Etelcalcetide
Also known as: Parsabiv, AMG 416, ONO-5163
An IV peptide calcimimetic FDA-approved in 2017 as Parsabiv for secondary hyperparathyroidism in adults on hemodialysis. Prescription.
Last updated
Mechanism of Action
Etelcalcetide is a synthetic peptide of seven D-amino acids linked by a disulfide bond to an L-cysteine. It acts as an allosteric activator of the calcium-sensing receptor (CaSR) on parathyroid chief cells, binding covalently to a cysteine on the receptor's extracellular domain. Raising the receptor's sensitivity to calcium suppresses parathyroid hormone secretion, with secondary falls in serum calcium and phosphate.
- Half-life
- ~3-4 days (in hemodialysis patients)
- Administration Routes
- Intravenous
- Research Status
- Clinical
Reported Benefits
- Lowers PTH by more than 30% in most hemodialysis patients versus placebo
- Was noninferior to cinacalcet, and superior on secondary endpoints, for PTH lowering
- Given by dialysis staff, removing a daily oral pill
Potential Side Effects
- Hypocalcemia, which can be serious
- Muscle spasms, paresthesia and headache
- Diarrhea, nausea and vomiting
- Worsening heart failure and QT prolongation linked to low calcium
- Upper gastrointestinal bleeding; adynamic bone if PTH is oversuppressed
Common Dosing
Given by dialysis staff as an intravenous bolus three times a week at the end of hemodialysis, starting at a low dose and titrated no more often than every 4 weeks based on PTH and corrected calcium. It is not started if corrected calcium is below normal. Dosing is set and supervised by the treating nephrology team.
The dosing information above is aggregated from research literature and anecdotal community reports for educational purposes only. It is not a recommendation, prescription, or medical advice. Peptides are sold as research chemicals only and are not intended for human use.
Contraindications
- Corrected serum calcium below the lower limit of normal (do not initiate)
- Not studied in parathyroid carcinoma, primary hyperparathyroidism or CKD not on hemodialysis
- Cinacalcet must be stopped at least 7 days before starting
No documented stacking partners for Etelcalcetide yet.
- View
Effect of Etelcalcetide vs Placebo on Serum Parathyroid Hormone in Patients Receiving Hemodialysis With Secondary Hyperparathyroidism: Two Randomized Clinical Trials
2017
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Effect of Etelcalcetide vs Cinacalcet on Serum Parathyroid Hormone in Patients Receiving Hemodialysis With Secondary Hyperparathyroidism: A Randomized Clinical Trial
2017