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Patients with vitamin D-resistant ricketsfamilial hypophosphataemiashould continue their oral phosphate therapyHoweverpossible stimulation of intestinal phosphate absorption by calcitriol should be taken into account since this effect may modify the requirement for phosphate supplements.
Calcitriol increases inorganic phosphate levels in serumWhile this is desirable in patients with hypophosphataemiacaution is called for in patients with renal failure because of the danger of ectopic calcificationIn such casesthe plasma phosphate level should be maintained at the normal level2-5 mg/100 ml or 0.65-1.62 mmol/lby the oral administration of appropriate phosphate-binding agents and low phosphate diet.
If hypercalcemia ensuesgreater than 1 mg/dL above the upper limit of the normal rangeadjust dosage to achieve normocalcemia by reducing Rocaltrolcalcitrioltherapy from 0.5 mcg to 0.25 mcg dailyIf the patient is receiving a therapy of 0.25 mcg dailydiscontinue Rocaltrolcalcitrioluntil patient becomes normocalcemicCalcium supplements should also be reduced or discontinuedSerum calcium levels should be determined 1 week after withdrawal of calcium supplementsIf serum calcium levels have returned to normalRocaltrolcalcitrioltherapy may be reinstituted at a dosage of 0.25 mcg/day if previous therapy was at a dosage of 0.5 mcg/dayIf Rocaltrolcalcitrioltherapy was previously administered at a dosage of 0.25 mcg/dayRocaltrolcalcitrioltherapy may be reinstituted at a dosage of 0.25 mcg every other dayIf hypercalcemia is persistent at the reduced dosageserum PTH should be measuredIf serum PTH is normaldiscontinue Rocaltrolcalcitrioltherapy and monitor patient in 3 monthstime.
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