Alfacalcidol

Oral
Hypoparathyroidism
Adult: As cap/oral drops: Initially, 1 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: As cap/oral drops: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily; >1 month <20 kg: Initially, 0.05 mcg/kg daily; >20 kg: Same as adult dose.
Elderly: As cap/oral drops: Initially, 0.5 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily.

Oral
Renal osteodystrophy
Adult: As cap/oral drops: Initially, 1 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: As cap/oral drops: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily; >1 month <20 kg: Initially, 0.05 mcg/kg daily; >20 kg: Same as adult dose.
Elderly: As cap/oral drops: Initially, 0.5 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily.

Oral
Hyperparathyroidism
Adult: As cap/oral drops: Initially, 1 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: As cap/oral drops: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily; >1 month <20 kg: Initially, 0.05 mcg/kg daily; >20 kg: Same as adult dose.
Elderly: As cap/oral drops: Initially, 0.5 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily.

Oral
Rickets
Adult: In patients with nutritional and malabsorptive, hypophosphataemic vitamin D-resistant, and pseudo-deficiency (D-dependent) cases: As cap/oral drops: Initially, 1 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: As cap/oral drops: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily; >1 month <20 kg: Initially, 0.05 mcg/kg daily; >20 kg: Same as adult dose.
Elderly: As cap/oral drops: Initially, 0.5 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily.

Oral
Osteomalacia
Adult: In patients with nutritional and malabsorptive, hypophosphataemic vitamin D-resistant, and pseudo-deficiency (D-dependent) cases: As cap/oral drops: Initially, 1 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: As cap/oral drops: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily; >1 month <20 kg: Initially, 0.05 mcg/kg daily; >20 kg: Same as adult dose.
Elderly: As cap/oral drops: Initially, 0.5 mcg daily, adjust subsequent doses according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Dose increases may be done in increments of 0.25-0.5 mcg daily. Usual maintenance dose: 0.25-1 mcg daily.

Oral
Neonatal hypocalcaemia
Child: As cap/oral drops: In neonates and premature infants: Initially, 0.05-0.1 mcg/kg daily, followed by careful titration; doses up to 2 mcg/kg may be required in severe cases.

Intravenous
Hyperparathyroidism
Adult: Initially, 1 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily via bolus inj over approx 30 seconds; >1 month <20 kg: Initially, 0.05 mcg/kg daily via bolus inj over approx 30 seconds; >20 kg: Same as adult dose.
Elderly: Initially, 0.5 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily.
Renal impairment: Patients undergoing haemodialysis: Initially, 1 mcg per dialysis, given into the return line from the haemodialysis machine at the end of each session. Max: 6 mcg per dialysis; 12 mcg/week.

Intravenous
Renal osteodystrophy
Adult: Initially, 1 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily via bolus inj over approx 30 seconds; >1 month <20 kg: Initially, 0.05 mcg/kg daily via bolus inj over approx 30 seconds; >20 kg: Same as adult dose.
Elderly: Initially, 0.5 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily.
Renal impairment: Patients undergoing haemodialysis: Initially, 1 mcg per dialysis, given into the return line from the haemodialysis machine at the end of each session. Max: 6 mcg per dialysis; 12 mcg/week.

Intravenous
Hypoparathyroidism
Adult: Initially, 1 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily via bolus inj over approx 30 seconds; >1 month <20 kg: Initially, 0.05 mcg/kg daily via bolus inj over approx 30 seconds; >20 kg: Same as adult dose.
Elderly: Initially, 0.5 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily.
Renal impairment: Patients undergoing haemodialysis: Initially, 1 mcg per dialysis, given into the return line from the haemodialysis machine at the end of each session. Max: 6 mcg per dialysis; 12 mcg/week.

Intravenous
Rickets
Adult: In patients with nutritional and malabsorptive, hypophosphataemic vitamin D-resistant, and pseudo-deficiency (D-dependent) cases: Initially, 1 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily via bolus inj over approx 30 seconds; >1 month <20 kg: Initially, 0.05 mcg/kg daily via bolus inj over approx 30 seconds; >20 kg: Same as adult dose.
Elderly: Initially, 0.5 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily.
Renal impairment: Patients undergoing haemodialysis: Initially, 1 mcg per dialysis, given into the return line from the haemodialysis machine at the end of each session. Max: 6 mcg per dialysis; 12 mcg/week.

Intravenous
Osteomalacia
Adult: In patients with nutritional and malabsorptive, hypophosphataemic vitamin D-resistant, and pseudo-deficiency (D-dependent) cases: Initially, 1 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily. Dose discontinuation may be required if hypercalcaemia occurs. Refer to detailed product guideline for further indication specific therapeutic measures.
Child: In neonates and premature infants <1 month: Initially, 0.05-0.1 mcg/kg daily via bolus inj over approx 30 seconds; >1 month <20 kg: Initially, 0.05 mcg/kg daily via bolus inj over approx 30 seconds; >20 kg: Same as adult dose.
Elderly: Initially, 0.5 mcg daily via bolus inj over approx 30 seconds, may be adjusted thereafter according to individual biochemical (e.g. plasma Ca levels), radiographic, or histological response. Usual maintenance dose: 0.25-1 mcg daily.
Renal impairment: Patients undergoing haemodialysis: Initially, 1 mcg per dialysis, given into the return line from the haemodialysis machine at the end of each session. Max: 6 mcg per dialysis; 12 mcg/week.

