100 units daily (injection); 200 units daily (spray)
Cycle
Continuous
Form
Ready-made product
A 32-amino-acid copy of the calcitonin hormone made by salmon, which is more potent and longer-acting in people than human calcitonin. It slows the cells that break down bone (osteoclasts) and lowers blood calcium.
Evidence. FDA-approved since 1975: injections for Paget’s disease of bone and high blood calcium, and injections or a nasal spray for postmenopausal osteoporosis when other treatments aren’t suitable. After 2012–2014 reviews found slightly more cancers with long-term use (4.1% vs 2.9% on placebo across 21 trials), nasal sprays left the European and Canadian markets and FDA added a warning and narrowed the uses.
What it’s used for
Approved uses first, then uses tested in people, then claims that rest on animal studies or user reports.
Paget’s disease of bone
LabelApproved as an injection when other treatments don’t work or don’t suit. In open-label trials, about 2 in 3 patients had a 30%+ fall in bone-turnover markers, and a similar share had less bone pain.
High blood calcium (hypercalcemia)
LabelApproved for early emergency treatment alongside other drugs. In 4 small trials (53 patients), calcium began falling within 1–2 hours and was about 9% lower 8 hours after a dose.
Osteoporosis in postmenopausal women
LabelUS only, when other treatments aren’t suitable; the label says fracture reduction isn’t shown. In PROOF, 200 units of nasal spray daily cut new spine fractures 33% over 5 years; 100 and 400 units didn’t.
Bone loss after sudden immobilization
LabelLicensed in the UK and EU for 2–4 weeks, for example after a recent osteoporotic fracture, to slow rapid bone loss. Not an approved use in the US.
Pain from a recent spine fracture
TrialPositive short term: across 13 small trials (589 people), calcitonin eased pain from recent osteoporotic spine fractures within a week. It didn’t help chronic pain from older fractures. Not an approved use.
Knee osteoarthritis
TrialNegative: two 2-year trials of oral calcitonin tablets in 2,206 people didn’t slow joint-space narrowing on X-ray. The tablets were never approved.
Spinal stenosis leg pain
TrialNegative: in 40 people with lumbar spinal stenosis, 4 weeks of nasal calcitonin didn’t improve disability, leg pain or walking distance more than placebo.
Phantom limb pain
TrialUnproven: IV infusions eased early phantom pain after amputation in a 21-person crossover trial (1992), but a 2008 trial found no benefit for long-standing phantom pain.
Label: an approved use. Trial: tested in people, with the result.
Approved in the US since 1975. Miacalcin and generic injections are approved for Paget’s disease of bone, high blood calcium and postmenopausal osteoporosis, and generic nasal sprays for postmenopausal osteoporosis; since 2014, osteoporosis and Paget’s use is limited to people for whom other treatments aren’t suitable. Brand Miacalcin and Fortical sprays are discontinued.
Approval history
1975US FDA: Calcimar: first US approval of salmon calcitonin injection
1986US FDA: Miacalcin injection: Paget’s disease, high blood calcium and postmenopausal osteoporosis
1999EU (EMA): Forcaltonin: first EU-wide calcitonin license (recombinant); withdrawn in 2008
2013EU (EMA): Calcitonin medicines: osteoporosis use and nasal sprays ended after cancer review
2014US FDA: Miacalcin: cancer warning added; osteoporosis and Paget’s use restricted
European Union
No EU-wide license now (Forcaltonin was withdrawn in 2008). National prescription injections only, for short courses in Paget’s disease, sudden immobilization and cancer-related high calcium; nasal sprays ended 2013.
United Kingdom
Prescription-only injections (50 and 100 units/mL) licensed by the MHRA for sudden immobilization (up to 4 weeks), Paget’s disease (usually up to 3 months) and cancer-related high calcium.
Canada
Nasal sprays left the market in October 2013, and Calcimar injection was cancelled in September 2026. Two injections remain approved but aren’t marketed.
