Common medications for hypercalcemia

Hypercalcemia refers to high calcium levels in the blood, often due to parathyroid glands releasing too much hormone.

Four parathyroid glands are located on the surface of the thyroid gland, at the base of your neck. They secrete essential hormones into the bloodstream that control the levels of important bone minerals like calcium, magnesium, and phosphorus. Too much parathyroid hormone may result in an excess of these minerals in your blood.

Symptoms of hypercalcemia may include:

• loss of appetite
• constipation
• abdominal pain
• nausea
• vomiting
• severe thirst
• urination urges
• fatigue
• muscle pain
• confusion and disorientation
• difficulty concentrating
• headaches

The possible complications of hypercalcemia may include:

• decreased bone density
• osteoporosis
• bone fractures
• kidney stones
• kidney damage
• kidney failure

Treatment is available and often effective for symptoms and complications of hypercalcemia.

What are the most common drug choices for hypercalcemia?

Hypercalcemia treatment aims to relieve symptoms, prevent bone loss, and address the underlying cause. It generally involves two types of prescription medications. They are:

• Calcitonin (Miacalcin): Calcitonin is a synthetic version of the hormone that your parathyroid produces to balance calcium levels.
• Cinacalcet (Sensipar): Cinacalcet has been approved for primary and secondary hyperparathyroidism (overactive parathyroid glands). It’s a first line of treatment for people with parathyroid carcinoma.

Hypercalcemia treatment may also include:

• Bisphosphonates: These drugs strengthen your bones to prevent bone thinning, a possible effect of hypercalcemia. They’re a first line of treatment for cancer-related hypercalcemia and osteoporosis. Bisphosphonates may include:
  • alendronate (Fosamax)
  • risedronate (Actonel or Atelvia)
  • ibandronate (Boniva)
• Hydrocortisone sodium succinate: This injection treats vitamin D intoxication or hypercalcemia in people with blood cancer. Examples include Solu-Cortef.

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Medications for complications of hypercalcemia

Hypercalcemia may lead to complications, including kidney stones and osteoporosis.

Depending on your symptoms and risk factors, your healthcare team may recommend one or more medications to address these complications.

If you have a high chance or a history of kidney stones, they may recommend the following:

• Increase liquid intake and diuretics to flush minerals out of your body. These may include hydrochlorothiazide (Microzide, HydroDiuril, or Oretic).
• Use potassium citrate to raise the pH and citrate levels in your urine. These may include Cytra-K.

If you have a high risk or symptoms of osteoporosis, your healthcare team may recommend the following, in addition to bisphosphonates:

• selective estrogen receptor modulators (SERMs) like:
  • raloxifene (Evista)
  • fareston (Toremifene)
  • tamoxifen (Soltamox)
• recombinant human parathyroid hormone
• monoclonal antibodies like denosumab (Xgeva or Prolia) or romosozumab (Evenity)
• calcium and vitamin D supplements
• hormone replacement therapy with dydrogesterone or oestradiol (Kliovance)

Medications that may increase blood calcium levels

Hypercalcemia may also be a side effect of some medications. Some of these medications include:

• Thiazide diuretics: These lower blood pressure and swelling (edema) by helping the body remove excess salts and water. Examples include hydrochlorothiazide (Microzide or Oretic).
• Lithium (Lithobid): Lithium is used for mood disorders like bipolar disorder.
• Vitamin A: These supplements help strengthen the immune system.
• Tamoxifen (Soltamox): These are sometimes used in hormone therapy for breast cancer.
• Theophylline (Theo-24): Theophylline is used for bronchospasm due to asthma, chronic bronchitis, and emphysema.
• Aluminum hydroxide (AlternaGEL, Amphojel): Doctors prescribe this medication for heartburn, acid indigestion, and upset stomach. These medications may also cause aluminum toxicity.

If you’re taking any of these medications and think you may be developing symptoms of hypercalcemia, it’s highly advisable to let your healthcare team know.

Summary

Medications for hypercalcemia can help manage calcium levels in your blood and balance the production of parathyroid hormones. The two most common prescription medications for hypercalcemia are calcitonin and cinacalcet.

A healthcare professional may prescribe other medications to manage possible complications of hypercalcemia, including kidney stones and brittle bones.

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