Calcitonin (salmon)
Calcitonins
Calcitonins
Synthetic salmon calcitonin, injected to lower dangerously high calcium within hours and for Paget disease; a nasal spray is a last-line osteoporosis option.
Also called: Calcitonin salmon, Salcatonin
Quick facts
- Group
- Calcitonins
- Target
- Calcitonin receptor (CTR), a G-protein–coupled receptor
- Used for
- Early treatment · Hypercalcaemia
- Key effects
- Nausea and vomiting · Flushing of the face or hands
- Monitor
- Serum calcium · Signs of hypersensitivity
- ATC
- H05BA01
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows salmon calcitonin itself (a peptide chain) bound to the human calcitonin receptor with its Gs protein; as a peptide, it has no small-molecule ligand code.
Salmon calcitonin is a 32-amino-acid peptide that activates the calcitonin receptor on osteoclasts and kidney tubule cells. Osteoclasts stop resorbing bone within hours, and the kidney excretes more calcium, phosphate and sodium. Serum calcium falls quickly, but the response weakens with repeated use.
- Calcitonin binds its receptor on osteoclasts
- Osteoclasts retract and stop resorbing bone
- The kidney excretes more calcium and phosphate
- Serum calcium falls within hours, then the effect wanes
Indications
- Early treatment of hypercalcaemic emergencies, together with other measures Hypercalcaemia →
- Hypercalcaemia of malignancy as a bridge until slower drugs act Hypercalcaemia of malignancy →
- Symptomatic Paget disease of bone when other drugs are unsuitable Paget disease of bone →
- Postmenopausal osteoporosis when other drugs cannot be used (nasal spray) Osteoporosis →
Adverse effects
Common
- Nausea and vomiting
- Flushing of the face or hands
- Injection-site reactions
- With the spray: runny nose, nosebleed, nasal crusts and irritation
- Back and joint pain
Contraindications
- Hypersensitivity to calcitonin salmon or any excipient
Key interactions
- Lithium
- Calcitonin can lower lithium levels by increasing its urinary clearance; the lithium dose may need adjusting
- Zoledronic acid and other bisphosphonates
- Additive lowering of calcium
What is monitored
- Serum calcium
- Signs of hypersensitivity, especially with the first dose
- Signs of hypocalcaemia: tingling, cramps, spasms
- Nasal mucosa with the spray
- Periodic review of whether treatment is still needed
Administration and safety
- The injection is given subcutaneously or intramuscularly; vials are kept refrigerated, not frozen or shaken, and brought to room temperature before use
- The nasal spray is primed before first use and the nostril is alternated each day
- A skin test may be done before treatment when allergy is suspected
- Adequate calcium and vitamin D accompany long-term use
Pregnancy and breastfeeding
There are no studies in pregnant women; it is not a drug of choice in pregnancy.
Nursing care
- Have resuscitation equipment ready with the first injection; watch for wheeze, swelling or rash
- Watch for low calcium and report tingling or muscle spasms
- Warn about nausea and flushing, which are common and usually mild
- With the spray, check the nose for crusts, bleeding or sores
- Ask about lithium use
Pharmacokinetics
- Absorption
- Injected under the skin or into muscle; the nasal spray is absorbed through the nasal mucosa
- Metabolism
- Broken down as a peptide, largely in the kidney
- Half-life
- About an hour after injection
- Onset and duration
- Serum calcium starts to fall within one to two hours of an injection
Test yourself
Think of the answer, then tap the question to see it.
How fast does injected calcitonin lower serum calcium?
Within one to two hours, which is why it bridges the gap until bisphosphonates take effect.
Which psychiatric drug can calcitonin lower in the blood?
Lithium: calcitonin increases its urinary clearance, so lithium levels may fall.
Why might a skin test be done before starting calcitonin?
Serious hypersensitivity reactions, including fatal anaphylaxis, have occurred with this foreign (salmon) peptide.
Connections
← Back to the class: Calcitonins
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - CALCITONIN SALMON injection, solution (DailyMed (U.S. National Library of Medicine), 2026); Calcitonin Salmon Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2018); Calcitonin Salmon Nasal Spray: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.