Salmon Calcitonin is indicated for the treatment of active Paget’s disease in patients who do not respond to alternative therapies or for whom such treatments are not suitable, and for the management of hypercalcaemia.

Naturally occurring calcitonin is produced by parafollicular cells of the thyroid gland in mammals and by the ultimobranchial gland in birds and fish. The potency of salmon calcitonin is standardized based on its ability to reduce plasma calcium levels in rats compared to an international reference standard.

Each mL of Salmon Calcitonin injection contains

• 50 or 100 IU of salcatonin (as polyacetate polyhydrate),
• sodium acetate 0.2%,
• glacial acetic acid 0.2%,
• and sodium chloride 0.75%.

Salmon Calcitonin is a linear polypeptide consisting of 32 amino acids with a disulphide bridge at positions 1 and 7, and a molecular weight of 3431.9 (free peptide). Salcatonin appears as a white or greyish-white amorphous powder. It is highly soluble in water and only slightly soluble in alcohol.

Calcitonin is a polypeptide hormone produced in non-mammalian vertebrates by the ultimobranchial gland and in mammals by thyroid parafollicular cells. It inhibits osteoclastic bone resorption and reduces bone turnover. It also decreases renal tubular reabsorption and increases urinary excretion of calcium, chloride, sodium, magnesium, potassium, and phosphate.

Intravenous (Adult)-

• Emergency treatment of hypercalcaemia: Up to 10 u/kg in 500 mL of sodium chloride 0.9% by slow IV infusion over at least 6 hr.

Parenteral (Adult)-

• Adjunct in hypercalcaemia: SC/IM: 4 u/kg 12 hrly, may increase after 1-2 days to 8 u/kg 12 hrly to max 8 u/kg 6 hrly after 2 days. Alternatively, 100 u every 6-8 hr, increased after 1-2 days to max 400 u every 6-8 hr.
• Paget's disease of bone: SC/IM: 50 u 3 times wkly to 100 u/day.

Nasal (Adult)-

• Nasal postmenopausal osteoporosis: 200 u/day, alternation nostrils everyday

Concurrent use with cardiac glycosides (e.g., digitalis) or calcium channel blockers may require dosage adjustments of these medications. It may also reduce serum lithium concentrations.

This is contraindicated in patients with hypersensitivity to the drug and in those with hypocalcaemia.

Gastrointestinal disturbances, dizziness, flushing, tingling sensation in the hands, unpleasant taste, skin rash, abdominal pain, increased urinary frequency, tremor, and injection site inflammation may occur. Rarely, a diabetogenic effect has been reported.

Pregnancy Category C. Animal studies have shown adverse effects on the fetus, and there are no adequate controlled studies in humans. The drug should be used only if the potential benefit justifies the potential risk to the fetus.

A skin test should be performed before starting therapy. Caution is required in patients with heart failure and renal impairment. Use during pregnancy, lactation, and in children should be carefully considered.

Renal impairment: Dose adjustment is required.

Symptoms may include flushing, nausea, vomiting, and dizziness.

Management is symptomatic and supportive.

Hormone that regulates bone formation by inhibiting bone resorption

Store between 2–8°C.