Classifications: vitamin d analog; Therapeutic:antihyperparathyroid agent; vitamin d analog
Pregnancy Category: B
0.5 mcg, 2.5 mcg capsule; 2 mcg/mL injection
Vitamin D2 analog that is activated by the liver. Activated vitamin D is needed for absorption of dietary calcium in the intestine,
and the parathyroid hormone (PTH), which mobilizes calcium from the bone tissue.
Regulates the blood calcium level.
Reduction of elevated iPTH in secondary hyperparathyroidism in patients undergoing chronic renal dialysis; secondary hyperparathyroidism
in chronic kidney disease not on dialysis.
Hypersensitivity to doxercalciferol or other vitamin D analogs; recent hypercalcemia, recent hyperphosphatemia, hypervitaminosis
Renal or hepatic insufficiency; renal osteodystrophy with hyperphosphatemia, prolonged hypercalcemia; pregnancy (category
B), lactation. Safety and efficacy in children are not established.
Route & Dosage
Adult: PO 10 mcg 3 times/wk at dialysis, adjust dose as needed to lower iPTH into the range of 150300 pg/mL by increasing the
dose in 2.5 mcg increments every 8 wk (max: 60 mcg/wk) IV 4 mcg 3 times/wk at end of dialysis (max: 18 mcg/wk)
- Give at time of dialysis.
- Withhold drug and notify physician if any of the following occurs: iPTH <100 pg/mL, hypercalcemia, hyperphosphatemia, or
product of serum calcium times serum phosphorus >70.
- Use beyond 16 wk is not recommended.
- Store at 20°25° C (66°77° F); excursions to 15°30° C (59°86°
F) are permitted.
PREPARE: Direct: ??No dilution is needed.??Withdraw appropriate dose from ampule using a filter needle.??Change needles before injecting as an IV bolus. Discard any unused portion.
ADMINISTER: Direct: Give a bolus injection at the end of dialysis sessions.
- Store at 15°20° C (59°77° F).
Adverse Effects (≥1%)Body as a Whole:
Abscess, headache, malaise, arthralgia
. CNS: Dizziness,
sleep disorder. CV:
Bradycardia, edema. GI:
, dyspepsia, nausea, vomiting. Respiratory: Dyspnea. Skin:
InteractionsDrug: Cholestyramine, mineral oil
may decrease absorption; magnesium-containing antacids
may cause hypermagnesemia; other vitamin d analogs
may increase toxicity
Absorbed from GI tract and is activated in the liver. Peak:
1112 h. Metabolism:
Activated by CYP 27 to form 1alpha, 25-(OH)2
) and 1alpha, 24-dihydroxyvitamin D2
Assessment & Drug Effects
- Lab tests: Baseline and periodic iPTH, serum calcium, serum phosphorus. Monitor levels weekly during dose titration.
- Monitor for S&S of hypercalcemia (see Appendix F).
Patient & Family Education
- Do not take antacids without consulting the physician.
- Notify the physician if you become pregnant while taking this drug.
- Do not use mineral oil on the days doxercalciferol is taken. Mineral oil may decrease absorption of drug.
- Do not take nonprescription drugs containing magnesium while taking doxercalciferol.
- Report S&S of hypercalcemia immediately: Bone or muscle pain, dry mouth with metallic taste, rhinorrhea, itching, photophobia,
conjunctivitis, frequent urination, anorexia and weight loss.