Issues for surgery
Potential hypocalcaemia if omitted; parathyroid hormone (PTH) and phosphate levels may alter secondary to hypocalcaemia.
Potential vitamin D deficiency if omitted for a prolonged period.
Advice in the perioperative period
Elective surgery
Continue – check serum adjusted calcium pre-operatively.
Consider checking parathyroid hormone, alkaline phosphatase (ALP) and serum phosphate levels pre-operatively if not checked within the previous 4 weeks.
Patients undergoing parathyroidectomy
Patients undergoing parathyroidectomy may be given 2 – 3 weeks pre-operative treatment with alfacalcidol.
Emergency surgery
Continue – check serum adjusted calcium pre-operatively.
Consider checking parathyroid hormone, alkaline phosphatase (ALP) and serum phosphate levels pre-operatively if not checked within the previous 4 weeks.
Post-operative advice
Restart post-operatively as soon as next dose is due.
Monitor serum phosphate and adjusted calcium levels, particularly if the patient has post-operative nausea and vomiting (PONV).
Patients undergoing parathyroidectomy
Patients undergoing parathyroidectomy may need an altered dose of alfacalcidol post-operatively. The drug, dose, frequency, and duration should be discussed with the patient’s Endocrinologist or Nephrologist.
Interactions with common anaesthetic agents
None.
Interactions with other common medicines used in the perioperative period
Magnesium-based antacids and laxatives should not be used during treatment with alfacalcidol due to increased risk of hypermagnesaemia.
Alfacalcidol may increase serum concentrations of aluminium. If there is concomitant use of aluminium-containing antacids monitor for signs of aluminium-related toxicities.
Further information
None relevant.
References
Summary of Product Characteristics – Alfacalcidol 0.25microgram soft capsules. Strides Pharma UK Ltd. Accessed via www.medicines.org.uk 10th April 2023 [date of revision of the text December 2022]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 10th April 2023]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 10th April 2023]