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Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Before starting

Required

  • Baseline
    • Alkaline Phosphatase
    • Parathyroid hormone
    • Serum calciumideally corrected calcium for protein binding
    • Serum creatinine (for creatinine clearance)
    • Serum phosphate
    • Urea and electrolytes
    • Vitamin D(25-hydroxy vitamin D level)

Continued until stable

Required

  • Once or twice a week; or whenever nausea and vomiting occurs
    • Serum calciumideally corrected for protein binding
    • Serum phosphate

Ongoing once stable

Required

  • Every 2 - 4 weeks
    • Alkaline Phosphatase
    • Parathyroid hormone
    • Serum calciumideally corrected for protein binding
    • Serum creatinine (for creatinine clearance)
    • Serum magnesium
    • Serum phosphate

Consider

  • Every 3 months
    • Alkaline Phosphatase
    • Parathyroid hormone
    • Serum calciumideally corrected calcium for protein binding
    • Serum creatinine (for creatinine clearance)
    • Serum magnesium
    • Serum phosphate

Reducing monitoring frequency

Alfacalcidol must not be prescribed without ongoing monitoring of serum calcium and renal function.

However, for stable patients, the licensed recommendation of 2-4 weekly testing may not always be necessary. Consider reducing the frequency to every 3 months, but continue monitoring throughout the duration of therapy.

Abnormal results

Serum calcium

Consider seeking specialist advice and hospital admission if any of:

  • Serum calcium less then 1.7 mmol/l
  • Serum calcium greater than 3.0 mmol/l
  • Patient markedly symptomatic (malaise, thirst, perioral tingling, cramps or tetany)

Notes

Cautions with concomitant medication

Thiazide diuretics and calcium containing preparations

Concurrent use of thiazide diuretics or calcium containing preparations may enhance the risk of hypercalcaemia, therefore calcium levels should be monitored more closely.

Bile acid sequestrants

Concomitant oral administration of bile acid sequestrants, such as colestyramine may impair the intestinal absorption of oral One-Alpha formulations. One-Alpha should be administered at least 1 hour before, or 4 to 6 hours after the intake of the bile acid sequestrant to minimise the potential risk of interaction.

Bibliography

Enquiries about this page

Contact us if you have any enquiries about the drug monitoring information on this page.