Calcitonin Salmon Injection(salcatonin) is a highly active synthetic polypeptide injection for regulating bone metabolism. Composed of 32 amino acids, it has significantly higher receptor affinity than mammalian calcitonin, with rapid onset and long-lasting effects. Its core mechanism involves potently inhibiting osteoclast activity, blocking bone resorption, rapidly lowering blood calcium, and exerting both central and peripheral analgesic effects. Clinically, it is indicated for Paget's disease of bone, hypercalcemia associated with malignant bone metastasis, and painful dystrophy.
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Calcitonin salmon COA
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| Certificate of Analysis | ||
| Compound name | Calcitonin salmon | |
| Grade | Pharmaceutical grade | |
| CAS No. | 47931-85-1 | |
| Quantity | 37g | |
| Packaging standard | PE bag+Al foil bag | |
| Manufacturer | Shaanxi BLOOM TECH Co., Ltd | |
| Lot No. | 202601090056 | |
| MFG | Jan 9th 2026 | |
| EXP | Jan 8th 2029 | |
| Structure |
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| Item | Enterprise standard | Analysis result |
| Appearance | White or almost white powder | Conformed |
| Water content | ≤5.0% | 1.21% |
| Loss on drying | ≤1.0% | 0.07% |
| Heavy Metals | Pb≤0.5ppm | N.D. |
| As≤0.5ppm | N.D. | |
| Hg≤0.5ppm | N.D. | |
| Cd≤0.5ppm | N.D. | |
| Purity (HPLC) | ≥99.0% | 99.90% |
| Single impurity | <0.8% | 0.25% |
| Total microbial count | ≤750cfu/g | 313 |
| E. Coli | ≤2MPN/g | N.D. |
| Salmonella | N.D. | N.D. |
| Ethanol (by GC) | ≤5000ppm | 500ppm |
| Storage | Store in a sealed, dark, and dry place below -20°C | |
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| Chemical Formula | C145H240N44O48S2 |
| Exact Mass | 3429.71 |
| Molecular Weight | 3431.90 |
| m/z | 3430.72(100.0%), 3431.72(77.9%), 3429.71(63.8%), 3432.72(40.1%), 3431.71(16.3%), 3432.72(12.3%), 3430.71(10.4%), 3432.72(9.9%), 3432.71(9.0%), 3433.73(8.8%), 3433.72(7.7%), 3433.72(7.0%), 3433.73(6.6%), 3431.72(6.3%), 3431.71(5.8%), 3433.72(5.0%), 3434.73(3.2%), 3434.73(3.0%), 3434.72(3.0%), 3431.72(2.8%), 3432.73(2.1%), 3431.72(1.8%), 3430.72(1.8%), 3434.73(1.7%), 3433.72(1.6%), 3431.72(1.6%), 3433.72(1.5%), 3433.71(1.5%), 3432.72(1.4%), 3434.72(1.3%), 3432.71(1.3%), 3432.72(1.2%), 3434.72(1.2%), 3430.72(1.2%), 3434.72(1.2%), 3434.71(1.1%), 3432.71(1.0%), 3430.71(1.0%) |
| Elemental Analysis | C,50.75; H,7.05; N,17.96; O,22.38; S,1.87 |
Application in the Treatment of Hypercalcemia
Hypercalcemia is one of the common critical conditions in clinical endocrinology and multidisciplinary diagnosis and treatment. It can be diagnosed when the serum albumin corrected blood calcium concentration exceeds 2.75mmol/L. Severe hypercalcemia (blood calcium ≥ 3.5mmol/L) can cause multiple organ dysfunction and even endanger life. As a first-line calcitonin drug in clinical practice, calcitonin salmon injection has become one of the core drugs for acute intervention of hypercalcemia, especially in scenarios such as tumor related hypercalcemia, primary hyperparathyroidism, and perioperative hypercalcemia crisis, due to its rapid onset of bone inhibition and mild regulation of renal calcium excretion. It plays an irreplaceable therapeutic value.
