Cinacalcet Tablets 60 mg: When They’re Used and What to Expect

CINASELECT 60 is a brand of Cinacalcet Tablets 60 mg, a medicine used to control high levels of parathyroid hormone (PTH) and calcium in the blood. It is commonly prescribed for people with chronic kidney disease on dialysis, as well as those with certain types of hyperparathyroidism and parathyroid cancer.

1. What is CINASELECT 60 (Cinacalcet 60 mg)?

CINASELECT 60 contains Cinacalcet 60 mg as its active ingredient. Cinacalcet belongs to a class of medicines called calcimimetics.

• Strength: 60 mg film‑coated tablet
• Drug class: Calcimimetic agent
• Form: Oral tablet

Calcimimetics act on the calcium‑sensing receptors in the parathyroid glands, making them more sensitive to calcium in the blood. This helps reduce the release of PTH, which in turn helps to control calcium and phosphate levels.

2. How CINASELECT 60 Works (Mechanism of Action)

To understand CINASELECT 60, it helps to know the role of the parathyroid glands:

• These tiny glands in your neck produce parathyroid hormone (PTH).
• PTH helps regulate blood calcium and phosphate levels.
• When PTH is too high, it can cause bone loss, weak bones, vascular calcification, and heart problems.

Cinacalcet (CINASELECT 60):

1. Binds to calcium‑sensing receptors (CaSR) on the parathyroid glands.
2. Increases the sensitivity of these receptors to existing calcium in the blood.
3. Tricks the glands into thinking there is “enough” or “more” calcium.
4. As a result, the glands release less PTH.
5. Lower PTH levels help reduce blood calcium and can also improve phosphate control (often in combination with other treatments).

This mechanism is particularly important in patients with chronic kidney disease (CKD), where the kidneys cannot maintain normal calcium, phosphate, and vitamin D balance, leading to secondary hyperparathyroidism.

3. Indications: When is CINASELECT 60 Used?

CINASELECT 60 (Cinacalcet 60 mg) is generally prescribed for three main conditions (always confirm exact approved indications in your country):

3.1 Secondary Hyperparathyroidism in CKD on Dialysis

• Who: Adults (and in some regions, adolescents) with chronic kidney disease on dialysis who develop secondary hyperparathyroidism (SHPT).
• Problem: Overactive parathyroid glands due to long‑term kidney disease, leading to high PTH, bone problems, and cardiovascular complications.
• Role of CINASELECT 60: Helps lower PTH levels, improve mineral balance, and may help protect bones and blood vessels when used as part of a comprehensive CKD‑MBD (chronic kidney disease‑mineral and bone disorder) strategy.

3.2 Parathyroid Carcinoma

• Who: Patients with parathyroid carcinoma (a rare parathyroid gland cancer).
• Problem: This cancer often causes very high levels of PTH and severe hypercalcemia (high blood calcium).
• Role of CINASELECT 60: Helps reduce calcium levels by lowering PTH, offering symptom control and improving quality of life.

3.3 Severe Hypercalcemia in Primary Hyperparathyroidism

• Who: Patients with primary hyperparathyroidism (PHPT) who:

  • Have high calcium levels and
  • Cannot undergo parathyroid surgery or
  • Surgery is not appropriate or has failed.

• Problem: Overactive parathyroid gland(s) produce too much PTH, causing persistent high calcium.

• Role of CINASELECT 60: Used to control high calcium levels when surgery is not an option, helping manage symptoms and complications.

4. Benefits of CINASELECT 60

Key potential benefits (when used correctly and monitored):

• Reduces PTH levels: Helps manage secondary hyperparathyroidism in CKD.
• Controls high calcium: Particularly in parathyroid carcinoma and primary hyperparathyroidism.
• Protects bones: By lowering PTH, it can help reduce bone turnover and bone pain.
• Supports cardiovascular health: Better mineral balance may reduce vascular calcification risk.
• Non‑surgical option: Offers an alternative to surgery in selected primary hyperparathyroidism patients.

Clinical decisions about CINASELECT 60 use should always be individualized and made by a nephrologist or endocrinologist.

5. CINASELECT 60 Dosage and Administration

Your doctor will determine the exact dose and schedule. The following is general information and does not replace medical advice.

