortness of breath
skin rash
slow or fast heartbeat
swelling
tightness in the chest
unusual tiredness or weakness
Less common
Abdominal or stomach pain
abnormal growth filled with fluid or semisolid material
ammonia-like breath odor
bladder pain
bloating or swelling of the face, arms, hands, lower legs, or feet
bloody or cloudy urine
burning, tingling, numbness or pain in the hands, arms, feet, or legs
chest pain or discomfort
cold sweats
coma
confusion
convulsions
cool, pale skin
decreased urine
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
fainting
frequent urge to urinate
general feeling of discomfort or illness
increase in heart rate
increased hunger
increased thirst
irregular heartbeat
joint pain
lightheadedness
loss of appetite
muscle aches and pains
nausea or vomiting
nightmares
numbness or tingling in the hands, feet, or lips
pain or discomfort in the arms, jaw, back, or neck
rapid breathing
rapid weight gain
sensation of pins and needles
shakiness
shivering
slurred speech
stabbing pain
sunken eyes
sweating
thirst
trouble sleeping
troubled breathing
unusual weight gain or loss
wrinkled skin
Incidence not known
Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
slow or irregular breathing
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Abdominal or stomach cramps
high urine levels of calcium
incoherent speech
increased urination
metallic taste
muscle cramps in the hands, arms, feet, legs, or face
muscle weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Acid or sour stomach
back pain
belching
bloody nose
bruising
change in vision
cough producing mucus
difficulty with moving
feeling of constant movement of self or surroundings
impaired vision
indigestion
lack or loss of strength
large, flat, blue, or purplish patches in the skin
leg cramps
muscle pain or stiffness
pain or tenderness around the eyes and cheekbones
pain, swelling, or redness in the joints
sensation of spinning
sores on the skin
stomach discomfort, upset, or pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Paricalcitol (Zemplar)
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
Pharmacist tips for Paricalcitol (Zemplar)
- Paricalcitol (Zemplar) can raise your calcium levels, which can cause tiredness, trouble thinking clearly, loss of appetite, nausea, vomiting, constipation, more thirst, more urination, and weight loss. Let your provider know right away if you feel any of these symptoms. You might need emergency medical treatment if your calcium levels go really high.
- Your provider will order blood work to watch your calcium, phosphorus, and PTH levels are while you're taking paricalcitol (Zemplar). Based on your test results, your provider might change your dose of paricalcitol (Zemplar).
- Don't take medications that contain aluminum, such as antacids and phosphate binders, while you're taking paricalcitol (Zemplar). This can raise the aluminum levels in your blood, which can damage your bones. Check with your provider or pharmacist if you're unsure if your medications contain alumnimum.
- If you're also taking cholestyramine (Prevalite) or mineral oil, don't take it at the same time that you take paricalcitol (Zemplar) because it can lower the amount of paricalcitol (Zemplar) your body absorbs. Take paricalcitol (Zemplar) at least 1 hour before or 4 to 6 hours after taking cholestyramine (Prevalite) or mineral oil.
- Take paricalcitol (Zemplar) exactly as it's prescribed, either once a day or 3 times a week. If you're taking paricalcitol (Zemplar) three times per week, don't take the medication more often than every other day.
- Take paricalcitol (Zemplar) with or without food.
Common questions about Paricalcitol (Zemplar)
Your provider might have you lower the amount of phosphorus in your diet because paricalcitol (Zemplar) can raise the phosphorus levels in your blood. To lower your risk of having side effects while taking paricalcitol (Zemplar), limit dairy, beans, nuts, oatmeal, and lentils, which are all high in phosphorus. Examples of foods with low phosphorus are apples, seafood, and turkey breast.
Your provider will monitor your calcium, phosphorus, and PTH levels at least every 2 weeks for the first 3 months after you start taking paricalcitol (Zemplar) or after your dose is changed. For the following 3 months, you'll need to have lab work done once a month. Afterwards, you'll have lab work done every 3 months.
