Everything about Cinacalcet

Cinacalcet is a positive allosteric modulator of the parathyroid calcium-sensing receptor (CaSR) indicated for hypercalcemia in primary hyperparathyroidism (PHPT) when parathyroidectomy is unfeasible. By enhancing receptor sensitivity to ambient calcium, it suppresses parathyroid hormone (PTH) secretion, normalizing serum calcium in up to 76% of patients. Crucially, cinacalcet does not improve bone mineral density or alter urinary calcium excretion. Initiation starts at 30 mg twice daily with food, titrating every 2-4 weeks. Monitoring requires weekly serum calcium during titration, every 2 months during maintenance, and tracking CYP2D6 inhibition and hepatic impairment.