5.1 Typical Starting Dose

Dosage varies based on the indication and local guidelines. Common starting doses for cinacalcet (check product label for CINASELECT 60 specifics):

• Secondary hyperparathyroidism in CKD on dialysis:

  • Often starts at 30 mg once daily, titrated up every 2–4 weeks based on PTH and calcium levels.
  • CINASELECT 60 may be used once you reach 60 mg dosing or higher (e.g., 60 mg once or twice daily, according to medical advice).

• Parathyroid carcinoma and primary hyperparathyroidism:

  • Doses may start around 30 mg twice daily, then gradually increased (e.g., 60–90 mg twice daily) as needed to control calcium.
  • CINASELECT 60 provides a convenient 60 mg strength for patients who require higher doses.

Exact starting and maintenance doses depend on your lab results, clinical condition, and tolerability.

5.2 How to Take CINASELECT 60

• Route: Oral, by mouth.
• With food: It is usually recommended to take CINASELECT 60 with food or shortly after a meal to improve absorption and reduce stomach upset.
• Swallow whole: Swallow the tablet whole with water. Do not crush, chew, or split the tablet unless your doctor/pharmacist specifically tells you it is acceptable.
• Timing: Take at the same time each day to help you remember and maintain stable blood levels.

Always follow the dosing regimen given by your healthcare provider.

5.3 Titration (Dose Adjustment)

Your doctor will adjust your CINASELECT 60 dose based on:

• PTH levels (for SHPT)
• Serum calcium and phosphate levels
• Side effects, especially symptoms of low calcium

Dose changes usually occur every 2–4 weeks, with frequent blood tests to guide safe titration.

6. Missed Dose and Overdose

6.1 If You Miss a Dose

• If you forget a dose of CINASELECT 60:
  • Take it as soon as you remember, if it is still the same day.
  • If it is almost time for your next dose, skip the missed dose and continue with your regular schedule.
• Do not take a double dose to make up for a missed tablet.

If you frequently forget doses, speak to your doctor or pharmacist about reminder strategies (pill boxes, alarms, etc.).

6.2 Overdose

Do not take more than prescribed. Taking too much CINASELECT 60 can cause severe hypocalcemia (very low calcium), which may be dangerous.

Possible symptoms of overdose/hypocalcemia include:

• Tingling around the mouth or in hands/feet
• Muscle cramps or spasms
• Seizures
• Confusion or fainting
• Irregular heartbeat

If you suspect you have taken too much CINASELECT 60, seek emergency medical attention immediately.

7. Common Side Effects of CINASELECT 60

Like all medicines, CINASELECT 60 can cause side effects, although not everyone gets them. Discuss any persistent or severe side effects with your doctor.

Common side effects may include:

• Nausea
• Vomiting
• Diarrhea
• Loss of appetite
• Abdominal pain or discomfort
• Muscle cramps
• Weakness or fatigue
• Headache
• Dizziness

Most mild side effects improve as your body adjusts to the medicine or with dose adjustments. Taking CINASELECT 60 with food can help reduce nausea and stomach upset.

8. Serious Side Effects and Warnings

Some side effects require urgent medical attention.

8.1 Hypocalcemia (Low Blood Calcium)

Hypocalcemia is the most significant risk with cinacalcet.

Symptoms of low calcium may include:

• Tingling or numbness around the mouth, lips, fingers, or toes
• Muscle cramps, twitching, or spasms
• Stiffness or difficulty moving muscles
• Seizures (fits)
• Mood changes, irritability, or confusion
• Fast, slow, or irregular heartbeat

If you notice these symptoms, contact your doctor urgently or go to the emergency department.

8.2 Seizures

• Low calcium levels can increase the risk of seizures, especially in people with a history of epilepsy or other seizure disorders.
• Inform your doctor if you have a history of seizures before starting CINASELECT 60.

8.3 Heart Rhythm Disturbances (Arrhythmias)

Significant changes in calcium levels may affect heart rhythm, especially in people with pre‑existing heart conditions or those taking certain heart medications.

