Rocaltrol

trademark for preparations of calcitriol, a form of vitamin D.

calcitriol

(kal-si-trye-ole) ,

1,25–dihydroxycholecalciferol

(trade name),

Calcijex

(trade name),

Rocaltrol

(trade name) Pregnancy Category: C

Indications

Action

Pharmacokinetics

Time/action profile (effects on serum calcium)

ROUTE	ONSET	PEAK	DURATION
PO	2–6 hr	2–6 hr	3–5 days
IV	unknown	unknown	unknown

Contraindications/Precautions

Adverse Reactions/Side Effects

Seen primarily as manifestations of toxicity (hypercalcemia)

Central nervous system

• headache
• somnolence
• weakness

Ear, Eye, Nose, Throat

• conjunctivitis
• photophobia
• rhinorrhea

Cardiovascular

• arrhythmias
• hypertension

Gastrointestinal

• abdominal pain
• anorexia
• constipation
• dry mouth
• liver function test elevation
• metallic taste
• nausea
• pancreatitis (life-threatening)
• polydipsia
• vomiting
• weight loss

Genitourinary

• albuminuria
• azotemia
• decreased libido
• nocturia
• polyuria

Dermatologic

• pruritus

Fluid and Electrolyte

• hypercalcemia

Local

• pain at injection site

Metabolic

• hyperthermia

Musculoskeletal

• bone pain
• metastatic calcification
• muscle pain

Miscellaneous

• allergic reactions (pruritis, rash, urticaria)

Interactions

Drug-Drug interaction

Cholestyramine, colestipol, or mineral oil ↓ absorption of vitamin D analogues.Use with thiazide diuretics may result in hypercalcemia.Corticosteroids ↓ effectiveness of vitamin D analogues.Use with digoxin ↑ risk of arrhythmias.Concurrent use of magnesium-containing drugs may lead to hypermagnesemia.Calcium-containing drugs may ↑ risk of hypercalcemia.Concurrent use of other Vitamin D supplements (↑ risk of hypercalcemia).Ingestion of foods high in calcium content (see ) may lead to hypercalcemia.

Route/Dosage

Hypocalcemia During DialysisHypoparathyroidismPredialysis PatientsRicketsHypocalcemia in Premature Infants

Availability (generic available)

Nursing implications

Nursing assessment

• Assess for symptoms of vitamin deficiency prior to and periodically during therapy.
• Assess patient for bone pain and weakness prior to and during therapy.
• Observe patient carefully for evidence of hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic, cardiac arrhythmias, and Chvostek’s or Trousseau’s sign). Protect symptomatic patient by raising and padding side rails; keep bed in low position.
• Children: Monitor height and weight; growth arrest may occur in prolonged high-dose therapy.
• Lab Test Considerations: Serum calcium and phosphorus concentrations should be drawn twice weekly during initial therapy. Serum calcium, phosphorus, magnesium, alkaline phosphatase, and intact PTH concentrations should then be monitored at least monthly.
  • The serum calcium times phosphate product (Ca X P) should no exceed 70 mg²/dL² (patients may be at ↑ risk of calcification).
  • May cause false ↑ cholesterol levels.
Toxicity is manifested as hypercalcemia, hypercalciuria, and hyperphosphatemia. Assess patient for appearance of nausea, vomiting, anorexia, weakness, constipation, headache, bone pain, and metallic taste. Later symptoms include polyuria, polydipsia, photophobia, rhinorrhea, pruritus, and cardiac arrhythmias. Notify physician or other health care professional immediately if these signs of hypervitaminosis D occur. Treatment usually consists of discontinuation of calcitriol, a low-calcium diet, use of low-calcium dialysate in peritoneal dialysis patients, or administration of a laxative. IV hydration and loop diuretics may be ordered to increase urinary excretion of calcium. Hemodialysis may also be used. If patient has hyperphosphatemia, treatment with an oral phosphate-binding agent (e.g. calcium acetate, sevelamer, lanthanum carbonate) may be needed.

Potential Nursing Diagnoses

Imbalanced nutrition: less than body requirements (Indications)

Implementation

• Oral: May be administered without regard to meals. Measure solution accurately with calibrated dropper provided by manufacturer. May be mixed with juice, cereal, or food, or dropped directly into mouth. Capsules and solution should be protected from light.
• Oral: Liquid may be withdrawn from capsules with a needle and syringe. Both the 0.25 mcg and 0.5 mcg capsules contain 0.17 mL.
• Administer by rapid injection through the catheter at the end of a hemodialysis period.

Patient/Family Teaching

• Advise patient to take medication as directed. Take missed doses as soon as remembered that day, unless almost time for next dose; do not double up on doses.
• Review diet modifications with patient. See for foods high in calcium and vitamin D. Renal patients must still consider renal failure diet in food selection. Health care professional may order concurrent calcium supplement.
• Encourage patient to comply with dietary recommendations of health care professional. Explain that the best source of vitamins is a well-balanced diet with foods from the 4 basic food groups and the importance of sunlight exposure. See for foods high in vitamin D.
• Patients self-medicating with vitamin supplements should be cautioned not to exceed RDA. The effectiveness of megadoses for treatment of various medical conditions is unproved and may cause side effects.
• Advise patient to avoid concurrent use of antacids containing magnesium.
• Review symptoms of overdosage and instruct patient to report these promptly to health care professional.
• Emphasize the importance of follow-up exams to evaluate progress.

Evaluation/Desired Outcomes

• Normalization of serum calcium and parathyroid hormone levels.