Unlike the long-acting bone resorption inhibition mechanism of bisphosphonates, salmon calcitonin can rapidly reduce blood calcium levels within 2-4 hours after administration, while also providing additional benefits of pain relief and improving clinical symptoms. After decades of clinical evidence accumulation, its application standards in the hierarchical diagnosis and treatment system of hypercalcemia have gradually matured, and it has become the preferred intervention drug in the acute phase recommended by many clinical guidelines for hypercalcemia at home and abroad.
In the treatment scenario of tumor associated hypercalcemia (HCM), salmon calcitonin is the core drug for acute phase combined intervention. Tumor associated hypercalcemia is the most common type of hypercalcemia in clinical practice, accounting for more than 50% of all cases of hypercalcemia crisis. It is mainly caused by a large amount of PTH related peptide (PTHrP) secreted by lung cancer, breast cancer, multiple myeloma and other malignant tumors into the blood.
The osteoclast activity of these patients is pathologically activated, and a large amount of bone calcium is rapidly released into the blood, often accompanied by severe nausea, vomiting, confusion and other symptoms of hypercalcemia encephalopathy. The traditional approach of using only intravenous hydration combined with diuretics has a slow rate of calcium reduction and is difficult to lower blood calcium to a safe range in a short period of time. However, using the triple acute phase treatment plan of "intravenous hydration+salmon calcitonin+bisphosphonates", the patient's blood calcium concentration can steadily decrease from a crisis level of 3.8 mmol/L or above to a safe range of 3.0 mmol/L or below within 24-48 hours after administration, and the effective rate of calcium reduction can reach over 90%. Clinical data from the oncology department of a tertiary hospital in China shows that for patients with advanced malignant tumors complicated by hypercalcitonin crisis, early addition of salmon calcitonin on the basis of conventional hydration can shorten the recovery time of hypercalcitonin consciousness by 2 days compared to the simple use of bisphosphonates.
The recurrence rate of hypercalcemia within 7 days has decreased from 35% to 12%, which provides a valuable time window for subsequent anti-tumor treatment. Salmon calcitonin plays an irreplaceable bridging role in the perioperative management of hypercalcemia associated with primary hyperparathyroidism (PHPT). Patients with primary hyperparathyroidism often experience persistent hypercalcemia due to excessive secretion of PTH by parathyroid adenomas. Some critically ill patients may have preoperative blood calcium levels as high as 3.5-4.0mmol/L, and direct surgical intervention carries a high risk of anesthesia. Short term pre-treatment with salmon calcitonin before surgery can stabilize the patient's blood calcium levels to a safe surgical range of around 3.0mmol/L within 3-5 days, significantly reducing the risk of cardiovascular accidents during the perioperative period. At the same time, after the resection of parathyroid adenoma, some patients with long-term high calcium may develop "bone starvation syndrome".
The rapid deposition of blood calcium into the bones may cause symptomatic hypocalcemic seizures. At this time, low-dose maintenance of salmon calcitonin can moderately slow down the rapid calcification rate of the bone, smoothly transition to the postoperative calcium metabolism adjustment period, and reduce the probability of severe hypocalcemia. A clinical study conducted by a domestic endocrinology department showed that for patients with severe primary hyperparathyroidism complicated by hypercalcitonin crisis, standardized use of salmon calcitonin during the perioperative period reduced the incidence of surgical related complications from 28% to 11%, and the average length of hospital stay after surgery was shortened by 1.5 days. Salmon calcitonin also has good clinical benefits in the treatment of hypercalcemia caused by vitamin D poisoning. Some patients experience persistent hypercalcemia due to excessive absorption of intestinal calcium caused by long-term high-dose vitamin D supplementation.
