Due to the association between occurrence of malignancies and long-term calcitonin use (see Precautions), the treatment duration in all indications should be limited to the shortest period of time possible and using the lowest effective dose.
Bone pain associated with osteolysis and/or osteopenia: Dosage should be adjusted to the individual patient's needs.
It may take several days of treatment until the analgesic effect is fully developed. For continuing therapy, the initial daily dosage can usually be reduced and/or the interval between administrations prolonged.
In bone pain associated with osteolysis and/or osteopenia the recommended dose is 100-200 IU daily by slow IV infusion in physiological saline or by subcutaneous or intramuscular injection in divided doses spread over the day, until a satisfactory response is achieved.
Paget's Disease: Dosage should be adjusted to the individual patient's needs. Treatment should be discontinued once the patient has responded and symptoms have resolved. Duration of treatment should not normally exceed 3 months due to the association of the increased risk of malignancies with long-term calcitonin use. Under exceptional circumstances, e.g., in patients with impending pathologic fracture, treatment duration may be extended up to a recommended maximum of 6 months.
Treatment markedly reduces serum alkaline phosphatase and urinary hydroxyproline excretion, often to normal levels. However, in rare cases, alkaline phosphatase and hydroxyproline excretion levels may rise after an initial fall; the physician must then judge from the clinical picture whether treatment should be discontinued and when it may be resumed.
Disorders of bone metabolism may recur one or several months after treatment has been discontinued, necessitating a new course of Miacalcic therapy.
In Paget's disease the recommended dose is 100 IU daily or every second day by s.c. or i.m. injection.
Neurodystrophic disorders: Early diagnosis of neurodystrophic disorders is essential and treatment should start as soon as the diagnosis is confirmed.
The recommended dosage is 100 IU daily by s.c. or i.m. injection for 2 to 4 weeks. Subsequently, 100 IU may be given every second day for up to 6 weeks depending on clinical progress.
Development of Antibodies: Antibodies to calcitonins may develop in patients under long-term therapy; however, clinical efficacy is usually not affected. Escape phenomena, which occur in particular in patients with Paget's disease receiving long-term therapy, may be due to saturation of the binding sites and are apparently not related to the development of antibodies. Following interruption of treatment, the therapeutic response to Miacalcic is restored.
Special Populations: Renal Impairment: There is no evidence of reduced tolerance or altered dosage requirements of Miacalcic in patients with renal impairment, although no formal studies have been carried out in this specific patient population.
Hepatic Impairment: There is no evidence of reduced tolerance or altered dosage requirements of Miacalcic in patients with hepatic impairment, although no formal studies have been carried out in this specific patient population.
Paediatric patients (below 18 years of age): There is limited experience with the use of Miacalcic in children, therefore no recommendations can be given for this patient population.
Geriatric patients (65 years of age and above): Extensive experience with the use of parenteral Miacalcic in the elderly has shown no evidence of reduced tolerance or altered dosage requirements.
Hypercalcemia: Emergency treatment of hypercalcemic crisis: Intravenous infusion is the most effective method of administration and should therefore be preferred in the treatment of emergencies or other severe conditions.
The recommended dose is 5 to 10 IU/kg body weight in physiological saline 500 mL daily by i.v. infusion over at least six hours or by slow IV injection in 2 to 4 divided doses spread over the day.
Treatment of chronic hypercalcemic states: The recommended dosage in treatment of chronic hypercalcemic states is 5 to 10 IU/kg body weight daily by subcutaneou or intramuscular injection as a single dose or in two divided doses. Treatment should be adjusted to the patient's clinical and biochemical response. If the volume of Miacalcic to be injected exceeds 2 mL, intravascular administration is preferable and multiple sites of injection should be used.
Acute pancreatitis: Miacalcic is a useful adjunct in conservative management of acute pancreatitis when administered at the recommended dosage of 300 IU by IV infusion in physiological saline over a 24 hours period for up to 6 consecutive days.