Intravenous
Neonatal hypocalcaemia
Child: In neonates and premature infants: Initially, 0.05-0.1 mcg/kg daily via bolus inj over 30 seconds, followed by careful titration; doses up to 2 mcg/kg may be required in severe cases.

Special Populations: Patients currently taking barbiturates and other anticonvulsants: May require larger doses to produce the desired effect.

Should be taken with food.

Hypercalcaemia, hyperphosphataemia, vitamin D toxicity, metastatic calcification.

Patient with pulmonary tissue calcification, granulomatous diseases (e.g. sarcoidosis), nephrolithiasis, hypermagnesaemia. Concomitant treatment with digitalis glycosides; barbiturates and other anticonvulsants. Renal impairment. Children and elderly. Pregnancy and lactation. Monitoring Parameters Monitor serum Ca and phosphate levels regularly, such as at least twice weekly, during treatment initiation and dose adjustments (particularly in children, patients with renal impairment, or taking high doses); PTH, alkaline phosphatase, and Ca x phosphate product as clinically indicated. Measurement frequency may be dependent on the presence and magnitude of abnormalities, and rate of disease progression.

Significant: Hypercalcaemia (when prolonged may cause generalised vascular and soft tissue calcification, and exacerbated nephrolithiasis, arteriosclerosis or cardiac valve sclerosis); over suppression of PTH, hypercalciuria, hyperphosphataemia, adynamic bone disease; transient or long-lasting decreased kidney function. Ear and labyrinth disorders: Vertigo. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain and discomfort, constipation. General disorders and administration site conditions: Lassitude, asthenia, malaise, calcinosis. Investigations: Increased plasma and urinary concentrations of Ca and phosphate, weight loss. Metabolism and nutrition disorders: Anorexia, thirst. Musculoskeletal and connective tissue disorders: Myalgia. Nervous system disorders: Headache. Rarely, dizziness. Psychiatric disorders: Confusional state. Renal and urinary disorders: Polyuria, acute renal failure, nephrocalcinosis. Skin and subcutaneous tissue disorders: Rash (e.g. maculo-papular, erythematous, pustular), pruritus, sweating, urticaria.

Symptoms: Hypercalcaemia including nausea, vomiting, diarrhoea, anorexia, weight loss, thirst, polyuria, lassitude, headache, vertigo, and increased Ca and phosphate levels in the plasma and urine. Management: Supportive treatment. In acute cases, perform gastric lavage or administer mineral oil to reduce the absorption and promote faecal excretion. Ensure hydration by giving IV infusion of saline (forced diuresis). Monitor electrolytes, Ca and renal indices; assess for ECG abnormalities (particularly in patients on digitalis). May consider treatment with glucocorticosteroids, bisphosphonates, loop diuretics, calcitonin, and haemodialysis with low Ca content.

Increased risk of hypercalcaemia with thiazide diuretics, Ca-containing or other vitamin D-containing preparations. May precipitate cardiac arrhythmias with digitalis glycosides. Intestinal absorption may be impaired by colestyramine, colestipol, sucralfate, Al-based antacids (high dose), and mineral oil (prolonged use). May increase serum levels of Al in aluminium hydroxide, sucralfate or other Al-containing preparations. May increase metabolism with anticonvulsants (e.g. phenytoin, phenobarbital, carbamazepine, primidone). May cause hypermagnesaemia with Mg-based antacids or laxatives in dialysis patients.

Alfacalcidol is a precursor of calcitriol, which is an active metabolite of vitamin D. It promotes intestinal absorption of Ca and phosphorus, resorption of Ca from the bone, and possibly renal reabsorption of Ca. Synonym: 1α-hydroxycholecalciferol.
Onset: 6 hours.
Duration: Effect on intestinal Ca absorption levels: 48 hours (1,25-dihydroxyvitamin D₃).
Absorption: Time to peak plasma concentration: 1,25-dihydroxyvitamin D₃: Approx 12 hours (oral); 4 hours (IV).
Distribution: Enters breast milk. Plasma protein binding: Extensively to vitamin D-binding protein.
Metabolism: Rapidly and almost completely converted in the liver into 1,25-dihydroxyvitamin D₃ (calcitriol).
Excretion: Mainly via faeces; urine. Elimination half-life: Approx 35 hours; approx 3 hours (renal insufficiency).

Intravenous: Solution for inj: Store between 2-8°C. Protect from light and direct sunlight. Do not freeze. Oral: Cap: Store between 15-25°C. Protect from direct sunlight. Oral drops: Store between 2-8°C. Protect from light and direct sunlight. Do not freeze.

Agents Affecting Bone Metabolism

A11CC03 - alfacalcidol ; Belongs to the class of vitamin D and analogues. Used as dietary supplements.