Calcitonin Salmon Nasal Spray (patient information)

# Why this medication is prescribed
Calcitonin salmon is used to treat osteoporosis in women who are at least 5 years past menopause and cannot or do not want to take estrogen products. Osteoporosis is a disease that causes bones to weaken and break more easily. Calcitonin is a human hormone that is also found in salmon. It works by preventing bone breakdown and increasing bone density (thickness).

# How this medication should be used
Calcitonin salmon comes as a spray to be used in the nose. It is usually used once a day, alternating nostrils every day. To help you remember to use calcitonin salmon, use it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use calcitonin salmon exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Calcitonin salmon helps treat osteoporosis but does not cure it. Continue to use calcitonin salmon even if you feel well. Do not stop using calcitonin salmon without talking to your doctor.
Before using calcitonin salmon nasal spray the first time, read the written instructions that come with it. Ask your doctor or pharmacist to show you how to use it. Practice using the nasal spray while he or she watches.
To put the pump and bottle together, remove the rubber stopper from the bottle, and then remove the plastic protective cap from the bottom of the spray unit. Put the spray pump into the bottle and turn to tighten. Then take the plastic cover off of the top of the spray unit.
Before the first time you use a new bottle, you need to prime (activate) the pump. To prime the pump, follow these steps:
- Allow the bottle to reach room temperature.
- Hold the bottle upright, and press down on the two white side arms of the pump until a full spray is produced. The pump is now primed.
To use the nasal spray, follow these steps:
- Keep your head up and place the nozzle in one nostril.
- Press down on the pump to release the calcitonin salmon.
- Use the opposite nostril each day.
- Each bottle has enough medication for 14 doses.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# Special precautions
Before using calcitonin salmon:
- tell your doctor and pharmacist if you are allergic to calcitonin salmon or any other medications. Your doctor may do a skin test before you start calcitonin salmon to make sure you do not have an allergic reaction to it.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using calcitonin salmon, call your doctor.

# Special dietary instructions
It is important that you get enough calcium and vitamin D while you are using calcitonin salmon. Your doctor may prescribe supplements if your dietary intake is not enough.

# What to do if you forget a dose
Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.

# Side effects

## Minor side effects
Calcitonin salmon may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- runny nose
- nosebleed
- sinus pain
- nose symptoms such as crusts, dryness, redness, or swelling
- back pain
- joint pain
- upset stomach
- flushing (feeling of warmth)

## Severe side effects
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
- hives
- skin rash
- itching
- difficulty breathing or swallowing
- swelling of the tongue or throat
Calcitonin salmon may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store unopened calcitonin salmon nasal spray in the refrigerator; do not freeze. Store opened bottles at room temperature in an upright position. Replace the plastic cover to keep the nozzle clean. Opened calcitonin salmon stored at room temperature should be thrown away after 30 days. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

# Other information
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to calcitonin salmon. You will also need occasional examinations of the nose to make sure calcitonin salmon nasal spray is not causing injury to the nose.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Miacalcin