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Contents
1Medical use
2Adverse effects
3Mechanism of action
4Biosynthesis and its regulation
o 4.1Interactive pathway map
o 4.2Metabolism
5History
6Names
7References
Medical use[edit]
Calcitriol is prescribed for:[12]
Adverse effects[edit]
The main adverse drug reaction associated with calcitriol therapy is hypercalcemia – early
symptoms
include: nausea, vomiting, constipation, anorexia, apathy, headache, thirst, pruritus, sweating,
and/or polyuria. Compared to other vitamin D compounds in clinical use
(cholecalciferol, ergocalciferol), calcitriol has a higher risk of inducing hypercalcemia. However,
such episodes may be shorter and easier to treat due to its relatively short half-life.[12]
Mechanism of action[edit]
Calcitriol increases blood calcium levels ([Ca2+
]) by:
Calcitriol is produced in the cells of the proximal tubule of the nephron in the kidneys by the
action of 25-hydroxyvitamin D3 1-alpha-hydroxylase, a mitochondrial oxygenase and
an enzyme which catalyzes the hydroxylation of 25-hydroxycholecalciferol (calcifediol) in the 1-
alpha position.
The activity of this enzyme is stimulated by PTH. This is an important control point
in Ca2+ homeostasis.[19] Additional effects on the production of calcitriol include an increase
by prolactin, a hormone which stimulates lactogenesis (the formation of milk in mammary
glands), a process which requires large amounts of calcium.[22] Activity is also decreased by
high levels of serum phosphate and by an increase in the production of the hormone FGF23 by
osteocyte cells in bone.[23]
Calcitriol is also produced outside the kidney in small amounts by many other tissues
including placenta and activated macrophages.[24]
When the drug alfacalcidol is used, 25-hydroxylation in the liver will produce calcitriol as the
active metabolite. This will produce greater effects than other vitamin D precursors in patients
with kidney disease who have loss of the renal 1-alpha-hydroxylase.[25]
Metabolism[edit]
Calcitriol's lifespan in the body is measured in hours, unlike its precursor calcifediol whose
lifespan is measured in weeks.[26] Calcitriol is inactivated by further hydroxylation to form
1,24,25-trihydroxyvitamin D, calcitroic acid. This occurs through the action of the CYP24A1 24-
hydroxylase.[27] Calcitroic acid is more soluble in water and is excreted in bile and urine.
History[edit]
It was first identified in 1971 by Michael F. Holick working in the laboratory of Hector
DeLuca,[28][29] and also by Tony Norman and colleagues.[30]
Names[edit]
Calcitriol usually refers specifically to 1,25-dihydroxycholecalciferol.
Because cholecalciferol already has one hydroxyl group, only two (1,25) are further specified in
this nomenclature, but there are three (1,3,25-triol), as indicated in when calcitriol is used. The
1-hydroxy group is in the alpha position, and this may be specified in the name, for instance in
the abbreviation 1α,25-(OH)2D3.[2]
Calcitriol is, strictly, the 1-hydroxylation product of calcifediol (25-OH vitamin D3), derived from
cholecalciferol (vitamin D3), rather than the product of hydroxylations of ergocalciferol(vitamin
D2).[2] 1α,25-Dihydroxyergocalciferol (ercalcitriol) should be used for the vitamin
D2 product.[2] However, the terminology of 1,25-dihydroxyvitamin D, or 1,25(OH)2D, is often
used to refer to both types of active forms of vitamin D. Indeed, both bind to the vitamin D
receptor and produce biological effects.[31] In clinical use, the differences are unlikely to have
major importance.[25]
Calcitriol is marketed as a pharmaceutical for medical use under various trade names including
Rocaltrol (Roche), Calcijex (Abbott), Decostriol (Mibe, Jesalis), Vectical (Galderma), and
Rolsical (Sun Pharma).