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# Calcimimetics

Drugs that make the parathyroid gland «feel» more calcium than there is, so it releases less PTH. Used in secondary hyperparathyroidism on dialysis.

Updated Nov 1, 2026

## What they are

Positive allosteric modulators of the calcium-sensing receptor (CaSR) of the parathyroid chief cells. By increasing its sensitivity to calcium they lower PTH secretion and, with it, serum calcium. Cinacalcet (oral) treats secondary hyperparathyroidism in people with chronic kidney disease on dialysis and hypercalcaemia from parathyroid carcinoma or from primary hyperparathyroidism when surgery is not possible; etelcalcetide is given intravenously at dialysis.

## Mechanism of action

The CaSR is a G-protein–coupled receptor that senses extracellular calcium and turns off PTH release when calcium is high. Calcimimetics bind the receptor's transmembrane region and shift its response so that a lower calcium switches it on. PTH falls within hours, and serum calcium and the calcium-phosphate product fall too.

Target: Calcium-sensing receptor (CaSR) of the parathyroid chief cell, a G-protein–coupled receptor

## Key points

- The main risk is hypocalcaemia, which can prolong the QT interval, lower the seizure threshold and worsen heart failure; they are not started when calcium is below normal.
- Cinacalcet is for dialysis patients with secondary hyperparathyroidism, not for chronic kidney disease before dialysis.
- Cinacalcet strongly inhibits CYP2D6 and is a substrate of CYP3A4.
- Over-suppressing PTH can cause adynamic bone disease.

## Drugs in this class

- [**Cinacalcet** An oral calcimimetic that lowers PTH and calcium in dialysis patients with secondary hyperparathyroidism and in… Calcium-sensing receptor (CaSR), a G-protein–coupled receptor of the parathyroid gland](https://durgical.com/en/pharmacology/cinacalcet/)
- [**Etelcalcetide** An intravenous peptide that makes the parathyroid's calcium sensor more sensitive. It lowers PTH in dialysis patients. Calcium-sensing receptor (CaSR) of the parathyroid gland](https://durgical.com/en/pharmacology/etelcalcetide/)

## Others in the class

- Etelcalcetide
- Evocalcet

## Test yourself

Think of the answer, then tap the question to see it.

## How do calcimimetics lower PTH?

They increase the sensitivity of the parathyroid calcium-sensing receptor, so the gland reads normal calcium as high and secretes less PTH.

## What is the main laboratory danger of calcimimetics?

Hypocalcaemia, which can bring on QT prolongation, arrhythmias, seizures and worse heart failure.

## In which kidney patients is cinacalcet indicated for secondary hyperparathyroidism?

Adults with chronic kidney disease on dialysis; it is not indicated before dialysis.

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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 - CINACALCET tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=02b8c11b-99e8-4039-b6fa-a9c38d2f48fa) (DailyMed (U.S. National Library of Medicine), 2026); [Cinacalcet: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a605004.html) (MedlinePlus (U.S. National Library of Medicine), 2026).

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Source: https://durgical.com/en/pharmacology/classes/calcimimetics/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/calcimimetics/