Rocaltrol (Calcitriol (1,25-dihydroxycholecalciferol))
Also sold as: Rocaltrol, Calcirol, Calvit, Cacitriol (Cipla), Calcijex (IV)
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Capsule 0.25 mcg, 0.5 mcg +2
Indications
- Renal osteodystrophy (secondary hyperparathyroidism in CKD stages 3–5)
- Hypoparathyroidism (surgical/idiopathic)
- Pseudohypoparathyroidism
- Osteoporosis (adjunct in postmenopausal — limited use)
- Hypocalcaemia in dialysis patients
- Vitamin D-dependent rickets type I (1-alpha-hydroxylase deficiency)
Adult Dosing
CKD-associated secondary hyperparathyroidism
0.25 mcg PO once daily (starting dose)
Titrate to suppress PTH while avoiding hypercalcaemia. Target PTH: 2–9× upper normal for CKD stage. Monitor calcium closely — risk of hypercalcaemia and hypercalciuria.
Hypoparathyroidism
0.25–2 mcg PO once daily; titrate to normalize serum calcium
Give alongside oral calcium supplements. Target Ca: low-normal range (2.0–2.2 mmol/L) to avoid hypercalciuria.
Dialysis patients (IV)
0.5 mcg IV 3 times per week after dialysis
IV route for haemodialysis patients — avoids GI absorption variability
Pediatric Dosing
CKD-MBD in children: specialist paediatric nephrology. Rickets type I: 0.25–2 mcg/day (dose depends on weight and response).
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| eGFR < 30 mL/min | This is the primary indication — use calcitriol (not cholecalciferol) because kidneys cannot convert standard vitamin D to active form. Careful dose titration with frequent calcium monitoring. |
Hepatic Adjustment
No specific adjustment — calcitriol is already the active form (no hepatic activation required; unlike cholecalciferol which requires hepatic 25-hydroxylation)
Pregnancy & Lactation
Pregnancy: Category C
Use only if clearly needed — calcitriol passes placenta and can cause hypercalcaemia in fetus. Hypercalcaemia in pregnancy associated with neonatal hypoparathyroidism. Target calcium at low-normal in pregnant hypoparathyroid patients.
Lactation: Caution
Calcitriol excreted in breast milk — monitor infant calcium. Neonatal hypercalcaemia possible. Usually dose reduction in lactation to maintain maternal calcium at low-normal.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Thiazide diuretics | Increase calcium reabsorption — risk of hypercalcaemia when combined with calcitriol. Monitor calcium closely. | Major |
| Calcium supplements (high-dose) | Additive hypercalcaemia risk — monitor calcium | Major |
| Digoxin | Hypercalcaemia potentiates digoxin toxicity — monitor digoxin toxicity signs if calcium rises | Major |
| Antacids (magnesium-containing) | Hypermagnesaemia risk in dialysis patients on calcitriol + magnesium antacids | Moderate |
| Corticosteroids | Antagonise calcitriol effects on calcium absorption — may need dose increase | Moderate |
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Side Effects
Common
- Hypercalcaemia (most important — nausea, constipation, polyuria, confusion, fatigue)
- Hypercalciuria (kidney stone risk)
- Weakness
- Anorexia
Serious / Discontinue If
- Hypercalcaemia — serious/fatal (calcinosis: metastatic calcification in blood vessels, heart, lungs, kidneys; especially in dialysis patients)
- Acute kidney injury (hypercalcaemia-induced)
- Pancreatitis (hypercalcaemia)
- Cardiac arrhythmias (hypercalcaemia — shortens QT)
Contraindications
- Hypercalcaemia (any cause)
- Hypervitaminosis D
- Metastatic calcification
- Sarcoidosis (increased sensitivity to vitamin D)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Rocaltrol 0.25 mcg | Roche India | 10 cap ₹185 |
| Calcirol 0.25 mcg | Cadila | 10 cap ₹145 |
| Calvit 0.25 mcg | Sun Pharma | 10 cap ₹138 |
Monitoring Required
- Serum calcium (weekly during titration; monthly when stable — TARGET: low-normal 2.1–2.4 mmol/L)
- Serum phosphate
- Serum PTH (KDIGO target varies by CKD stage)
- Urinary calcium/creatinine ratio (spot urine — hypercalciuria risk)
- Serum creatinine/eGFR
- Signs of hypercalcaemia (thirst, polyuria, constipation, confusion)
Patient Counseling Points
- This is the active form of vitamin D — do NOT take additional vitamin D3 (cholecalciferol) without your doctor knowing
- Watch for signs of too much calcium: unusual thirst, frequent urination, constipation, nausea, confusion, muscle weakness — report immediately
- Drink adequate water — especially important to prevent kidney stones
- Attend all blood tests — calcium levels must be checked regularly to keep you safe
- Do not change your calcium supplement doses without consulting your doctor — works together with calcitriol
- Avoid antacids containing calcium without checking — can raise calcium too high
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Clinically reviewed by: Dr. Anand Prabhakar, DM (Nephrology), Consultant Nephrologist
Last reviewed: 2026-04-01
References
- KDIGO CKD-MBD Guidelines 2017 (updated 2020)
- BNF — Calcitriol
- Endocrine Society Hypoparathyroidism Guidelines 2016
- ISN CKD Guidelines
- Indian Society of Nephrology — CKD-MBD Management