Cinacalcet

SENSIPAR

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Pronunciation: sin-a-KAL-set

Cinacalcet ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Cinacalcet ballicule

Cinacalcet SENSIPAR mascot mnemonic cartoon — Visual mnemonic: Cinacalcet mascot
**“Cynical cow sat (on) parathyroid sensor”**

What it isCalcium-sensing receptor agonist; secondary hyperparathyroidism in dialysis and parathyroid carcinoma.

Why this oneIt lowers PTH without raising calcium and phosphate, which vitamin D analogues cannot do.

What limits itHypocalcemia, which lengthens QT and can cause seizures. Nausea limits titration; it inhibits CYP2D6.

Cinacalcet molecular structure (skeletal formula) — Molecular structure: Cinacalcet

FDA-approved for

hyperparathyroidism (2004)

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target	Max
Secondary hyperparathyroidism in CKD on dialysis	Adults	30 mg QD	Titrate to iPTH 150–300 pg/mL	180 mg QD
Hypercalcemia in parathyroid carcinoma / severe primary HPT	Adults	30 mg BID	Titrate to normalize serum calcium	90 mg TID–QID

Titration Titrate no more frequently than every 2–4 weeks

Renal Undefined

Hepatic Undefined

Instructions

Take with food or shortly after a meal
Swallow whole — do not chew, crush, or divide
iPTH measured no earlier than 12h after most recent dose

Available strengths

tab 30, 60, 90 mg

Contraindications

Serum calcium below the lower limit of normal (do not initiate)

Cautions

Hypocalcemia — life-threatening/fatal events reported; can prolong QT, lower seizure threshold, cause hypotension/heart failure/arrhythmia; monitor serum calcium
Upper GI bleeding in patients with risk factors
Hypotension, worsening heart failure and/or arrhythmias in impaired cardiac function
Adynamic bone disease if iPTH <100 pg/mL
Not established/indicated in pediatric patients (fatal hypocalcemia reported)

Adverse reactions

Nausea and vomiting (≥25%)
Diarrhea, myalgia
Dizziness, hypertension, asthenia, anorexia
Seizures (1.4%)

Pregnancy Limited human data insufficient; animal studies show pup loss/reduced weight with maternal hypocalcemia

Lactation No human data; excreted in rat milk — consider benefits vs. risks

Cost

Cinacalcet (SENSIPAR)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
30 mg	tab	30 qd	$12.34	offered
60 mg	tab	30 qd	$22.97	offered
90 mg	tab	30 qd	$31.86	offered

Generic entry2018

NO BOXED WARNINGS

Principal riskHypocalcemia, which lengthens QT

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryUnknown / historical label unavailable

Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.

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Memory aids: interaction avatars

CYP2D6 inhibitor (moderate)

CYP3A4 substrate

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