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General Medication Fact Sheet for Alfacalcidol
| Field | Information |
|---|---|
| Generic Name | Alfacalcidol |
| Brand Name Versions | One-Alpha, AlphaD3 |
| Purpose | Treats conditions where there is a disturbance in calcium metabolism due to impaired vitamin D activation, such as chronic kidney disease, hypoparathyroidism, and certain types of rickets/osteomalacia. Helps increase absorption of calcium and phosphate. |
| Mechanism of Action | A vitamin D analog (prodrug) that is converted in the liver to Calcitriol (active vitamin D), bypassing the kidney’s 1-alpha-hydroxylase enzyme activity. Calcitriol increases intestinal absorption of calcium and phosphate and regulates parathyroid hormone. |
| Dosage Forms | Oral capsules, Oral solution, Injection |
| Available Strengths | Capsules: 0.25 mcg, 0.5 mcg, 1 mcg. Oral Solution: 2 mcg/mL. Injection: 2 mcg/mL. |
| Dosage Frequency | Typically once daily. |
| Common Side Effects | Hypercalcemia (high blood calcium) symptoms such as nausea, vomiting, constipation, thirst, increased urination, muscle weakness, fatigue, headache, rash. |
| Serious Side Effects | Severe hypercalcemia leading to kidney damage, kidney stones, heart rhythm problems, allergic reactions, calcification of soft tissues with long-term excessive use. |
| Drug Interactions | Thiazide diuretics, magnesium-containing antacids, phosphate binders, digitalis, corticosteroids, other vitamin D supplements or analogs. |
| Important Notes | Regular monitoring of blood calcium, phosphate, PTH, and alkaline phosphatase levels is required. Dosage is highly individualized. Avoid taking other vitamin D supplements unless directed by a doctor. Report symptoms of high calcium immediately to your doctor. |
| Storage | Store at room temperature, away from moisture and light. Keep out of reach of children. |
| Missed Dose | Take as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not double the dose. |
| Alternatives | Calcitriol, Doxercalciferol, Paricalcitol, Ergocalciferol, Cholecalciferol |
Alfacalcidol Alternatives
| Medication | Mechanism of Action | Notes |
|---|---|---|
| Calcitriol (Rocaltrol) | Active form of Vitamin D; increases intestinal calcium and phosphate absorption. | Directly provides active vitamin D, bypassing the need for renal activation. Often used in similar conditions, especially severe renal impairment. |
| Doxercalciferol (Hectorol) | Vitamin D2 analog; requires liver activation to become active Calcitriol. | Used primarily for secondary hyperparathyroidism in chronic kidney disease. |
| Paricalcitol (Zemplar) | Vitamin D analog; requires minimal activation. | Used primarily for secondary hyperparathyroidism and vitamin D deficiency in chronic kidney disease. |
| Ergocalciferol (Vitamin D2) / Cholecalciferol (Vitamin D3) | Require both liver and kidney activation (via 1-alpha-hydroxylase) to become active Calcitriol. | Less suitable when kidney function is significantly impaired as the kidney activation step is often deficient. |
Alfacalcidol Side Effects
| Common Side Effects | Serious Side Effects |
|---|---|
| Hypercalcemia symptoms (nausea, vomiting, constipation, thirst, frequent urination, muscle weakness, fatigue) | Severe hypercalcemia leading to organ damage (kidneys, heart) |
| Headache | Kidney stones |
| Rash | Heart rhythm problems |
| Itching | Allergic reactions (severe rash, swelling, difficulty breathing) |
Alfacalcidol Dosage Guide
| Condition | Starting Dose | Maintenance Dose | Administration Notes |
|---|---|---|---|
| Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) | Typically 0.25 mcg once daily or every other day. | Individualized based on serum calcium, phosphate, and PTH levels. Often ranges from 0.25 mcg to 2 mcg daily or intermittently. | Doses should be adjusted based on regular laboratory monitoring. May be taken with or without food. |
| Hypoparathyroidism | Varies; often starts at 0.25 mcg to 1 mcg once daily. | Individualized based on serum calcium levels and clinical response. | Requires careful monitoring of serum calcium. Dosage adjustments needed to maintain calcium within the target range. |
| Vitamin D-Dependent Rickets/Osteomalacia | Highly variable depending on type and severity. Can range from 0.25 mcg to several mcg daily. | Individualized based on clinical response and biochemical parameters (calcium, phosphate, alkaline phosphatase). | Treatment requires close medical supervision and monitoring. |
