Cinacalcet

Cinacalcet
Names
Trade namesSensipar, Mimpara
IUPAC name
  • (R)-N-[1-(1-naphthyl)ethyl]-3-
    [3-(trifluoromethyl)phenyl]propan-1-amine
Clinical data
Drug classCalcimimetic[1]
Main usesSecondary hyperparathyroidism, parathyroid carcinoma, primary hyperparathyroidism[2]
Side effectsNausea, upper GI bleeding, low calcium, low blood pressure, adynamic bone disease[1][2]
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Pregnancy
category
  • AU: B3[3]
  • US: C (Risk not ruled out)[3]
    Routes of
    use    		By mouth
    External links
    AHFS/Drugs.comMonograph
    MedlinePlusa605004
    Legal
    License data
    Legal status
    • AU: S4 (Prescription only) [4]
    • UK: POM (Prescription only) [5]
    • US: ℞-only
    • EU: Rx-only
    • In general: ℞ (Prescription only)
    Pharmacokinetics
    Bioavailability20 to 25%
    increases if taken with food
    Protein binding93 to 97%
    MetabolismLiver (CYP3A4-, CYP2D6- and CYP1A2-mediated)
    Elimination half-life30 to 40 hours
    ExcretionKidney (80%) and fecal (15%)
    Chemical and physical data
    FormulaC22H22F3N
    Molar mass357.420 g·mol−1
    3D model (JSmol)
    SMILES
    • CC(C1=CC=CC2=CC=CC=C21)NCCCC3=CC(=CC=C3)C(F)(F)F
    InChI
    • InChI=1S/C22H22F3N/c1-16(20-13-5-10-18-9-2-3-12-21(18)20)26-14-6-8-17-7-4-11-19(15-17)22(23,24)25/h2-5,7,9-13,15-16,26H,6,8,14H2,1H3/t16-/m1/s1 checkY
    • Key:VDHAWDNDOKGFTD-MRXNPFEDSA-N checkY

    Cinacalcet, sold under the brand name Sensipar among others, is a medication used to treat secondary hyperparathyroidism, parathyroid carcinoma, and primary hyperparathyroidism.[2][1] In secondary hyperparathyroidism, it is used in those who require dialysis; while in parathyroid carcinoma, it is used to treat high blood calcium.[6] It is taken by mouth with food.[2]

    Common side effects include nausea and vomiting.[1] Other side effects may include upper GI bleeding, low calcium, low blood pressure, and adynamic bone disease.[2] It should not be used in people with low blood calcium.[1] Safety in pregnancy is unclear.[7] It is a calcimimetic, meaning that it mimics the action of calcium in the body.[1]

    Cinacalcet was approved in the United States and Europe in 2004.[2][1] It is available as a generic medication.[8] In the United States 30 pills of 30 mg costs about 17 USD as of 2022.[8] This amount in the United Kingdom costs the NHS about £114.[6]

    Medical uses

    In the United States, cinacalcet is indicated for the treatment of secondary hyperparathyroidism in people with chronic kidney disease on dialysis and hypercalcemia in people with parathyroid carcinoma.[2][9] Cinacalcet can also be used to treat severe hypercalcemia in patients with primary hyperparathyroidism who are unable to undergo parathyroidectomy.[2][10]

    In the European Union cinacalcet is indicated for:

    • the treatment of secondary hyperparathyroidism (HPT) in adults with end stage renal disease (ESRD) on maintenance dialysis therapy.[1]
    • the treatment of secondary hyperparathyroidism (HPT) in children aged three years and older with end stage renal disease (ESRD) on maintenance dialysis therapy in whom secondary HPT is not adequately controlled with standard of care therapy.[1]
    • part of a therapeutic regimen including phosphate binders and/or vitamin D sterols, as appropriate.[1]
    • the treatment of parathyroid carcinoma and primary hyperparathyroidism in adults.[1]
    • the reduction of hypercalcaemia in adults with:
      • parathyroid carcinoma;[1]
      • primary HPT for whom parathyroidectomy would be indicated on the basis of serum calcium levels (as defined by relevant treatment guidelines), but in whom parathyroidectomy is not clinically appropriate or is contraindicated.[1]

    Dosage

    It is used at a dose of 30 mg once per day up to 90 mg four times per day based on blood calcium levels.[1]

    Contraindications

    Hypocalcemia (decreased calcium levels) is a contraindication of cinacalcet. Those who have serum calcium levels less than 7.5 mg/dL should not be started on cinacalcet. Hypocalcemia symptoms include parathesias, myalgias, muscle cramping, tetany, and convulsions. Cinacalcet should not be administered until serum calcium levels are above 8.0 mg/dL and/or hypocalcemia symptoms are resolved.[2] Cinacalcet is not approved for pediatric use in the United States.[11][2][1]

    Side effects

    Common side effects of cinacalcet include stomach upset, vomiting, diarrhea, dizziness, nausea, weakness, and chest pain.[10]

    Clinical trials conducted in the United States by Amgen to determine whether the drug is safe in children were halted by the U.S. Food and Drug Administration (FDA) in February 2013, following the death of a 14-year-old participant.[11][12]

