Paricalcitol/ja: Difference between revisions
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'''パリカルシトール'''（化学的には'''19-ノル-1,25-(OH)<sub>2</sub>-ビタミンD<sub>2</sub>'''である。[[Abbott Laboratories]]から'''ゼンプラール'''の商品名で販売されている）は、[[chronic kidney failure/ja|慢性腎不全]]に伴う[[secondary hyperparathyroidism/ja|二次性副甲状腺機能亢進症]]（[[parathyroid hormone/ja|副甲状腺ホルモン]]の過剰分泌）の予防と治療に用いられる[[pharmaceutical drug/ja|医薬品]]である。[[Vitamin D2/ja|ビタミンD<sub>2</sub>]]（エルゴカルシフェロール）の活性型である1,25-ジヒドロキシエルゴカルシフェロールの[[analog (chemistry)/ja|類似体]]である。 | |||
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1989年に特許を取得し、1998年に医療用として承認された。 | |||
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==薬物動態{{Anchor|Pharmacokinetics}}== | |||
==Pharmacokinetics== | パリカルシトールの血漿中濃度は、初回静脈内投与後2時間以内に急速に対数直線的に減少する。したがって、パリカルシトールの投与頻度は通常1日おき（週3回）以下であるため、複数回の投与による蓄積は期待できない。 | ||
{{Vitamins/ja}} | |||
{{Vitamins}} | {{Calcium homeostasis/ja}} | ||
{{Calcium homeostasis}} | {{Vitamin D receptor modulators/ja}} | ||
{{Vitamin D receptor modulators}} | |||
[[Category:Secosteroids]] | [[Category:Secosteroids]] | ||
[[Category:Vitamin D]] | [[Category:Vitamin D]] | ||
[[Category:Drugs developed by AbbVie]] | [[Category:Drugs developed by AbbVie]] | ||
Revision as of 23:17, 12 April 2024
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| Clinical data | |
|---|---|
| Trade names | Zemplar |
| Other names | (1R,3S)-5-[2-[(1R,3aR,7aS)-1-[(2R,5S)-6-hydroxy-5,6-dimethyl-3E-hepten-2-yl]-7a-methyl-2,3,3a,5,6,7-hexahydro-1H-inden-4-ylidene]ethylidene]-cyclohexane-1,3-diol |
| AHFS/Drugs.com | Monograph |
| MedlinePlus | a682335 |
| Pregnancy category |
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| Routes of administration | Oral, Intravenous |
| ATC code | |
| Legal status | |
| Legal status | |
| Pharmacokinetic data | |
| Bioavailability | 72% |
| Protein binding | 99.8% |
| Metabolism | Hepatic |
| Elimination half-life | 14-20 hours |
| Excretion | Faeces (74%), urine (16%) |
| Identifiers | |
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| CAS Number | |
| PubChem CID | |
| IUPHAR/BPS | |
| DrugBank | |
| ChemSpider | |
| UNII | |
| KEGG | |
| ChEBI | |
| ChEMBL | |
| Chemical and physical data | |
| Formula | C27H44O3 |
| Molar mass | 416.646 g·mol−1 |
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  (what is this?) (verify) | |
パリカルシトール（化学的には19-ノル-1,25-(OH)2-ビタミンD2である。Abbott Laboratoriesからゼンプラールの商品名で販売されている）は、慢性腎不全に伴う二次性副甲状腺機能亢進症（副甲状腺ホルモンの過剰分泌）の予防と治療に用いられる医薬品である。ビタミンD2（エルゴカルシフェロール）の活性型である1,25-ジヒドロキシエルゴカルシフェロールの類似体である。
1989年に特許を取得し、1998年に医療用として承認された。
Medical uses
Its primary use in medicine is in the treatment of secondary hyperparathyroidism associated with chronic kidney disease. However current evidence is not sufficient to demonstrate an advantage of paricalcitol over non-selective vitamin D derivatives for this indication.