Australia
Prescription only (Schedule 4). Miacalcic injection is registered for active Paget’s disease when alternatives don’t suit, and for high blood calcium.
Sport (WADA 2026)
Not banned in sportNot named on the 2026 list, and S0 doesn’t apply to an approved drug. Calcitonin isn’t among the S2 peptide hormones and growth factors the list names.
Sport status follows the WADA Prohibited List in force since January 1, 2026; athletes should confirm with their anti-doping organization. Checked October 5, 2026. Status outside the US checked October 7, 2026 against EMA, MHRA, Health Canada and TGA records. By country: EU, UK, Canada, Australia. Status of every compound.
How it works
Calcitonin salmon binds the calcitonin receptor on osteoclasts, the cells that break down bone, and on kidney cells. It quickly slows bone breakdown, so less calcium leaves the bone, and makes the kidneys pass more calcium, phosphate and sodium; together these lower blood calcium. The salmon form is more potent per mg and longer-acting than human calcitonin. In Paget’s disease, markers of fast bone turnover fall.
LabelBased on the product label.
Not known
The labels say calcitonin’s role in normal human bone isn’t fully understood. Why trial patients had slightly more cancers, and how it eases pain after spine fractures, are unknown.
Protocol
Label
Miacalcin injection
Paget’s disease: 100 units (0.5 mL) once a day under the skin or into a muscle. High blood calcium: 4 units per kg every 12 hours, raised to 8 units per kg every 12 hours and then every 6 hours if calcium doesn’t respond.
Label
Calcitonin salmon nasal spray and Miacalcin
Postmenopausal osteoporosis, only when other treatments aren’t suitable: 1 spray (200 units) into one nostril once a day, alternating nostrils, or 100 units a day by injection, with enough calcium and vitamin D.
Label
UK and EU injections
After sudden immobilization: 100 units a day (or 50 units twice a day) for 2 weeks, never more than 4. Paget’s treatment normally stops by 3 months.
Frequency
Once daily (every 6–12 hours for high calcium)
Route
Subcutaneous or intramuscular injection; nasal spray (US, for osteoporosis); IV infusion abroad for high calcium
Timing
Any time of day; the UK label says giving it at bedtime, or in the evening after a meal, makes nausea less likely.
Cycle
Ongoing in the US, but the labels say to recheck the need for it regularly because of the cancer signal. UK and EU labels limit Paget’s treatment to about 3 months and immobilization use to 2–4 weeks.
Week 15913172125
Continuous, shown over 26 weeks
Common protocols
The ways Calcitonin is most often run, each tagged with where it comes from.
Paget’s disease (injection)
Label
Dose
100 units
How often
Once daily, under the skin or into a muscle
How long
Ongoing in the US with regular review; normally up to 3 months in the UK and EU
Only when other treatments don’t work or don’t suit. The UK label says 50 units 3 times a week has also worked.
High blood calcium (injection)
Label
Dose
4–8 units per kg
How often
Every 12 hours, up to every 6 hours
How long
Days, as a bridge until other treatment works
Given early, with IV fluids and other drugs. In hospitals abroad it may also run as an IV drip over at least 6 hours.
Postmenopausal osteoporosis (nasal spray)
Label
Dose
200 units (1 spray)
How often
Once daily, alternating nostrils
How long
Ongoing, rechecked regularly
US only, for women more than 5 years past menopause when other treatments aren’t suitable. The US label says fracture reduction hasn’t been shown.
Sudden immobilization (UK and EU)
Label
Dose
100 units, or 50 units twice daily
How often
Daily, under the skin or into a muscle
How long
2 weeks, never more than 4
To prevent rapid bone loss, for example after a recent osteoporotic fracture; the dose may drop to 50 units as the person gets moving. Not a US use.
Dosing by body weight
Label
4–8 IU/kg. Miacalcin injection for high blood calcium only: every 12 hours, rising to 8 units per kg every 6 hours if calcium doesn’t respond. Other uses have fixed doses.