    Pregnancy and breastfeeding

    Cinacalcet has pregnancy category C in the US, meaning that adequate and well-controlled studies involving cinacalcet in pregnant women have not been done.[2][3]

    Studies have not been done in lactating women; therefore it is not known whether cinacalcet is excreted into human milk.[2][3]

    Overdose

    Serious side effects, including overdose symptoms, of cinacalcet include:[10]

    • burning
    • tingling
    • unusual feelings of the lips, tongue, fingers, or feet
    • muscle aches or cramps
    • sudden tightening of muscles in hands, feet, face, or throat
    • seizures

    Interactions

    Cinacalcet is a strong inhibitor of the liver enzyme CYP2D6 and is partially metabolized by CYP3A4 and CYP1A2. Dose adjustments may be necessary if people are treated with CYP3A4 and CYP1A2 inhibitors and medications that are metabolized by CYP2D6.[2][5]

    Pharmacology

    Mechanism of action

    Cinacalcet is a drug that acts as a calcimimetic[2][1] (i.e. it mimics the action of calcium on tissues) by allosteric activation of the calcium-sensing receptor that is expressed in various human organ tissues. The calcium-sensing receptors on the surface of the chief cell of the parathyroid gland is the principal negative regulator of parathyroid hormone secretion.[13] Cinacalcet increases the sensitivity of calcium receptors on parathyroid cells to reduce parathyroid hormone (PTH) levels and thus decrease serum calcium levels.[9]

    History

    It was the first allosteric G protein-coupled receptor modulator to enter the pharmaceutical market.[14]

    Society and culture

    In the fourth quarter of 2013, it had the 76th highest sales for a medication in the United States at 217 million.[15][16]

    References

    1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 "Mimpara EPAR". European Medicines Agency (EMA). 22 August 2019. Archived from the original on 24 December 2019. Retrieved 23 December 2019. Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
    2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 "Sensipar- cinacalcet hydrochloride tablet, coated". DailyMed. 5 December 2019. Archived from the original on 25 September 2020. Retrieved 24 December 2019.
    3. 1 2 3 4 "Cinacalcet (Sensipar) Use During Pregnancy". Drugs.com. 19 July 2019. Archived from the original on 7 December 2019. Retrieved 24 December 2019.
    4. ↑ "Sensipar Tablets". NPS MedicineWise. 1 May 2018. Archived from the original on 7 December 2019. Retrieved 7 December 2019.
    5. 1 2 "Mimpara 30 mg Film-coated Tablets - Summary of Product Characteristics (SmPC)". electronic medicines compendium (emc). 8 July 2019. Archived from the original on 7 December 2019. Retrieved 7 December 2019.
    6. 1 2 BNF 81: March-September 2021. BMJ Group and the Pharmaceutical Press. 2021. p. 1093. ISBN 978-0857114105.
    7. ↑ "Cinacalcet (Sensipar) Use During Pregnancy". Drugs.com. Archived from the original on 7 December 2019. Retrieved 5 January 2022.
    8. 1 2 "Cinacalcet Prices and Cinacalcet Coupons - GoodRx". GoodRx. Retrieved 5 January 2022.
    9. 1 2 2014 Nurses Drug Handbook (13th ed.). Burlington, MA: Jones & Bartlett Learning. 2014. pp. 245–6. ISBN 978-1-284-03115-7.
    10. 1 2 3 "Cinacalcet". U.S. National Library of Medicine. Archived from the original on 5 July 2016. Retrieved 29 October 2014.
    11. 1 2 "FDA Drug Safety Communication: Pediatric clinical studies of Sensipar (cinacalcet hydrochloride) suspended after report of death". U.S. Food and Drug Administration (FDA). 15 January 2016. Archived from the original on 24 December 2019. Retrieved 23 December 2019. Public Domain This article incorporates text from this source, which is in the public domain.
    12. ↑ Edney A (February 26, 2013). "Amgen Pediatric Trials of Sensipar Halted by FDA After Death". Bloomberg Businessweek. Archived from the original on March 2, 2013. Retrieved February 26, 2013.
    13. ↑ "Cinacalcet". Archived from the original on 10 August 2020. Retrieved 19 October 2020.
    14. ↑ Bräuner-Osborne H, Wellendorph P, Jensen AA (2007). "Structure, pharmacology and therapeutic prospects of family C G-protein coupled receptors". Current Drug Targets. 8 (1): 169–84. doi:10.2174/138945007779315614. PMID 17266540.
    15. ↑ "U.S. Pharmaceutical Statistics". Drugs.com. February 2014. Archived from the original on 23 June 2018. Retrieved 13 July 2020.
    16. ↑ "Sales Statistics for Sensipar Prescriptions". Drugs.com. 2 September 2020. Archived from the original on 22 November 2020. Retrieved 8 September 2020.
    Identifiers:
    • "Cinacalcet". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on 21 October 2020. Retrieved 19 October 2020.
    • "Cinacalcet hydrochloride". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on 2 November 2021. Retrieved 19 October 2020.
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