An intravenous calcimimetic
Etelcalcetide
An injectable calcimimetic given into the dialysis line to lower an overactive parathyroid hormone.
What is Etelcalcetide?
Etelcalcetide works like cinacalcet to lower an overactive parathyroid hormone in people with kidney disease, but instead of being a daily tablet it is given as an injection into the dialysis line three times a week at the end of dialysis. This makes it convenient for people already attending for haemodialysis. As with cinacalcet, its main risk is low blood calcium, so it is monitored with regular blood tests, and nausea and vomiting can occur.
Education and reference only. This is a plain-language guide to Etelcalcetide — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Etelcalcetide is a calcimimetic medicine used to treat an overactive parathyroid gland (secondary hyperparathyroidism) in adults with long-standing kidney disease who are on haemodialysis. The parathyroid glands make parathyroid hormone (PTH), which controls calcium; in kidney disease they often become overactive and release too much, harming the bones over time. Etelcalcetide brings this raised hormone down. Unlike cinacalcet, which is a daily tablet, etelcalcetide is given by injection into the dialysis circuit, so no extra needles are usually needed.
How it works
Like other calcimimetics, etelcalcetide acts on the calcium-sensing receptors of the parathyroid glands, making them behave as though blood calcium is higher than it really is. As a result the glands release less parathyroid hormone, so the body stops drawing so much calcium from the bones and blood calcium falls. Because it is given three times a week at dialysis, it provides steady control without a daily tablet, but the same need to watch for low calcium applies.
Company & origin
Originated / developed by: Amgen.
An injectable calcimimetic used in the UK to lower an overactive parathyroid hormone in adults on haemodialysis.
What it treats
Conditions Etelcalcetide is used for
Practical use
How to take Etelcalcetide
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by a nurse as an injection into your dialysis line at the end of dialysis, usually three times a week.
- You do not take it yourself; it is administered as part of your dialysis session.
- Tell the team about any tingling, cramps or muscle twitching, as these can be signs of low calcium.
- Attend your regular dialysis and blood-test appointments so calcium and parathyroid hormone can be checked.
- Let your team know if you have heart problems, as low calcium can affect the heart rhythm.
Weighing it up
Advantages & disadvantages of Etelcalcetide
Advantages
- Given conveniently into the dialysis line three times a week, with no daily tablet to remember.
- Effectively lowers an overactive parathyroid hormone in people on haemodialysis.
- Helps protect the bones from the harm of long-standing high parathyroid hormone.
Disadvantages
- Can lower blood calcium too far, causing cramps, tingling and sometimes heart rhythm changes.
- Can cause nausea, vomiting and muscle spasms.
- Only suitable for people already on haemodialysis, and still needs regular blood-test monitoring.
Practical use
Good to know
The biggest practical advantage is convenience: it is injected into the line at the end of a dialysis session three times a week, so people do not have to remember a daily tablet. The main risk, as with cinacalcet, is calcium falling too low, which can cause tingling around the mouth and fingers, muscle cramps, twitching and, if severe, heart rhythm changes or fits — these should be reported quickly. Nausea and vomiting can occur, and some people notice muscle spasms or worsening of heart failure if calcium drops. It is started and adjusted using regular blood tests for calcium and parathyroid hormone, and is used as part of a wider plan that may include phosphate binders and vitamin D. People should not switch straight from cinacalcet to etelcalcetide without a gap, as too much calcium-lowering effect can build up.
Who should not take it / use with caution
- It should not be started if blood calcium is already low until that has been corrected.
- It is only for adults on haemodialysis, not for those not yet on this form of dialysis.
- It is used with caution in people with heart failure or significant heart rhythm problems.
Monitoring
- Regular blood tests for calcium, phosphate and parathyroid hormone to guide treatment.
- Watching for signs of low calcium, especially when starting or increasing it.
- Reviewing heart status in people with heart failure or rhythm problems.
Side effects
- Low calcium can cause tingling, muscle cramps, twitching and, rarely, heart rhythm changes or fits.
- Nausea, vomiting and muscle spasms are relatively common.
- Headache, worsening of heart failure and low phosphate can also occur.
Key interactions
- Other medicines that lower calcium can add to the risk of calcium falling too low.
- It should not be combined with cinacalcet, and switching between them needs a gap to avoid too much effect.
- Caution is needed with medicines that affect the heart rhythm if calcium is low.
Available as: Solution given by injection into the dialysis line.
Answers
Etelcalcetide: frequently asked questions
How is etelcalcetide different from cinacalcet?
They work in the same way to lower an overactive parathyroid hormone, but cinacalcet is a daily tablet whereas etelcalcetide is injected into the dialysis line three times a week.
Do I have to take it myself?
No. It is given by a nurse into your dialysis line at the end of a dialysis session, so there is no daily tablet to remember.
What is the main risk?
As with cinacalcet, the main risk is blood calcium falling too low, which is why you have regular blood tests and should report tingling, cramps or twitching.
Can I take it if I am not on dialysis?
No. It is only for adults on haemodialysis; people with kidney disease not on this form of dialysis would be considered for other treatments.
Can I switch straight from cinacalcet tablets?
A gap is needed when switching, because using both effects together can lower calcium too much; your team will manage the change.
Authoritative sources
- BNF
- NICE CKS
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