Taking it
Where it goes
Under the skin or into a muscle (label); doses over 2 mL go into a muscle, split between sites. The spray goes into one nostril a day, alternating sides. Hospitals abroad also give it by IV drip.
If you miss a dose
The US and UK labels give no missed-dose rule. Don’t double up; take the next dose at the usual time and ask the prescriber.
In people with high calcium, blood calcium starts to fall: about 9% (2–3 mg/dL) 8 hours after a dose, with the peak effect at 24–48 hours (4 small trials, 53 patients).
Label
Months of Paget’s treatment
In open-label trials lasting months to 2 years, about 2 in 3 patients had a fall of more than 30% in bone-turnover markers, and a similar share had less bone pain.
Label
2 years of the nasal spray
Spine density rose 1.0–1.6%, vs a change of −1.9% to +0.2% on placebo, with no effect on the hip or forearm. The US label says fracture reduction hasn’t been shown.
Label
2–18 months
About half of people with Paget’s disease who were tested developed antibodies; high levels usually go with a loss of response.
Label
Side effects and what to do
Nausea, with or without vomiting (label: about 10% with injections)
Worst at the start and tends to fade. The UK label suggests evening doses after a meal, and an anti-nausea drug if needed.
Flushing of the face or hands (label: 2–5% with injections) and injection-site inflammation (about 10%)
Flushing comes 10–20 minutes after a dose and isn’t an allergy, the UK label says. Rotate injection sites.
Runny or stuffy nose 12% vs 7% on placebo, nosebleeds 4% and sinusitis 2% (nasal spray label)
The label recommends nose exams and stopping for ulcers over 1.5 mm across, deep ulcers or heavy bleeding.
Low blood calcium, with cramps, twitching or, rarely, seizures (label)
Low calcium is corrected before starting. In active Paget’s disease, calcium dips most 4–6 hours after a dose, usually without symptoms.
Serious allergic reactions, rarely fatal (label)
Swelling of the tongue or throat, wheezing or trouble breathing needs emergency care.
Stop and get medical help
Swelling of the tongue or throat, wheezing or trouble breathing: get emergency care (label). Also report muscle cramps, twitching or seizures, which can mean low calcium, and heavy nosebleeds or nose sores with the spray.
Can it cause …?
The side effects people ask about most, answered one by one. Each answer says where it comes from.
Tiredness
LabelFatigue is listed as common (up to 1 in 10 people) in the UK label, which warns it can affect driving.
Headache
LabelHeadache: 3% on the nasal spray vs 5% on placebo. The UK injection label lists it as common, up to 1 in 10 people.
Nausea or vomiting
LabelNausea, with or without vomiting, in about 10% on injections, mostly at the start. It rises with dose and is less frequent with evening doses after meals (UK label).
Diarrhea or constipation
LabelDiarrhea and belly pain are listed as common (up to 1 in 10) in the UK label and appear in US post-marketing reports.
Dizziness
LabelDizziness is listed as common in the UK label (up to 1 in 10) and was reported by 1–3% of nasal spray users in trials.
Trouble sleeping
Not reportedTrouble sleeping isn’t listed in the US or UK labels; the nasal spray safety trials followed 341 women for 1–2 years.
Hair loss
Not reportedHair loss isn’t listed in the US or UK labels; the nasal spray safety trials followed 341 women for 1–2 years.
Acne, rash or skin changes
LabelFlushing of the face or hands in 2–5% on injections, 10–20 minutes after a dose, and site inflammation in about 10%. Rash and itching are uncommon.
Water retention or swelling
LabelSwelling of the face, legs or whole body (edema) is listed as uncommon. Swelling of the tongue or throat can signal a serious allergic reaction.
Joint or muscle pain
LabelBack pain 5% vs 2% on placebo with the nasal spray; joint pain 4% vs 5%. The UK label lists muscle and joint pain as common.
Anxiety, low mood or irritability
LabelDepression was reported by 1–3% of nasal spray users in trials; the label gives no placebo comparison for it.
Low or high blood sugar
Not reportedBlood sugar changes aren’t listed in the US or UK labels; the nasal spray safety trials followed 341 women for 1–2 years.
