Salmon calcitonin

Summary

Salmon calcitonin (salcatonin) is a 32-amino acid polypeptide hormone derived from salmon, used clinically for Paget's disease of bone, hypercalcemia, and postmenopausal osteoporosis. It is approximately 40–50 times more potent than human calcitonin on a molar basis. Available as subcutaneous/intramuscular injection and nasal spray.

Mechanism of Action

Binds to calcitonin receptors on osteoclasts, inhibiting bone resorption and reducing osteoclast activity; also acts on renal tubules to reduce calcium and phosphate reabsorption, lowering serum calcium levels. Nasal formulation additionally has central analgesic effects via endorphin release.

Routes of Administration

Goals & Uses

• Postmenopausal osteoporosisBone MetabolismModerate
• Analgesia in bone painPain ManagementModerate
• Treatment of Paget's disease of boneBone MetabolismHigh
• Treatment of hypercalcemiaMineral HomeostasisHigh
• Prevention of immobilization hypercalcemiaMineral HomeostasisModerate

Contraindications

• PregnancyPopulationModeratePotential fetal risk or insufficient safety data
• Hypersensitivity to salmon calcitoninAllergy/ImmunologyHigh
• HypocalcemiaElectrolyte DisorderHigh

Adverse Effects

• Facial flushingCardiovascular/DermatologicCommon
• Rhinitis and nasal symptomsENTCommon
• Nausea and vomitingGastrointestinalCommon
• HypocalcemiaMetabolicUncommon
• Malignancy (long-term use)OncologyRare
• TachyphylaxisPharmacodynamicCommon

Drug Interactions

• BisphosphonatesLow
• Calcium supplements / Vitamin DLow
• LithiumModerate

Population Constraints

• Renal impairmentOrgan ImpairmentRelative
• Pediatric patientsAgeRelative
• Lactating womenReproductiveRelative
• Patients with History of MalignancyOncologyRelative

Regulatory Status

• European UnionApprovedApproved: Paget's disease of bone, Hypercalcemia, Prevention of acute bone loss due to sudden immobilizationEMA 2013 review resulted in restriction of nasal spray for osteoporosis due to unfavorable benefit-risk; injectable forms retained with restrictions.
• United StatesApprovedApproved: Postmenopausal osteoporosis (nasal spray), Paget's disease of bone (injection), Hypercalcemia (injection)FDA approved; Miacalcin and Fortical brands marketed; label updated with cancer risk warning.
• United KingdomApprovedApproved: Paget's disease of bone, Hypercalcemia, Postmenopausal osteoporosis (injectable, restricted)Follows EMA guidance post-Brexit transition; nasal formulation for osteoporosis withdrawn from marketing.

FDA approved; EMA approved. In 2013, EMA recommended restricting use due to increased cancer risk with long-term oral and nasal formulations; nasal spray was removed from many EU markets for osteoporosis. FDA added safety label updates regarding malignancy risk with prolonged use.

Evidence & Sources

No sources recorded yet.