Pericon 1

• Secondary hyperparathyroidism in CKD Stages 3 and 4
• Secondary hyperparathyroidism in CKD Stage 5 on hemodialysis or peritoneal dialysis

CKD Stages 3 & 4 (Adults):

• Initial dose (iPTH <500 pg/ml): 1 mcg daily OR 2 mcg three times weekly
• Initial dose (iPTH >500 pg/ml): 2 mcg daily OR 4 mcg three times weekly
• Titration: If iPTH 30-60% decrease: maintain dose; <30% decrease: increase by 1 mcg (daily) or 2 mcg (3x/week); >60% decrease or iPTH <60 pg/ml: decrease by 1 mcg (daily) or 2 mcg (3x/week)

CKD Stage 5 (Adults):

• Initial dose (old formula): baseline iPTH/80; max 5 mcg
• Initial dose (new formula): baseline iPTH/120 (round down)
• Titration: Increase by 1 mcg every 4 weeks or decrease by 1-2 mcg; discontinue if needed

Pediatric Dose (≥10 years): Same as adults for CKD Stages 3, 4, and 5; as directed by physician.

Side Effects:

• Hypercalcemia
• Hypercalciuria
• Hyperphosphatemia
• Over-suppression of PTH

• Hypercalcemia: Progressive hypercalcemia due to vitamin D overdose may require emergency attention; acute hypercalcemia may exacerbate cardiac arrhythmias and seizures and potentiate digitalis action
• Chronic hypercalcemia can lead to vascular calcification and soft tissue calcification
• Concomitant use with calcium preparations or thiazide diuretics increases hypercalcemia risk
• Digitalis toxicity: Hypercalcemia potentiates digitalis toxicity; caution required
• Prescription-based vitamin D and derivatives should be withheld during treatment