Fast heartbeat or blood pressure changes
LabelRaised blood pressure is listed as uncommon in the UK label and appears in US post-marketing reports. Flushing is common but isn’t an allergy.
More hunger
LabelMore hunger isn’t a listed effect. Poor appetite has been reported with the injection.
Liver strain
LabelLiver problems aren’t a listed effect. The UK label says people with liver disease tolerated it without dose changes.
Kidney problems
LabelAbnormal urine sediment appeared in volunteers on bed rest and cleared after stopping, so the labels suggest periodic urine checks. Passing more urine is listed as uncommon.
Cancer risk
LabelIn 21 trials of nasal and oral forms, cancers were more common on calcitonin (4.1%) than placebo (2.9%); no cause was found. Labels advise rechecking the need regularly.
Label: from the prescribing information. Not reported: studied in people and not reported. A side effect that hasn’t been reported can still happen, especially with long or high-dose use. Any of these across every compound: the side-effect finder.
Who should avoid it
What its label rules out or warns about, most important first.
Allergy to calcitonin salmon
LabelRuled out by the labels. Fatal anaphylaxis, airway spasm and throat swelling have been reported; skin testing is suggested first when an allergy is suspected.
Low blood calcium
LabelRuled out by the UK label. The US labels say low calcium and vitamin D deficiency must be treated first, since calcitonin can cause cramps, twitching and seizures.
Anyone needing long-term treatment
LabelTrials found slightly more cancers with long-term use (4.1% vs 2.9%). US labels say to recheck the need regularly; Europe limits courses to weeks or a few months.
Pregnancy or breastfeeding
LabelNo human data; it lowered fetal weight in rabbits and reduced milk production in rats. Australia’s label rules out both, and the UK label advises against breastfeeding.
Nose sores or damage (nasal spray)
LabelThe spray can cause ulcers and bleeding. Its label calls for a nose exam before starting and stopping for ulcers over 1.5 mm, deep ulcers or heavy bleeding.
Children and teens
LabelSafety and effectiveness aren’t established in children (US labels), and the UK label doesn’t recommend it under 18.
Interactions
Only interactions stated on a product label or measured in a human study are listed.
Lithium
LabelCalcitonin can lower lithium levels by raising its loss in urine, so the US and UK labels say the lithium dose may need adjusting.
Heart drugs sensitive to calcium (digoxin, calcium channel blockers such as verapamil)
LabelCalcitonin can briefly push calcium below normal, which can change their effects; the UK label urges care and says their doses may need adjusting.
Bisphosphonates (such as alendronate or zoledronic acid)
LabelUsed together, they may lower blood calcium more than either alone, the UK label says.
Label: a product label rules it out, warns about it or lists the interaction. This isn’t a complete list: a pharmacist or doctor can check a specific medicine or condition. Every documented interaction, by medicine: drug interactions.
Special situations
What the label and studies say about pregnancy, breastfeeding, kidney and liver problems, age and surgery.
Pregnancy
LabelNo human data; at 4–18 times the human dose it lowered fetal weight in rabbits. Australia’s label rules it out, and the UK label allows it only if absolutely essential.
Breastfeeding
LabelUnknown whether it passes into human milk; in animals it reduced milk production and passed into milk. The UK label advises against breastfeeding, and Australia’s rules it out.
Kidney problems
LabelThe kidneys break it down, and clearance is much lower in kidney failure, though the UK label calls the importance unknown. Australia’s label says a smaller dose may be needed.
Liver problems
LabelNo dose change: the UK label says people with liver problems tolerated it without altered dosing. The US labels don’t address liver disease.
Older adults
LabelUS trials had few people over 65, but no differences in response were seen in practice. Most people with Paget’s disease are older; the UK label reports no reduced tolerability.
Children and teens
LabelNot approved for children: safety and effectiveness aren’t established (US labels), and the UK label doesn’t recommend it under 18.
