Table 4.

Management of hypocalcemia according to the 2013 Summary of Product Characteristics

Serum Ca Value or Clinical Symptoms of Hypocalcemia	Recommendations
<8.4 mg/dl (2.1 mmol/L) and >7.5 mg/dl (1.9 mmol/L), or persistent symptoms of hypocalcemia despite attempts to increase serum Ca	Ca-containing P binders, vitamin D sterols, and/or adjustment of dialysis fluid Ca concentrations can be used to raise serum Ca according to clinical judgment
<8.4 mg/dl (2.1 mmol/L) and >7.5 mg/dl (1.9 mmol/L), or in the presence of clinical symptoms of hypocalcemia	Reduce or withhold the dose of cinacalcet
≤7.5 mg/dl (1.9 mmol/L) or persistent symptoms of hypocalcemia and vitamin D cannot be increased	Withhold administration of cinacalcet until serum Ca levels reach 8 mg/dl (2.0 mmol/L) and/or symptoms of hypocalcemia have resolved. Treatment should be reinitiated using the next lowest dose of cinacalcet

Ca, calcium; P, phosphate.