It's not known if paricalcitol (Zemplar) will be present in your breast milk, what the effects of the medication would be on your baby, or what the effects of paricalcitol (Zemplar) would be on your milk supply. Because paricalcitol (Zemplar) can cause serious side effects, such as high calcium in your baby, it’s not recommended that you breastfeed while taking paricalcitol (Zemplar).
Taking too much vitamin D can cause your PTH levels to go too low, which can lead to high calcium in your blood and urine, high phosphorus levels, and bone disease. Don't take any other vitamin D supplements (prescription or over-the-counter) until you and your provider weigh the risks and benefits of taking these medications together.
Paricalcitol (Zemplar) can cause high calcium levels, which can lead to heart problems and seizures. It's important that you watch out for signs and symptoms of high calcium and let your provider know right away if you experience any. These include feeling tired, having difficulty thinking clearly, loss of appetite, nausea, vomiting, constipation, being thirstier than normal, urinating more often, or losing weight.
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Risks and warnings for Paricalcitol (Zemplar)
Paricalcitol (Zemplar) 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.
High calcium levels in your blood and urine
- Risk factors: Taking digoxin (Lanoxin), high doses of medications that contain calcium, certain water pills such as hydrochlorothiazide (Microzide), or prescription-strength vitamin D medications | History of high calcium levels
Taking too much vitamin D can cause dangerously high calcium levels in your blood. This can lead to serious changes to your heart rhythm, seizures, and if you're taking digoxin (Lanoxin), it can raise your risk of digitalis toxicity, which is a condition where digoxin builds up in your system. The risk of this is higher if you're taking high doses of medications that contain calcium, certain water pills such as hydrochlorothiazide (Microzide), or other vitamin D medications. Avoid prescription-strength doses of vitamin D while taking paricalcitol (Zemplar). It's important that you can recognize the signs and symptoms of high calcium because severely elevated calcium levels might require emergency medical care. High calcium levels can cause tiredness, trouble thinking clearly, loss of appetite, nausea, vomiting, constipation, more thirst, more urination, and weight loss. If you feel any of these symptoms, let your provider know right away. They will monitor your calcium levels occasionally while you're taking paricalcitol (Zemplar).
High aluminum levels
- Risk factors: Taking medications that contain aluminum
Taking paricalcitol (Zemplar) with medications that contain aluminum, such as antacids and phosphate binders, can cause dangerously high levels of aluminum in your body, which can cause bone pain, muscle pain, fractures, and softening of your bones. Check with your provider or pharmacist if you're unsure if your medications contain alumnimum.
Paricalcitol (Zemplar) dosage
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 1mcg | 30 capsules | $35.57 | $1.19 |
| 2mcg | 30 capsules | $62.28 | $2.08 |
| 4mcg | 30 capsules | $129.44 | $4.31 |
Typical dosage for Paricalcitol (Zemplar)
- Adults with CKD stage 3 or 4: The typical starting dose is 1 mcg to 2 mcg by mouth once per day or 2 mcg to 4 mcg by mouth three times per week.
- Adults on dialysis (CKD stage 5): Your provider will prescribe a dose based on your PTH levels. Paricalcitol (Zemplar) is taken three times per week.
- Children (aged 10–16 years) with CKD stage 3 or 4: The typical starting dose is 1 mcg by mouth three times a week.
- Children (aged 10–16 years) on dialysis (CKD stage 5): The provider will prescribe a dose based on the child's PTH levels. Paricalcitol (Zemplar) is taken three times per week.
Paricalcitol (Zemplar) is also available as an IV into the vein that your provider administers, often during dialysis.
Interactions between Paricalcitol (Zemplar) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Burosumab-twza
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Paricalcitol (Zemplar) cost?
Paricalcitol (Zemplar) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Paricalcitol (Zemplar) will not be safe for you to take.
- High calcium levels
- High vitamin D levels (toxicity) which can cause nausea, vomiting, weakness, and frequent urination
What are alternatives to Paricalcitol (Zemplar)?
Paricalcitol (Zemplar) images
