Fortical, Miacalcin
Classifications: bone metabolism regulator;
Therapeutic:bone metabolism regulator

Pregnancy Category: C


200 IU/mL injection; 200 IU/spray


Calcitonin salmon is a synthetic polypeptide. Calcitonin opposes the effects of parathyroid hormone on bone and kidneys, reduces serum calcium by binding to a specific receptor site on osteoclast cell membrane, and alters transmembrane passage of calcium and phosphorus. Promotes renal excretion of calcium and phosphorus.

Therapeutic Effect

Effective in osteoporosis due to inhibition of bone resorption. Effective in symptomatic hypercalcemia by rapidly lowering serum calcium.


Symptomatic Paget's disease of bone (osteitis deformans), postmenopausal osteoporosis. Orphan drug approval (calcitonin human): short-term adjunctive treatment of severe hypercalcemic emergencies.

Unlabeled Uses

Diagnosis and management of medullary carcinoma of thyroid; treatment of osteogenesis imperfecta.


Hypersensitivity to fish proteins or to synthetic calcitonin; history of serious allergy; hypocalcemia; pregnancy (category C), lactation. Safe use in children not established.

Cautious Use

Renal impairment; osteoporosis; pernicious anemia; Zollinger-Ellison syndrome.

Route & Dosage

Paget's Disease
Adult: SC/IM 100 IU/d, may decrease to 50–100 IU/d or q.o.d.

Adult: SC/IM 4 IU/kg q12h, may increase to 8 IU/kg q6h if needed

Postmenopausal Osteoporosis
Adult: SC/IM 100 IU/d Intranasal 1 spray (200 IU) daily, alternate nostrils


Allergy Test Dose
  • An allergy skin test is usually done prior to initiation of therapy. The appearance of more than mild erythema or wheal 15 min after intracutaneous injection indicates that the drug should not be given.
  • Activate the pump prior to first use; hold bottle upright and depress white side arms 6 times.
  • The nasal spray is administered in one nostril daily; alternate nostrils.
  • Calcitonin human is administered only by SC injection; calcitonin salmon may be administered by SC or IM injection.
  • Use IM route when the volume to be injected is >2 mL.
  • Rotate injection sites.
  • Store calcitonin (human) at 25° C (77° F) or less, protected from light, unless otherwise specified by manufacturer.
  • Store calcitonin (salmon) in refrigerator, preferably at 2°–8° C (36°–46° F) unless otherwise directed.

Adverse Effects (≥1%)

Body as a Whole: Headache, eye pain, feverish sensation, hypersensitivity reactions, anaphylaxis. Reported for calcitonin human only: Urinary frequency, chills, chest pressure, weakness, paresthesias, tender palms and soles, dizziness, nasal congestion, shortness of breath. GI: Transient nausea, vomiting, anorexia, unusual taste sensation, abdominal pain, diarrhea. Skin: Inflammatory reactions at injection site, flushing of face or hands, pruritus of earlobes, edema of feet, skin rashes. Urogenital: Nocturia, diuresis, abnormal urine sediment.


Drug: May decrease serum lithium levels.


Onset: 15 min. Peak: 4 h. Duration: 8–24 h. Distribution: Does not cross placenta; distribution into breast milk unknown. Metabolism: In kidneys. Elimination: In urine. Half-Life: 1.25 h.

Nursing Implications

Assessment & Drug Effects

  • Have on hand epinephrine 1:1000, antihistamines, and oxygen in the event of a reaction. Also have readily available parenteral calcium, particularly during early therapy. Hypocalcemic tetany is a theoretical possibility.
  • Examine urine specimens periodically for sediment with long-term therapy.
  • Lab tests: Monitor for hypocalcemia (see Signs & Symptoms, Appendix F). Theoretically, calcitonin can lead to hypocalcemic tetany. Latent tetany may be demonstrated by Chvostek's or Trousseau's signs and by serum calcium values: 7–8 mg/dL (latent tetany); below 7 mg/dL (manifest tetany).
  • Examine nasal passages prior to treatment with the nasal spray and anytime nasal irritation occurs.
  • Nasal ulceration or heavy bleeding are indications for drug discontinuation.

Patient & Family Education

  • Use the SC route for self-administration.
  • Watch for redness, warmth, or swelling at injection site and report to physician, as these may indicate an inflammatory reaction. The transient flushing that commonly occurs following injection of calcitonin, particularly during early therapy, may be minimized by administrating the drug at bedtime. Consult physician.
  • Maintain your drug regimen even though symptoms have been ameliorated to prevent early relapses.
  • Ensure that you feel comfortable using the nasal pump properly. Notify physician if significant nasal irritation occurs.
  • Consult physician before using OTC preparations. Some supervitamins, hematinics, and antacids contain calcium and vitamin D (vitamin may antagonize calcitonin effects).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

© 2006-2023 Last Updated On: 01/29/2023 (0)
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