If a satisfactory response in the biochemical parameters and clinical manifestations of the disease state is not observed, dosage may be increased by 0.25 mcg/day at 4 to 8 week intervals. In dialysis patients, a fall in serum alkaline phosphatase levels usually antedates the appearance of hypercalcemia and may be an indication of impending hypercalcemia. Serial serum electrolyte determinations (especially calcium), rate of urinary calcium excretion and assessment of electrocardiographic abnormalities due to the hypercalcemia should be obtained. Warnings. When serum calcium levels have returned to within normal limits, calcitriol therapy may be reinstituted at a dose of 0.25 mcg/day less than prior therapy. Calcitriol Injection prescription and dosage sizes information for physicians and healthcare professionals. An abrupt increase in calcium intake as a result of changes in diet (e.g., increased consumption of dairy products) or uncontrolled intake of calcium preparations may trigger hypercalcemia.Should hypercalcemia develop, treatment with calcitriol should be stopped immediately. Samples for serum calcium estimation should be taken without a tourniquet.The recommended initial dose of calcitriol capsules is 0.25 mcg/day. It is available as capsules containing 0.25 mcg or 0.5 mcg calcitriol. Serum calcium levels should be obtained at least twice weekly after all dosage changes and subsequent dosage titration. A non-aluminum phosphate-binding compound and a low-phosphate diet should be used to control serum phosphorus levels in patients undergoing dialysis.Magnesium-containing preparations (e.g., antacids) and calcitriol should not be used concomitantly in patients on chronic renal dialysis because such use may lead to the development of hypermagnesemia.Studies in dogs and rats given calcitriol for up to 26 weeks have shown that small increases of calcitriol above endogenous levels can lead to abnormalities of calcium metabolism with the potential for calcification of many tissues in the body.Excessive dosage of calcitriol induces hypercalcemia and in some instances hypercalciuria; therefore, early in treatment during dosage adjustment, serum calcium should be determined twice weekly. Some reports have shown that the concomitant administration of thiazides with calcitriol causes hypercalcemia. Therefore, pharmacologic doses of vitamin D and its derivatives should be withheld during Calcitriol Oral Solution treatment to avoid possible additive effects and hypercalcemia. Elevated serum creatinine levels were observed in about 1 in 6 patients (approximately one half of whom had normal levels at baseline).In concurrent hypercalcemia and hyperphosphatemia, soft-tissue calcification may occur; this can be seen radiographically (see In patients with normal renal function, chronic hypercalcemia may be associated with an increase in serum creatinine (see Hypersensitivity reactions (pruritus, rash, urticaria, and very rarely severe erythematous skin disorders) may occur in susceptible individuals. Following intravenous administration of radiolabeled Calcitriol in normal subjects, approximately 27% and 7% of the radioactivity appeared in the feces and urine, respectively, within 24 hours. Samples for serum calcium estimation should be taken without a tourniquet.The recommended initial dose of Calcitriol Oral Solution is 0.25 mcg/day. The duration of pharmacologic activity of a single dose of Calcitriol is about 3 to 5 days.Calcitriol is rapidly absorbed from the intestine. The safety and effectiveness of Calcitriol Oral Solution in pediatric predialysis patients is based on evidence from adequate and well-controlled studies of Calcitriol Oral Solution in adults with predialysis chronic renal failure and additional supportive data from nonplacebo-controlled studies in pediatric patients. Most patients undergoing hemodialysis respond to doses between 0.5 and 1 mcg/day.Calcitriol Oral Solution may normalize plasma-ionized calcium in some uremic patients, yet fail to suppress parathyroid hyperfunction. When a 1 mcg oral dose of radiolabeled calcitriol was administered to normal subjects, approximately 10% of the total radioactivity appeared in urine within 24 hours. 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