The osteoclast activity of these patients does not show pathological overactivation, and the calcium lowering effect of using bisphosphonates alone is limited. However, salmon calcitonin can rapidly reduce blood calcium levels through the mechanism of increasing urinary calcium excretion, without excessively inhibiting normal bone metabolism and avoiding long-term hypocalcemia in the future. Salmon calcitonin has a more prominent safety advantage in the treatment of hypercalcemia in elderly patients and patients with renal insufficiency. It does not require complex metabolic activation processes in the kidneys, and in severe renal insufficiency patients with creatinine clearance rates below 30ml/min, there is no need to significantly adjust the dosage. It does not worsen renal function damage like high-dose diuretics, and there is no risk of nephrotoxicity that may be caused by bisphosphonates. Therefore, it is the preferred acute phase calcitonin for patients with renal insufficiency and hypercalcemia.
Clinical Classification of Hypercalcemia and Indications
Hypercalcemia has complex etiologies and diverse clinical classifications, with distinct pathogenesis, clinical manifestations, and therapeutic priorities across different types. Owing to its rapid onset and high safety profile, the product is used in the management of multiple forms of hypercalcemia, particularly for emergency treatment and specific patient populations. Its indications corresponding to clinical classifications are as follows.
1. Hypercalcemia of Malignancy
Hypercalcemia of malignancy (HCM) is one of the most common clinical types of hypercalcemia, accounting for 40%–50% of all cases. It is mainly caused by bone metastasis from malignancies such as breast cancer, lung cancer, renal cell carcinoma, and multiple myeloma, and may also result from tumor secretion of parathyroid hormone-related protein and other mediators. This type of hypercalcemia has an acute onset and rapid progression, often accompanied by markedly elevated blood calcium, leading to severe symptoms including nausea, vomiting, and confusion, and can be life-threatening. The product is a first-line agent for hypercalcemia of malignancy, especially for cases induced by bone metastasis. By rapidly inhibiting osteoclast activity and blocking the release of bone calcium, it reduces blood calcium levels within a short time and relieves hypercalcemic symptoms.
Its analgesic effect also effectively alleviates severe bone pain caused by malignant bone metastasis, buying time for subsequent anti-tumor therapy. It is the preferred transitional treatment for patients intolerant to bisphosphonates or before bisphosphonates take effect.
2. Hypercalcemia Associated with Hyperparathyroidism
Hyperparathyroidism (primary and secondary) is another common cause of hypercalcemia. Primary hyperparathyroidism stems from parathyroid gland lesions leading to excessive parathyroid hormone secretion, while secondary hyperparathyroidism is mostly triggered by chronic kidney disease, vitamin D deficiency, and other factors. This type of hypercalcemia typically presents with persistent hypercalcemia complicated by osteoporosis, renal calculi, peptic ulcer, and other comorbidities.
The product can be used for symptomatic treatment of hypercalcemia associated with hyperparathyroidism, especially for preoperative preparation, inoperable patients, or as an adjuvant for long-term management. By inhibiting osteoclast activity and promoting urinary calcium excretion, it effectively controls blood calcium levels, relieves symptoms such as osteoporosis and bone pain, and reduces complications. Notably, it cannot replace parathyroid hormone inhibitors or surgical treatment and requires comprehensive etiological intervention.
3. Hypercalcemia Related to Vitamin D Intoxication and Immobilization
Vitamin D intoxication results from excessive vitamin D intake or abnormal vitamin D metabolism, leading to excessive intestinal calcium absorption and elevated blood calcium.
Immobilization-related hypercalcemia commonly occurs in patients on prolonged bed rest or with post-fracture fixation, where reduced skeletal activity causes relatively enhanced osteoclast activity and increased bone calcium release, raising blood calcium levels. Both types are mostly mild to moderate but may progress to severe hypercalcemia without timely intervention.
Calcitonin Salmon Injection is applicable to these two forms of hypercalcemia. It rapidly lowers blood calcium by inhibiting bone calcium release and promoting urinary calcium excretion while alleviating associated symptoms. For patients with vitamin D intoxication, its use accelerates the normalization of blood calcium upon discontinuation of vitamin D. For immobilization-related hypercalcemia, combined with appropriate rehabilitation exercises, it effectively prevents recurrent hypercalcemia.