Surgery and anesthesia
PrecautionNo label advice. It lowers blood calcium for hours after a dose; tell the surgical team about any injected or nasal medicine.
Label: what the prescribing information says. Precaution: not studied, so the caution follows from how it works or from a related drug. Ages are given as approved or studied; this site never gives doses for children. Across every compound: pregnancy, breastfeeding, kidney disease, liver disease, older adults and surgery.
Tracking and pairing
Worth tracking
Blood calcium, especially over the first doses
Nose exams before and during nasal spray use (label)
Alkaline phosphatase or other bone-turnover markers in Paget’s disease
Urine sediment from time to time (label)
Lithium level if taking lithium
Often paired with
Usually run on its own.
Human studies
5 key published human studies, with how many people took part. Animal studies aren’t listed here.
20001,255 people
200 units cut new spine fractures 33% vs placebo (51 of 287 vs 70 of 270 women; RR 0.67); the 100 and 400 unit doses didn’t differ significantly from placebo.
Design
Randomized double-blind placebo-controlled trial in postmenopausal women with osteoporosis (PROOF)
Dose
Nasal spray, 100, 200 or 400 units daily
Length
5 years (511 women completed)
Chesnut et al., Am J Med 2000, PMID 10996576
2012565 people
Spine density rose 1.5% on the tablets vs 0.78% on the nasal spray and 0.5% on placebo; the spray didn’t differ from placebo. The tablets were never approved.
Design
Randomized double-blind double-dummy trial vs nasal calcitonin and placebo in postmenopausal women with osteoporosis (ORACAL)
Dose
Oral recombinant calcitonin 0.2 mg daily, nasal spray 200 units daily, or placebo
Length
48 weeks
Binkley et al., J Bone Miner Res 2012, PMID 22437792
20152,206 people
No effect on joint-space narrowing on X-ray in either trial; gains in pain and function in one trial weren’t confirmed statistically.
Design
Two randomized double-blind placebo-controlled trials in painful knee osteoarthritis
Dose
Oral calcitonin tablets, 0.8 mg twice daily
Length
24 months
Karsdal et al., Osteoarthritis Cartilage 2015, PMID 25582279
2012589 people
Pain at rest from a recent fracture was lower by week 1 and kept improving through week 4; for chronic pain from older fractures there was no difference at rest.
Design
Systematic review and meta-analysis of 13 randomized controlled trials in people with osteoporotic spine fractures
Dose
Calcitonin by various routes and doses
Length
Up to 4 weeks for recent fractures; up to 6 months for older ones
Knopp-Sihota et al., Osteoporos Int 2012, PMID 21660557
200740 people
No difference from placebo at 4 weeks in disability (Oswestry score change 1.3 vs 0.6 points), leg pain or walking distance.
Design
Randomized double-blind placebo-controlled trial in lumbar spinal stenosis
Registered trials that are still running, or that finished without published results, most important first. Checked on ClinicalTrials.gov, October 7, 2026.
Phase 3NCT07655804
Daily salmon calcitonin injections vs saline for 3 weeks in 168 adults with shingles: whether it prevents lasting nerve pain at 3 months
Recruiting since July 2026; completion expected October 2027
Not applicableNCT06330168
Calcitonin added to a nerve block before chest surgery (thoracotomy) in 92 patients: morphine use and chronic pain at 3 months
Completed May 2026; no results posted
Phase 4NCT03935984
Calcitonin to lower calcium before repeat parathyroid scans in 37 people with primary hyperparathyroidism: scan sensitivity
Recruiting since May 2019; completion expected December 2026
Not applicableNCT07033104
Calcitonin added to a bupivacaine nerve block for cesarean section in 70 women: time to first rescue pain relief
Listed as recruiting, but its estimated September 2025 completion has passed; no results posted
The US approvals rest on small open-label trials in Paget’s disease and high calcium and on bone-density trials. The only large fracture trial, PROOF (1,255 women), lost more than half its participants by 5 years and helped at only one of three doses. The cancer signal comes from pooled trials of nasal and oral forms, not injections. Uses for arthritis, spinal stenosis and long-term pain are unproven or negative.