Adverse effects
Adverse effects by frequency:
Very common (>10% frequency):
- Nausea
Common (1-10% frequency):
- Diarrhoea†
- Oedema
- Allergic reaction
- Arthritis
- Dizziness†
- Stomach discomfort‡
- Gastroesophageal reflux disease†
- Acne†
- Hypercalcaemia†
- Hypocalcaemia†
- Hyperphosphataemia
- Decreased appetite†
- Headache
- Breast tenderness†
- Taste changes
- Hypoparathyroidism
- Vertigo
- Rash‡
Uncommon (0.1-1% frequency):
- Abnormal hepatic enzymes‡
- Constipation‡
- Dry mouth‡
- Itchiness‡
- Hives
- Hypersensitivity‡
- Muscle spasms‡
- Bleeding time prolonged
- Aspartate aminotransferase increased
- Laboratory test abnormal
- Weight loss
- Elevated blood creatinine
- Cardiac arrest
- Arrhythmia
- Atrial flutter
- Anaemia
- Leucopenia
- Lymphadenopathy
- Coma
- Stroke
- Transient ischemic attack
- Fainting
- Myoclonus
- Hypoaesthesia
- Paraesthesia
- Glaucoma
- Conjunctivitis
- Ear disorder
- Pulmonary oedema
- Asthma
- Shortness of breath
- Nose bleed
- Cough
- Rectal haemhorrhage
- Colitis
- Gastritis
- Indigestion
- Difficulty swallowing
- Gastrointestinal disorder
- Gastrointestinal haemorrhage
- Bullous dermatitis
- Hair loss
- Hirsutism
- Hyperhidrosis
- Joint pain
- Joint stiffness
- Back pain
- Muscle twitching
- Muscle aches
- Hyperparathyroidism
- Hyperkalaemia
- Hypocalcemia
- Breast cancer
- Sepsis
- Pneumonia
- Infection
- Pharyngitis
- Vaginal infection
- Influenza
- High blood pressure
- Hypotension
- Gait disturbance
- Injection site pain
- Fever
- Chest pain
- Condition aggravated
- Muscle weakness
- Malaise
- Thirst
- Breast pain
- Impotence
- Confusional state
- Delirium
- Depersonalization
- Agitation
- Insomnia
- Nervousness
‡ These are adverse effects only seen in patients with grade 3 or 4 chronic kidney disease. † These are adverse effects only seen in patients with grade 5 chronic kidney disease.
Contraindications
Contraindications include:
- Vitamin D intoxication
- Hypercalcaemia
- Hypersensitivity to paricalcitol or any of its excipients
whereas cautions include:
- Impaired liver function
- It is also advised that physicians regularly monitor their patients' calcium and phosphorus levels.
Interactions
Drugs that may interact with paricalcitol include:
- Ketoconazole, as it may interfere with paricalcitol's metabolism in the liver.
- Digitoxin, hypercalcaemia due to any cause can exacerbate the toxicity of digitoxin.
- Thiazide diuretics or calcium supplements as hypercalcaemia may be induced by this combination
- Magnesium-containing products such as antacids may increase the risk of hypermagnesemia.
- Aluminium-containing products such as antacids may increase the risk of aluminium toxicity.
- Drugs that interfere with the absorption of fat-soluble vitamins, such as cholestyramine may interfere with the absorption of paricalcitol.
Overdose
Electrolyte abnormalities (e.g. hypercalcaemia and hyperphosphataemia) are common overdose symptoms. Treatment is mostly supportive, with particular attention being paid to correcting electrolyte anomalies and reducing intake of calcium in both the form of supplementation and diet. As it is so heavily bound to plasma proteins haemodialysis is unlikely to be helpful in cases of overdose.
Early symptoms of overdose can include:
- Weakness
- Headache
- Somnolence
- Nausea
- Vomiting
- Dry mouth
- Constipation
- Muscle pain
- Bone pain
- Metallic taste in the mouth.
It is worth noting, however, that may of these symptoms are also indicative of kidney failure and hence may be masked by the patient's condition.
Late symptoms of overdose include:
- Loss of appetite
- Weight loss
- Conjunctivitis (calcific)
- Pancreatitis
- Photophobia
- Rhinorrhoea
- Pruritus
- Hyperthermia
- Decreased libido
- Elevated BUN
- Hypercholesterolaemia
- Elevated AST and ALT
- Ectopic calcification
- Hypertension
- Cardiac arrhythmias
- Somnolence
- Death
- Psychosis (rare)
Mechanism of action
Like 1,25-dihydroxyergocalciferol, paricalcitol acts as an agonist at the vitamin D receptor and thereby lowers parathyroid hormone levels in the blood.
薬物動態
パリカルシトールの血漿中濃度は、初回静脈内投与後2時間以内に急速に対数直線的に減少する。したがって、パリカルシトールの投与頻度は通常1日おき（週3回）以下であるため、複数回の投与による蓄積は期待できない。