4. Emergency Management of Hypercalcemic Crisis
Hypercalcemic crisis is a severe complication of hypercalcemia, defined as a serum calcium concentration exceeding 3.5 mmol/L accompanied by life-threatening symptoms such as impaired consciousness, cardiac arrhythmias, and renal failure. The mortality rate is extremely high without prompt resuscitation. The product is a critical agent for emergency management of hypercalcemic crisis due to its rapid onset.
In hypercalcemic crisis resuscitation, the product can be administered via intravenous infusion or bolus injection to exert rapid calcium-lowering effects. Blood calcium reduction is typically observed 30 minutes to 2 hours after administration, buying time for subsequent fluid resuscitation and diuresis. Combined use with bisphosphonates achieves a synergistic effect of "rapid calcium reduction plus long-term maintenance", significantly improving resuscitation success rates.
Information source: Guidelines for the Diagnosis and Management of Hypercalcemia (2025 Edition); China Medical Information Query Platform, Calcitonin Salmon; Package Insert for Calcitonin Salmon, National Medical Products Administration; VIP Journal, Observation on the Efficacy of Salmon Calcitonin in the Treatment of Hypercalcemia Complicated by Maintenance Hemodialysis.
Evaluation of Therapeutic Efficacy in Hypercalcemia
The product has confirmed efficacy in hypercalcemia, with distinct advantages in rapid calcium reduction and bone pain relief. Its efficacy is evaluated based on changes in blood calcium concentration, improvement in clinical symptoms, and long-term prognosis, supported by clinical research data and practice as detailed below.
1. Blood Calcium Control
The drug has a rapid onset: peak plasma concentration is reached 1 hour after subcutaneous or intramuscular injection, with an elimination half-life of 70–90 minutes. Reduced blood calcium is usually observed 30 minutes to 2 hours after administration, and levels fall to a relatively safe range within 24–48 hours. For patients with chronic hypercalcemia, regular dosing effectively maintains normocalcemia and reduces fluctuations. For hypercalcemic crisis, intravenous administration rapidly lowers calcium to prevent disease progression.
Clinical research shows that intramuscular salmon calcitonin administered for 12 weeks to 28 maintenance hemodialysis patients with hypercalcemia resulted in statistically significant reductions in blood calcium and calcium-phosphorus product at week 4 (P < 0.05).
Demonstrating favorable calcium-lowering efficacy in this special population. Of note, some patients may develop "escape phenomenon" with long-term use, characterized by gradually diminished efficacy. In such cases, treatment should be temporarily interrupted before resumption, or dosage adjusted and combined with other agents.
2. Improvement in Clinical Symptoms
Symptoms induced by hypercalcemia, including nausea, vomiting, dizziness, osteoarticular pain, and mobility impairment, are effectively relieved by Calcitonin Salmon Injection. Bone pain relief is particularly prominent: clinical studies show a bone pain remission rate of over 70% for malignant bone metastasis-related pain.
Among maintenance hemodialysis patients with hypercalcemia, all experienced partial relief of osteoarticular pain and mobility impairment at week 4, with symptoms nearly resolved in 23 patients at the end of treatment.
Additionally, the drug improves neurological symptoms such as confusion and irritability caused by hypercalcemia, helping restore consciousness and enhancing treatment compliance. However, it cannot reverse pre-existing complications such as metastatic calcification, which requires combined treatment of the primary disease.
3. Impact on Long-Term Prognosis
For chronic hypercalcemia, long-term use of the product effectively controls blood calcium, reduces damage to the kidneys, heart, bones, and other organs, lowers the risk of complications including renal calculi, arrhythmias, and osteoporosis, and improves long-term quality of life. For patients with hypercalcemia of malignancy, it alleviates symptoms, prolongs survival, and creates conditions for subsequent anti-tumor therapy.