How it’s supplied
Injection vials of 200 units per mL (2 mL, multi-dose) and nasal sprays giving 200 units per spray; abroad, single-use ampoules of 50 or 100 units per mL. Injected under the skin or into a muscle, often by the patient, or sprayed into one nostril once a day. Abroad, hospitals also give it by IV drip. It’s used as supplied, so the calculator and dose log don’t apply.
Nothing to mix: the injections and sprays come ready to use. Doses are measured in units of activity, not mg; the US injection holds 200 units per mL, so 100 units is 0.5 mL.
Datasheet
Half-life
about 1 hourLabelAfter injection under the skin (59–64 minutes) or into a muscle (58 minutes); levels peak about 23 minutes after a dose under the skin. After the nasal spray, about 18 minutes.
Type
Peptide, 32 amino acids
Molecular weight
3,431.9 g/mol
Formula
C145H240N44O48S2
Sequence
CSNLSTCVLGKLSQELHKLQTYPRTNTGSGTP-NH2Disulfide bridge between Cys1 and Cys7; C-terminal prolinamide
Storage before use
Not a powder: injections and sprays are ready-made solutions. Injection vials and unopened sprays: fridge (2–8 °C), never frozen.
After mixing or opening
An opened spray is kept upright at 20–25 °C for up to 30 days (2 mL bottle, 14 doses) or 35 days (3.7 mL bottle, 30 doses). UK ampoules are single use.
Half-life: Miacalcin injection prescribing information, section 12.3; calcitonin salmon nasal spray prescribing information (Apotex, September 2026), section 12.3
Molecule: PubChem CID 16220016 (free peptide); FDA GSRS, UNII 7SFC6U2VI5 (sequence, 1–7 disulfide, calculated MW 3432.0). Products contain the acetate.
Storage:Label Miacalcin injection prescribing information, section 16; calcitonin salmon nasal spray prescribing information (Apotex, September 2026), section 16; UK SmPC (Essential Pharma, September 2024), section 6.6
Doses are units of biological activity, not weight: the UK label says 1 unit is 0.167 mcg of peptide and Australia’s says 0.2 mcg, so 100 units is about 17–20 mcg. Products hold synthetic calcitonin as the acetate; Fortical used a recombinant form.
Cautions
In 21 trials, cancers were more common with calcitonin than placebo (4.1% vs 2.9%), so the labels say to recheck the need for ongoing use regularly. Europe allows only short courses.
Serious allergic reactions, including fatal anaphylaxis, have been reported; the labels suggest skin testing first in people with a suspected allergy.
Can lower blood calcium enough to cause cramps, twitching or seizures. Low calcium must be corrected before starting, and calcium and vitamin D intake kept up.
The nasal spray can irritate the nose, cause nosebleeds and, rarely, ulcers; its label recommends nose exams before and during use.
Antibodies developed in about half of people with Paget’s disease tested after 2–18 months, and high levels can stop it working.
Questions
What is calcitonin?
A 32-amino-acid copy of the calcitonin hormone made by salmon, which is more potent and longer-acting in people than human calcitonin. It slows the cells that break down bone (osteoclasts) and lowers blood calcium.
How does calcitonin work?
Calcitonin salmon binds the calcitonin receptor on osteoclasts, the cells that break down bone, and on kidney cells. It quickly slows bone breakdown, so less calcium leaves the bone, and makes the kidneys pass more calcium, phosphate and sodium; together these lower blood calcium. The salmon form is more potent per mg and longer-acting than human calcitonin. In Paget’s disease, markers of fast bone turnover fall. The labels say calcitonin’s role in normal human bone isn’t fully understood. Why trial patients had slightly more cancers, and how it eases pain after spine fractures, are unknown.
Is calcitonin FDA-approved?
Approved in the US since 1975. Miacalcin and generic injections are approved for Paget’s disease of bone, high blood calcium and postmenopausal osteoporosis, and generic nasal sprays for postmenopausal osteoporosis; since 2014, osteoporosis and Paget’s use is limited to people for whom other treatments aren’t suitable. Brand Miacalcin and Fortical sprays are discontinued.
