Background Cinacalcet is approved for the treatment of hypercalcaemia in patients with primary hyperparathyroidism for which parathyroidectomy is contraindicated. At present, there is little information available on the administration of cinacalcet via percutaneous endoscopic gastrostomy (PEG).

Purpose To describe the impact of administration of crushed film coated cinacalcet tablets via a PEG catheter on reduction of corrected serum calcium values in a patient with hypercalcaemia due to primary hyperparathyroidism.

Material and methods A case of hypercalcaemia in a 72-year-old man with a PEG tube, diagnosed with spinal cord injury was reported to our pharmacy department. Pharmacotherapeutic information was required by physicians since the oral route was not possible. He was unsuccessfully treated with hydration, alendronate 70 mg/weekly and intravenous zoledronic acid (4 mg) in a single dose. A systematic review of the literature was performed by searching Medline and Micromedex databases for studies about cinacalcet crushed tablets via PEG but no references were found in the published literature. According to product information, dividing tablets is not recommended. Nevertheless, it was decided to administer cinacalcet through the PEG catheter due to the ineffectiveness of other treatments previously used.

Results Cinacalcet tablets were crushed and given through the PEG tube. Dietary calcium was controlled during hospitalisation. The starting cinacalcet dose was 30 mg/day (day 1). Dosage was increased to 30 mg twice daily (day 14) and a clear variation in calcaemia values was observed over time (day 1: 11.86 mg/dL; day 7: 11.35 mg/dL; day 11: 11.40 mg/dL; day 20: 10.10 mg/dL; day 30: 9.76 mg/dL; day 60: 9.58 mg/dL). After 3 weeks, serum calcium levels declined and returned to the normal range (8.7–10.4 mg/dL) and remained stable during follow-up.

Conclusion Cinacalcet given as crushed tablets via a PEG effectively decreased serum calcium levels and normalised calcium levels in a patient with primary hyperparathyroidism not eligible for surgical treatment, although further pharmacokinetic/pharmacodynamic studies are required.

References and/or acknowledgements Arranz Martín A, et al. Endocrinol Nutr2011;58:24–31.

No conflict of interest