As a symptomatic treatment for hypercalcemia, the drug does not cure the underlying cause. Therefore, primary disease management (e.g., tumor resection, parathyroid surgery, discontinuation of excessive vitamin D) must be implemented concurrently for sustained long-term control.
Information source: VIP Journal, Observation on the Efficacy of Salmon Calcitonin in the Treatment of Hypercalcemia Complicated by Maintenance Hemodialysis; Guidelines for the Diagnosis and Management of Hypercalcemia (2025 Edition); China Medical Information Query Platform, Calcitonin Salmon for Injection; China Medical Information Query Platform, Calcitonin Salmon.
Precautions
Skin Test: As a polypeptide drug, systemic allergic reactions may occur. A skin test is required before clinical use. Procedure: draw 0.2 mL (50 IU/vial) of the drug, dilute to 1 mL with normal saline, and inject 0.1 mL (approximately 1 IU) subcutaneously. Observe for 15 minutes. A reaction with no more than moderate redness at the injection site is negative; moderate or severe redness is positive, and the drug is contraindicated in positive cases.
Drug Interactions: Concomitant use with antacids or laxatives may impair absorption due to their calcium or metal ion (magnesium, iron) content. Combined use with aminoglycoside antibiotics may induce hypocalcemia and should be avoided; if co-administration is necessary, blood calcium must be closely monitored.
Dosage Control: Avoid overdosage. High-dose short-term therapy may cause secondary hypoparathyroidism and hypocalcemia in a small number of patients, requiring prompt calcium and vitamin D supplementation.
Special Populations: Elderly patients and those with hepatic or renal impairment should use the drug under medical supervision; dosage adjustment for renal impairment is based on renal function. Prolonged bedridden patients should receive appropriate rehabilitation exercises to prevent further bone calcium loss.
Information source: Package Insert for Calcitonin Salmon, National Medical Products Administration; China Medical Information Query Platform, Miacalcic Calcitonin Salmon; Gutongning® Calcitonin Salmon, Beijing Shuanglu Pharmaceutical Co., Ltd.; China Medical Information Query Platform, Calcitonin Salmon for Injection.
FAQ
Is calcitonin derived from salmon?
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Salmon calcitonin ( sCT ) is the type of calcitonin hormone found in salmon.
Can you get calcitonin from eating salmon?
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Various exogenous sources of calcitonin exist, of which salmon is among the most potent. Calcitonin is approved for the treatment of osteoporosis and other diseases involving accelerated bone turnover.
Who should not take calcitonin salmon?
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Calcitonin salmon may cause allergic reactions, which can be serious. Stop using calcitonin salmon and get help right away if you have any of the following symptoms of a serious allergic reaction. Low Calcium Levels (Hypocalcemia).
Reference
1.Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fourth International Workshop [J]. Journal of Clinical Endocrinology & Metabolism, 2014, 99(10): 3561-3569.
2.NCCN Clinical Practice Guidelines in Oncology: Bone Health and Cancer Version 2.2025 [S]. NCCN Guidelines, 2025.
3.Clinical Practice Guideline for the Management of Disorders of Calcium and Phosphate Metabolism in Chronic Kidney Disease [J]. Kidney International Supplements, 2017, 7(1): 1-126.
4.Calcitonin for the Rapid Control of Severe Hypercalcemia: A Randomized, Double-blind Study in 127 Malignancy-associated Hypercalcemia Patients [J]. Journal of Clinical Oncology, 2019, 37(12): 1017-1025.
5.Chinese Expert Consensus on the Diagnosis and Treatment of Hypercalcemia (2023 Edition) [J]. Chinese Journal of Endocrinology and Metabolism, 2023, 39(8): 645-652.
6.Goodman & Gilman's The Pharmacological Basis of Therapeutics (14th Edition) [M]. McGraw-Hill Education, 2022: Chapter 48, 897-903.
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