Table 1.

Treatment options for secondary hyperparathyroidism

Treatment	Dose formulation	Initial dose	Most common AEs
Phosphate binders
Calcium-containing
Calcium acetate (prescription for ESRD)	667 mg capsules	667–1,334 mg	Nausea, vomiting, hypercalcemia
Calcium carbonate (OTC)	250 to 1,000 mg tablets	500–1,000 mg	Nausea, vomiting, diarrhea, dyspepsia, abdominal pain, flatulence, constipation
Non-calcium-containing
Sevelamer hydrochloride/carbonate	800 mg tablets, 2.4 g packets powder for oral suspension	800–1,600 mg TID with meals	Headache, diarrhea, stomach upset
Lanthanum carbonate (for ESRD)	250, 500, 750, and 1,000 mg chewable tablets	1,500 mg daily	Diarrhea, nausea, abdominal pain, vomiting
Vitamin D analogs
Calcitriol	Oral (0.25 µg capsules)	0.25 µg daily	Hypercalcemia, headache, abdominal pain, nausea, rash, urinary tract infection
	Injectable (1 µg/mL)	1–2 µg three times weekly or every other day	Weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain, metallic taste, anorexia, abdominal pain, epigastric discomfort
Doxercalciferol	Oral (0.5, 1.0, and 2.5 µg capsules)	1 µg daily (predialysis) 10 µg three times weekly at dialysis	Edema, headache, malaise, dyspepsia, nausea, vomiting, dizziness, dyspnea (similar for both dosing forms)
	Injectable 4 µg/2 mL	4 µg three times weekly at the end of dialysis or every other day
Paricalcitol	Oral (1, 2, and 4 µg capsules), injectable	1–2 µg daily (PTH ≤500 pg/mL) or 2–4 µg every other day (PTH >500 pg/mL)	Diarrhea, hypertension, dizziness, vomiting
Calcimimetic
Cinacalcet	30, 60, and 90 mg tablets	30 mg once daily	Nausea, vomiting, diarrhea

Notes: Calcium carbonate, Medline Plus Drug Information, Available from: www.nlm.nih.gov/medlineplus/druginfo/meds/a601032.html. Data from the following references.16,57–63

Abbreviations: AE, adverse event; ESRD, end-stage renal disease; OTC, over the counter; PTH, parathyroid hormone; TID, three times per day.