Meditrol Dosage/Direction for Use

Standard Dosage: The optimal daily dose of calcitriol must be carefully determined for each patient on the basis of the serum calcium level. Calcitriol therapy should always be started at lowest possible dose and should not be increased without careful monitoring of serum calcium.
When the optimal dosage of calcitriol has been determined, serum calcium levels should be checked every month. Samples for serum calcium estimation should be taken without a tourniquet. As soon as the serum calcium levels rise to 1 mg/100 mL above normal, or serum creatinine rises to >120 μmol/L the dosage of calcitriol should be substantially reduced or treatment stopped altogether until normocalcemia ensues.
During the periods of hypercalcemia, serum calcium and phosphate levels must be determined daily. When normal levels have been attained, treatment with calcitriol can be continued, at daily dose 0.25 μg lower than that previously used. An estimate of dally dietary calcium intake should be made and the intake adjusted when indicated. A prerequisite for optimal efficacy of calcitriol is adequate but not excessive calcium intake (in adults: approximately 800 mg daily) at the beginning of therapy. Calcium supplements may be necessary.
Because of improved calcium absorption from the gastrointestinal tract, some patients on calcitriol may be maintained on lower calcium intake. Patients who tend to develop hypercalcemia may require only low doses of calcium or no supplementation at all.
The total daily calcium intake (i.e. from food and where applicable, from drugs) should average approximately 800 mg and should not exceed 1000 mg.
Special Dosage Instruction: Postmenopausal Osteoporosis: The recommended dosage is 0.25 μg twice daily. Serum calcium and creatinine levels should be determined at 4 week, 3 and 6 months and at 6 monthly intervals thereafter.
Rena/Osteodystrophy (Dialysis Patients): Initial daily dose should be 0.25 μg. In patients with normal or slightly reduced serum calcium levels, doses of 0.25 μg every other day are sufficient. If no satisfactory response in the biochemical parameters and clinical manifestations of the disease is observed within 2-4 weeks, the dosage may be increased by 0.25 μg/day for 2 to 4 week intervals. During this period, serum calcium levels should be determined at least twice weekly. Most patients respond to between 0.5 and 1 μg daily.
Hypoparathyroidism and Rickets: Recommended initial dose should be 0.25 μg/day given in the morning. If a satisfactory response in the biochemical parameters and clinical manifestations of the disease are not observed, the dose may be increased at 2 to 4 week intervals. During this period, serum calcium levels should be determined at least twice weekly.
Malabsorption is occasionally noted in patients with hypoparathyroidism; hence larger doses of calcitriol may be needed.
Elderly: No specific dosage modifications are required in elderly patients. The general recommendations for monitoring serum calcium and creatinine should be observed.