Seek urgent help if you notice:

• Palpitations (feeling your heart racing or pounding)
• Chest pain or discomfort
• Feeling faint or severe dizziness

8.4 Allergic Reactions

While rare, allergic reactions can occur.

Symptoms to watch for:

• Rash, itching, or hives
• Swelling of the face, lips, tongue, or throat
• Difficulty breathing or swallowing

These may be signs of a serious allergic reaction. Stop taking CINASELECT 60 and seek immediate medical help.

9. Who Should Not Take CINASELECT 60?

CINASELECT 60 may be contraindicated or used with great caution in some people. Inform your doctor if:

• You have seriously low calcium levels at baseline.
• You have a known allergy to cinacalcet or any of the tablet’s ingredients.
• You are pregnant, planning to become pregnant, or breastfeeding.
• You have a history of seizures.
• You have severe liver impairment (dose adjustment may be needed).

Your doctor will decide whether CINASELECT 60 is safe and appropriate for you and may order extra monitoring.

10. Drug Interactions with CINASELECT 60

Cinacalcet (CINASELECT 60) is metabolized in the liver by certain enzymes and can interact with other medicines. Always tell your doctor and pharmacist about all medicines you are taking, including:

• Prescription drugs
• Over‑the‑counter medicines
• Herbal supplements and vitamins

10.1 CYP3A4, CYP2D6, CYP1A2 Interactions

Cinacalcet is mainly metabolized by CYP3A4 and CYP1A2, and it is a strong inhibitor of CYP2D6.

Examples of potential interactions (not complete):

• CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin)
  • May increase cinacalcet levels → higher risk of side effects.
• CYP3A4 inducers (e.g., rifampicin, phenytoin, carbamazepine)
  • May reduce cinacalcet effectiveness.
• CYP2D6 substrates (e.g., some antidepressants, beta‑blockers, antiarrhythmics, tamoxifen)
  • CINASELECT 60 can raise their levels, increasing side effect risk.

Your doctor may adjust doses, change medications, or increase monitoring if there is a risk of interactions.

11. CINASELECT 60 with Other CKD‑MBD Treatments

In dialysis patients, CINASELECT 60 is often part of a combination strategy to manage mineral and bone disorder:

• Vitamin D analogues (e.g., calcitriol, alfacalcidol, paricalcitol)
• Phosphate binders (e.g., sevelamer, calcium carbonate, lanthanum)
• Dialysate calcium adjustment in hemodialysis

Your nephrologist will design an individualized plan that may include CINASELECT 60 to control:

• PTH
• Calcium
• Phosphate
• Vitamin D levels

13. Monitoring Requirements

Regular blood tests and clinical review are essential while on CINASELECT 60.

Your doctor will usually monitor:

• Serum calcium (closely, especially when starting or changing dose)
• Parathyroid hormone (PTH) levels
• Serum phosphate
• Kidney function (if applicable)
• Signs and symptoms of hypocalcemia or hypercalcemia

Frequency of testing depends on your condition and stability of your results, but testing is often more frequent in the first few months of therapy or after dose changes.

14. Lifestyle and Dietary Advice While Taking CINASELECT 60

Lifestyle measures can support the effectiveness and safety of CINASELECT 60, particularly in patients with kidney disease:

• Dietary phosphate control: Follow your dietitian’s advice regarding phosphate restriction and use of phosphate binders.
• Calcium intake: Do not change calcium supplements or dairy intake without consulting your doctor, as this may affect calcium levels.
• Vitamin D: Take vitamin D or analogues only as prescribed.
• Adherence: Take CINASELECT 60 regularly, as inconsistent use may lead to unstable PTH and calcium levels.
• Report symptoms: Inform your healthcare team promptly if you experience muscle cramps, tingling, confusion, or unusual fatigue.

15. CINASELECT 60 vs Parathyroid Surgery

15.1 In Secondary Hyperparathyroidism (CKD)

• Medical therapy (cinacalcet, vitamin D, phosphate binders) is usually tried first.
• Parathyroidectomy (surgical removal of glands) may be recommended if:
  • PTH remains very high despite optimal medical treatment, or
  • There are severe symptoms or complications.

CINASELECT 60 helps many patients avoid or delay surgery, but some may still ultimately need an operation.

