Etelcalcetide
Calcimimetics
Calcimimetics
An intravenous peptide that makes the parathyroid's calcium sensor more sensitive. It lowers PTH in dialysis patients.
Quick facts
- Group
- Calcimimetics
- Target
- Calcium-sensing receptor (CaSR) of the parathyroid gland
- Used for
- Secondary hyperparathyroidism
- Key effects
- Low blood calcium · Nausea · Headache
- Monitor
- Serum calcium · PTH · Signs of heart failure
- ATC
- H05BX04
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows etelcalcetide itself (a short peptide chain) bound to the extracellular domain of the human calcium-sensing receptor dimer (cryo-EM).
Etelcalcetide is a synthetic peptide of eight D-amino acids. It forms a disulfide bond with a cysteine in the extracellular domain of the calcium-sensing receptor and acts as a positive allosteric modulator: in the presence of calcium, the receptor is activated at lower calcium levels. Parathyroid cells then secrete less PTH, and serum calcium and phosphate fall.
- Etelcalcetide links to the calcium-sensing receptor
- The receptor responds to lower calcium levels
- Parathyroid PTH secretion falls
- Serum calcium and phosphate decrease
Indications
- Secondary hyperparathyroidism in adults with chronic kidney disease on haemodialysis CKD-mineral and bone disorder (renal osteodystrophy) →
Adverse effects
Common
- Low blood calcium (muscle spasms, cramps, tingling)
- Nausea, vomiting and diarrhoea
- Headache
Contraindications
- Serum calcium below the normal range (not started)
- Hypersensitivity to etelcalcetide
Key interactions
- Other drugs that lower calcium (other calcimimetics, bisphosphonates, calcitonin)
- Additive fall in serum calcium
- Drugs metabolised by CYP enzymes
- No expected interaction: etelcalcetide is neither a CYP substrate nor an inhibitor
What is monitored
- Serum calcium and phosphate after starting and after each dose change
- PTH, to adjust treatment and avoid over-suppression
- Signs of heart failure and of gastrointestinal bleeding
- Seizure control in people with epilepsy
Administration and safety
- Intravenous bolus at the end of the haemodialysis session
- Given by dialysis staff
- Calcium is checked before starting; it is not started if calcium is low
Pregnancy and breastfeeding
Information in pregnancy is limited; the prescriber is told about pregnancy or breastfeeding.
Nursing care
- Check calcium results before each session's dose
- Ask about cramps, tingling or muscle spasms
- Watch for weight gain and swelling between sessions
- Ask about black stools or vomiting blood
Pharmacokinetics
- Absorption
- Given intravenously at the end of haemodialysis
- Elimination
- Not a substrate or inhibitor of CYP enzymes or drug transporters
Test yourself
Think of the answer, then tap the question to see it.
How does etelcalcetide lower PTH?
It is a positive allosteric modulator of the calcium-sensing receptor, so the parathyroid senses lower calcium as high and secretes less PTH.
What is the main adverse effect of calcimimetics such as etelcalcetide?
Hypocalcaemia, which can cause cramps, seizures and QT prolongation.
When is etelcalcetide given?
Intravenously at the end of a haemodialysis session.
Connections
← Back to the class: Calcimimetics
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Etelcalcetide Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.