How does this medication work? What will it do for me?

October 4, 2013

Calcitonin salmon nasal spray is no longer being manufactured for sale in Canada. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

Calcitonin salmon nasal spray belongs to the group of medications called bone metabolism regulators. It is used to treat osteoporosis for women who are more than 5 years past menopause.

Calcitonin is a hormone that occurs naturally in the human body. Calcitonin salmon is similar to human calcitonin hormone in many ways, but is longer-acting and more potent than human calcitonin. Calcitonin salmon is not derived from salmon, but is a man-made version of calcitonin produced by salmon. Calcitonin salmon nasal spray works by reducing the rate of bone breakdown caused by cells in the bone called osteoclasts and may encourage cells called osteoblasts to build up the bones. This increases the density of bone in the lower spine.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Sandoz-Calcitonin is no longer being manufactured for sale in Canada. For brands that may still be available, search under calcitonin salmon nasal spray. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The recommended dose of calcitonin salmon nasal spray is one spray (200 IU) in one nostril daily, alternating nostrils each day.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the one above, do not change the way that you are taking the medication without talking to your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

When starting a new bottle of nasal spray, allow the spray to reach room temperature and then prime the pump by pressing down firmly on the pump 3 times. When green is showing in the dose counter window, the new spray is ready to use.

Directions for use (refer to the package for detailed instructions):

  • Remove the protective cap.
  • Bend your head slightly forward and insert the applicator nozzle into one of your nostrils. Make sure the nozzle is placed in a straight line with your nasal passage to allow the spray mist to spread after taking a dose. Depress the plunger once and release.
  • After taking a dose, sniff several times to prevent the solution from dripping out of your nostril. Do not blow your nose immediately after taking a dose.

Be aware that the nasal spray contains 14 doses. You will know the 14 doses have been used when a red marker appears in the counter window.

Store new, unopened bottles in the refrigerator between 2°C and 8°C. Do not allow the spray to freeze, avoid shaking, and keep it out of the reach of children.

Once opened, keep the spray at room temperature and use within 4 weeks. Store and carry the bottle in an upright position to ensure the correct dose is measured each time.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you are allergic to calcitonin salmon or any ingredients of the medication.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • back pain
  • burning, dry, or itching eyes
  • changes in sense of taste
  • crusting, patches, or sores inside the nose
  • diarrhea
  • dizziness
  • dryness, itching, redness, swelling, tenderness, or other signs of nasal irritation not present before use of this medication
  • flushing
  • heartburn
  • joint pain
  • mild nosebleeds
  • nasal odour
  • nausea or upset stomach
  • runny nose
  • sneezing
  • symptoms of a sinus infection (e.g., pressure or pain in the nose, cheeks or behind the eyes; headache; fever)
  • tiredness or weakness
  • vision changes

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • symptoms of a severe allergic reaction (e.g., hives; difficulty breathing; fast heart rate; swelling of the face, mouth, tongue, or throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

HEALTH CANADA ADVISORY

July 31, 2013

Health Canada has issued new information concerning the use of Miacalcin NS®, Apo-Calcitonin NS, and Sandoz Calcitonin NS (calcitonin salmon). To read the full report, visit Health Canada's website at www.hc-sc.gc.ca.

Calcium and vitamin D intake: This medication is intended to be used along with an adequate intake of calcium and vitamin D. Your doctor or pharmacist can advise you as to whether or not you consume enough of these in your diet.

Vision changes: This medication can cause vision changes. Do not drive or operate machinery while taking this medication until you know it does not affect your ability to perform these tasks safely.

Pregnancy: This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if calcitonin salmon passes into breast milk. Women taking this medication should not breast-feed.

What other drugs could interact with this medication?

There may be an interaction between calcitonin salmon and any of the following:

  • lithium
  • medications that tend to cause loss of bone density with long-term use (e.g., corticosteroids such as prednisone)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.