15.2 In Primary Hyperparathyroidism

• Surgery is usually the treatment of choice and is often curative.
• CINASELECT 60 is typically used:
  • When surgery is not possible, not desired, or risky.
  • As a bridge therapy before surgery in selected cases to control calcium.

16. Duration of Treatment with CINASELECT 60

The length of therapy varies:

• CKD on dialysis: Often long‑term or lifelong while the patient remains on dialysis and has SHPT. Dose may change over time.
• Parathyroid carcinoma or non‑surgical primary hyperparathyroidism: Treatment may be long‑term to maintain calcium control.

Your doctor will regularly reassess the need for continued therapy based on your labs, clinical status, and any new treatment options.

17. Storage and Handling of CINASELECT 60 Tablets

To keep CINASELECT 60 safe and effective:

• Store at room temperature, away from excessive heat and moisture.
• Keep the tablets in the original blister or container until use.
• Protect from light, as instructed on the packaging.
• Keep out of reach and sight of children and pets.
• Do not use tablets past their expiry date.
• Do not use tablets that are damaged, discolored, or crumbling.

Return unused or expired medicines to a pharmacy for safe disposal; do not throw them in household waste or flush them down the toilet.

18. Patient Counselling Tips for CINASELECT 60

Healthcare professionals can support patients using CINASELECT 60 by emphasizing:

1. Purpose: Explain that CINASELECT 60 helps control PTH and calcium and protects bones and organs.
2. How to take: Stress the importance of taking it with food, at the same time every day, and not skipping doses.
3. Monitoring: Highlight the need for regular blood tests.
4. Side effects: Educate about common side effects and warning signs of hypocalcemia.
5. Drug interactions: Encourage patients to inform all providers about CINASELECT 60 use before any new medication is started.
6. When to seek help: Clearly explain when to call the clinic or go to emergency care (e.g., seizures, severe cramps, chest pain, severe dizziness or confusion).

19. Key Takeaways About CINASELECT 60 (Cinacalcet 60 mg)

• CINASELECT 60 is a calcimimetic that lowers PTH and calcium by increasing the sensitivity of parathyroid calcium‑sensing receptors.
• It is used in secondary hyperparathyroidism in dialysis patients, parathyroid carcinoma, and some cases of primary hyperparathyroidism.
• Proper dosing, adherence, and regular monitoring of calcium, phosphate, and PTH are essential for safety and effectiveness.
• The main safety concern is hypocalcemia, which can be serious if not recognized and treated early.
• CINASELECT 60 is usually part of a broader treatment plan that may include vitamin D, phosphate binders, and other medications.

20. Frequently Asked Questions About CINASELECT 60

Q1. What is CINASELECT 60 used for?
CINASELECT 60 (Cinacalcet 60 mg) is used to treat secondary hyperparathyroidism in patients with chronic kidney disease on dialysis, and to control high calcium levels in parathyroid carcinoma or primary hyperparathyroidism when surgery is unsuitable.

Q2. How long does CINASELECT 60 take to work?
PTH and calcium levels may start to change within days to weeks, but full response and dose optimization can take several weeks to months. Regular blood tests will guide adjustments.

Q3. Can I stop CINASELECT 60 once my levels are normal?
Never stop CINASELECT 60 on your own. Your parathyroid problem usually persists, and stopping may cause PTH or calcium to rise again. Any change must be directed by your doctor.

Q4. Is CINASELECT 60 safe with dialysis?
Yes, cinacalcet is commonly used in dialysis patients with SHPT. Your nephrologist will adjust dosing based on your dialysis schedule and lab results.

Q5. Can I drink alcohol while taking CINASELECT 60?
Moderate alcohol consumption may be allowed for some patients but can worsen dizziness or nausea. Ask your doctor, especially if you have liver disease or other health issues.

Q6. What happens if I take CINASELECT 60 on an empty stomach?
Taking it without food may reduce absorption and may increase the chance of stomach upset. It is best to take CINASELECT 60 with food or shortly after a meal.

Q7. Can CINASELECT 60 cure my condition?
CINASELECT 60 controls PTH and calcium levels; it does not “cure” underlying CKD or parathyroid cancer. In primary hyperparathyroidism, surgery is often the curative option.