Hypercalcaemia associated with calcipotriol (Dovonex) treatment.

Hardman, K A; Heath, D. A.; Nelson, Helen M.

doi:10.1136/bmj.306.6882.896-a

Cited by 41 publications

(9 citation statements)

References 10 publications

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“…4,7,8 Cases of hypercalcemia due to the consumption of calcium lactate and milk in addition to topical application of calcipotriol ointment have also been reported, 9 and hypercalcemia can occur in cases of widespread erythrodermic psoriasis, even at topical doses of less than 100 g/week. 10,11 Bleiker et al 12 reported hypercalcemia in five of 28 patients with severe psoriasis receiving high-dose topical calcipotriol (200-360 g/week) over a 6-month observation period. During their observation, with the exception of topical application of steroids/dithranol, no concomitant systemic therapy, such as phototherapy, was administered.…”

Section: Discussionmentioning

confidence: 99%

Safety profiles of topical vitamin D3 in psoriasis patients: a retrospective large-scale study

Yamamoto¹,

Furuhashi²,

Matsumoto³

et al. 2012

PTT

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Topical vitamin D 3 ointments are widely used to treat psoriasis, sometimes in combination with cyclosporine, phototherapy, and biologic agents. However, the risk factors for hypercalcemia resulting from these ointments, and interactions with underlying disorders and age are unclear. We performed a retrospective study of psoriasis patients at Nagoya City University Hospital between January 1, 2004, and December 31, 2009, treated with a vitamin D 3 -containing topical drug, either calcipotriol, maxacalcitol, or tacalcitol. Data from blood samples and clinical scores collected during routine visits throughout the study period were analyzed. We assessed changes in the serum calcium levels over time in association with age, liver dysfunction, renal dysfunction, concomitant medication, and concomitant therapy. Serum calcium levels were significantly lower in the calcipotriol group than in the maxacalcitol group (P , 0.05), regardless of other factors, at the observation period. Calcipotriol was associated with lower serum calcium levels than maxacalcitol in patients $ 65 years (P , 0.05), those with renal disease (P = 0.0362), and those with liver disease (P = 0.0255). Only three patients using calcipotriol developed hypercalcemia that did not seem to be related to the treatment. Hypercalcemia was observed in 10 patients using maxacalcitol, although serum calcium levels rapidly recovered when use was discontinued. Only one patient using tacalcitol developed hypercalcemia. Hypercalcemia tended to occur in patients with conditions in which the skin is more vulnerable, even at standard doses; patients taking oral etretinate; patients requiring concomitant systemic therapy, even if the Psoriasis Area and Severity Index score was not severe; and patients with renal or liver dysfunction. These findings highlight the importance of the awareness of the risk factors for hypercalcemia in patients treated with topical vitamin D 3 ointment, and point to calcipotriol as the first-choice treatment for those over 65 years old, or those with renal or liver disease.

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Section: Discussionmentioning

confidence: 99%

Safety profiles of topical vitamin D3 in psoriasis patients: a retrospective large-scale study

Yamamoto¹,

Furuhashi²,

Matsumoto³

et al. 2012

PTT

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“…Thus, at least 2 of the 3 reported cases of hypercalcaemia occuring after applying 70-80 g of calcipotriol ointment per week had some degree of renal impairment [71,72]. These results may indicate that the small amounts of calcipotriol absorbed systemically (less than 5%) may be sufficient to cause hypercalcemia in patients with a decreased renal capacity to regulate urinary calcium excretion.…”

Section: Long-term Therapymentioning

confidence: 91%

Recent Developments in Vitamin D Analogs

Fogh

Kragballe²

2000

CPD

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Within the past decade it has been shown that psoriasis can be treated topically with analogs of vitamin-D3. Impaired differentiation and increased proliferation of keratinocytes are key features in psoriatic lesions together with a local activation of T lymphocytes. Evidence has accumulated showing that analogs of vitamin D3 increase differentiation and inhibit proliferation of keratinocytes. Therefore, analogs of vitamin D3 have been investigated in a number of trials showing improvement of psoriasis. It has been shown that vitamin D analogs are better than their vehicle and show the same potency as potent topical steroids. However, vitamin D analogs have been proven efficacious and without side effects also when used on long term basis. Vitamin D analogs can be used both as monotherapy and in combination topical steroids, UVB, PUVA, retinoids and cysclosporine. The vitamin D3 analog calcipotriol has been investigated in most detail and is available as an ointment, a creme and as a scalp solutation. From clinical studies involving thousands of patients, it can be concluded that calcipotriol is efficacious, safe, well tolerated and can be used on a long term basis. Other analogs are available, however, these analogs have not been studied in greater details yet.

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“…There are however reports of hypercalcemia in psoriatic patients who used 200 g of calcipotriol within 7 days [11]. 400 g/10 days [12], 500 g/45 days and 770 g/77 days [ 13].…”

Section: Discussionmentioning

confidence: 99%

Oral Calcium Tolerance Test in Extensive Psoriasis Treated with Topical Calcipotriol

Gumowski‐Sunek¹,

Rizzoli

Saurat³

1995

Dermatology

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Background: The vitamin D₃ derivative calcipotriol (Daivonex®) is an efficient topical treatment of psoriasis. When applied at a dose of about 25 g/week over a mean body surface of 16%, it is not associated with any detectable change in calcium metabolism. Objective: Our purposes were (i) to analyze the effects of calcipotriol on various parameters of calcium metabolism when applied on a large body surface and (ii) to evaluate the usefulness of an oral calcium tolerance test in monitoring psoriatic patients under topical calcipotriol. Methods: In group 1, 10 patients with psoriasis affecting 67.0 ± 2.7% of total body surface (range 55–80%) were treated with calcipotriol for 6.5 weeks (mean 383 g/month). In group 2, 19 patients with psoriasis involving 15% of body surface were treated with calcipotriol for 9 weeks (mean 105 g/month). In group 3, 7 patients without topical calcipotriol for at least 1 week were given 1.5 μg of oral calcitriol for 7 days. An extended survey of blood and urinary parameters of calcium metabolism was performed before and after 45 days of treatment (group 1). Since one of the actions of vitamin D is to stimulate intestinal calcium absorption, an oral calcium-loading test (groups 1, 2 and 3) was done in order to detect more subtle changes possibly induced by calcipotriol. Results: We did not detect any significant change in various parameters of calcium metabolism in group 1 (large body surface treated) patients. The urinary calcium responses to the oral calcium load were identical to controls in both group 1 (large body surface treated) and group 2 (limited body surface treated), whereas in group 3 (oral calcitriol therapy) an increased urinary calcium response to the calcium load was identified. Conclusions: No significant changes in calcium metabolism were detectable when calcipotriol was administered once a day over a large body surface with doses up to 100 g/week. The oral calcium tolerance test appears to be a cheap, simple and sensitive test to monitor patients exposed to high doses of calcipotriol as it detects increased intestinal calcium absorption induced by 1.5 μg of oral calcitriol.

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Hypercalcaemia associated with calcipotriol (Dovonex) treatment.

Cited by 41 publications

References 10 publications

Safety profiles of topical vitamin D3 in psoriasis patients: a retrospective large-scale study

Safety profiles of topical vitamin D3 in psoriasis patients: a retrospective large-scale study

Recent Developments in Vitamin D Analogs

Oral Calcium Tolerance Test in Extensive Psoriasis Treated with Topical Calcipotriol

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