[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Calcimimetics](https://durgical.com/en/pharmacology/classes/calcimimetics/) › Etelcalcetide # Etelcalcetide ## Calcimimetics? Calcimimetics An intravenous peptide that makes the parathyroid's calcium sensor more sensitive. It lowers PTH in dialysis patients. Updated Nov 1, 2026 ## Quick facts **Group** [Calcimimetics](https://durgical.com/en/pharmacology/classes/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. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## Mechanism of action ◎**Calcium-sensing receptor (CaSR) of the parathyroid gland**Etelcalcetide ⓘ The figure shows etelcalcetide itself (a short peptide chain) bound to the extracellular domain of the human calcium-sensing receptor dimer (cryo-EM). **Target in 3D:** Calcium-sensing receptor (CaSR) of the parathyroid gland. PDB structure 7M3G (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/7M3G) · Drag to rotate · pinch to zoom 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) →](https://durgical.com/en/conditions/ckd-mineral-and-bone-disorder/) ## Adverse effects ### Common - Low blood calcium (muscle spasms, cramps, tingling) - Nausea, vomiting and diarrhoea - Headache ### Serious (rare, important) - Symptomatic hypocalcaemia, seizures and QT prolongation - Worsening heart failure (sudden weight gain, leg swelling, breathlessness) - Upper gastrointestinal bleeding - Adynamic bone disease if PTH is suppressed too far ## 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 ## Memory aid ETELcalcetide «TELls» the parathyroid there is enough calcium: PTH down, calcium down. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/etelcalcetide/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## Connections ## Related drugs 3 - [Cinacalcet](https://durgical.com/en/pharmacology/cinacalcet/) - [Sevelamer](https://durgical.com/en/pharmacology/sevelamer/) - [Calcitriol](https://durgical.com/en/pharmacology/calcitriol/) ## Related conditions 1 - [CKD-mineral and bone disorder (renal osteodystrophy)](https://durgical.com/en/conditions/ckd-mineral-and-bone-disorder/) [← Back to the class: Calcimimetics](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a617011.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=H05BX04) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/etelcalcetide/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/etelcalcetide/