Calcitonin Salmon Nasal Spray 

How does Apo-Calcitonin work? What will it do for me? 

Calcitonin is a hormone that occurs naturally in the human body.  Calcitonin salmon is similar to human calcitonin hormone in many ways. However, calcitonin salmon is longer-acting and more potent than human calcitonin. Calcitonin salmon nasal spray is used in the treatment of  osteoporosis in women who are more than 5 years past menopause.

Intranasal calcitonin has been shown to increase bone mass in postmenopausal women with established osteoporosis. Calcitonin salmon reduces the rate of bone breakdown caused by cells in the bone called osteoclasts  and may encourage cells called osteoblasts to build up the bones. 

Because osteoporosis does not make you feel any different until you  break or fracture  a bone, it  is difficult to know if the medication is working or not. Your doctor will have your  bone mineral  density tested at regular intervals to check on the effectiveness of your treatment. Improvements can usually be seen in 1 to 3 months. 

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. 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. 

How should I use Apo-Calcitonin? 

Calcitonin salmon is  used in the form of  a nasal spray. The recommended dose of calcitonin salmon is one spray (200 IU) in one nostril daily,  alternating nostrils each day. The doctor will check on a periodic basis  to see if  the medication is working by ordering a test that measures  the density of your bones. 

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 that this medication be taken  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 one. 

When  using the nasal spray: 

• Store new, unopened bottles in  the refrigerator between 2°C  and 8°C. Do not allow the spray to freeze. Avoid shaking. 
• When starting a new  bottle of nasal spray, allow  the spray to reach room temperature and then prime the pump according to  the package instructions. 

• 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. Do NOT inhale while spraying. 
• 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. 
• 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. 
• 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  and there is noticeable resistance to  the movement  of the plunger. 
• If you miss  a dose, do not take an extra dose. Just resume your usual schedule of one  spray daily. 
• 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. 

What form(s) does Apo-Calcitonin come in? 

Each nasal spray solution contains synthetic calcitonin (salmon) 200 IU. Nonmedicinal ingredients: benzalkonium chloride (as a preservative), hydrochloric acid, purified water, sodium chloride  and sodium hydroxide. 

Some medications may have other generic brands available. Always ask your doctor or pharmacist about  the safety of switching between brands of the same medication. 

Who should NOT take Apo-Calcitonin? 

Calcitonin salmon should not be taken by anyone who is sensitive or allergic  to calcitonin salmon or any ingredients of the medication. 

What side effects are possible with Apo-Calcitonin? 

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. 

More common: 

• back pain 
• joint pain 

Less common or rare: 

• abdominal pain 
• burning, dry, or itching eyes 
• constipation
• diarrhea
• flu-like symptoms (e.g., fever with or without chills, headache, body ache) 
• flushing
• mental depression 
• muscle pain 
• nausea
• unusual tearing of eyes 
• unusual tiredness or weakness 
• upset stomach 

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention. 

Check with your doctor as soon as possible if any of the following side effects occur: 

More common: 

• crusting, patches, or sores inside  the nose 
• dryness, itching, redness, swelling, tenderness, or other signs  of nasal irritation  not present before use  of this medication
• headaches (severe or continuing) 
• nosebleeds
• runny nose 

Less common: 

• bloody or cloudy urine 
• breathing difficulty or wheezing (severe) 
• difficult, burning, or painful urination 
• dizziness
• frequent urge to urinate 
• loss  of sense of smell 
• swollen glands 
• upper respiratory infection with any of  the following: 

                           *  chest pain
                           *  chills
                           *  cough
                           *  ear congestion or pain
                           * fever
                           * head congestion
                           * hoarseness or  other voice changes
                           * nasal congestion
                           * runny nose
                           * sneezing or sore throat 

Rare:

• changes in sense of taste 
• hair loss 
• hives
• increased thirst 
• itching or skin rash 

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 Apo-Calcitonin? 

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. 

Age:  Currently this medication is approved for use by women who are at least 5 years past menopause. The safety and effectiveness  of calcitonin salmon nasal spray for use by people of other age groups have  not been established. 

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.

Pregnancy: There are no adequate studies of the use of calcitonin salmon nasal spray by women who are pregnant. If you are pregnant or planning to become pregnant, discuss with your doctor the potential risks and benefits of using this medication. 

Breast-feeding: It is not known if calcitonin salmon passes into breast milk. If you are breast-feeding or planning to breast-feed, discuss with your doctor the potential risks and benefits of using this medication. 

What other drugs could interact with Apo-Calcitonin? 

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

• 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 prescribe 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 prescribe know if you use them.