What is the usual calcitonin dose?
From the label (Miacalcin injection): Paget’s disease: 100 units (0.5 mL) once a day under the skin or into a muscle. High blood calcium: 4 units per kg every 12 hours, raised to 8 units per kg every 12 hours and then every 6 hours if calcium doesn’t respond. Calcitonin salmon nasal spray and Miacalcin: Postmenopausal osteoporosis, only when other treatments aren’t suitable: 1 spray (200 units) into one nostril once a day, alternating nostrils, or 100 units a day by injection, with enough calcium and vitamin D. These are the amounts sources reference, not recommendations.
How is calcitonin given?
Injected under the skin or into a muscle, often by the patient, or sprayed into one nostril once a day. Abroad, hospitals also give it by IV drip. Any time of day; the UK label says giving it at bedtime, or in the evening after a meal, makes nausea less likely.
Who should avoid calcitonin?
Allergy to calcitonin salmon: Ruled out by the labels. Fatal anaphylaxis, airway spasm and throat swelling have been reported; skin testing is suggested first when an allergy is suspected. Low blood calcium: Ruled out by the UK label. The US labels say low calcium and vitamin D deficiency must be treated first, since calcitonin can cause cramps, twitching and seizures. Anyone needing long-term treatment: Trials found slightly more cancers with long-term use (4.1% vs 2.9%). US labels say to recheck the need regularly; Europe limits courses to weeks or a few months. The “Who should avoid it” section lists 3 more groups and 3 interactions.
What is the half-life of calcitonin?
About 1 hour, according to the prescribing information. After injection under the skin (59–64 minutes) or into a muscle (58 minutes); levels peak about 23 minutes after a dose under the skin. After the nasal spray, about 18 minutes.
How should calcitonin be stored?
Not a powder: injections and sprays are ready-made solutions. Injection vials and unopened sprays: fridge (2–8 °C), never frozen. An opened spray is kept upright at 20–25 °C for up to 30 days (2 mL bottle, 14 doses) or 35 days (3.7 mL bottle, 30 doses). UK ampoules are single use.
Is calcitonin banned in sport?
No. Not named on the 2026 list, and S0 doesn’t apply to an approved drug. Calcitonin isn’t among the S2 peptide hormones and growth factors the list names.
Has calcitonin been studied in people?
Yes. The human studies section lists 5 published studies. The largest, from 2015, included 2,206 people. No effect on joint-space narrowing on X-ray in either trial; gains in pain and function in one trial weren’t confirmed statistically.
How long has calcitonin been studied in people?
Trial PROOF: 1,255 women randomized to nasal calcitonin or placebo for up to 5 years; 511 completed all 5 years.
Does calcitonin come in other forms, like a pill or nasal spray?
Label Injected under the skin or into a muscle, or by IV drip abroad. The US nasal spray delivers 3–5% of what a muscle injection does. Oral tablets reached large trials but were never approved.
Can you drink alcohol while taking calcitonin?
No study The labels don’t mention alcohol, and no study has tested the combination.
Can calcitonin be taken with semaglutide or tirzepatide?
No study No study has combined them, and neither drug’s label lists an interaction. Calcitonin receptors also form part of the amylin receptors that cagrilintide targets.
What happens if you take too much calcitonin?
Label Per the US label, an overdose could cause low-calcium muscle spasms (tetany), and 1,000 units under the skin may cause nausea and vomiting. Call Poison Help (1-800-222-1222), or emergency services for severe symptoms.
Sources
Miacalcin (calcitonin salmon) injection prescribing information, Mylan Institutional (DailyMed, version of September 2024)
FDA supplement approval letter, Miacalcin injection NDA 017808/S-035: malignancy warning and revised indications (March 11, 2014)
FDA notice of the March 5, 2013 joint advisory committee meeting on calcitonin salmon and cancer risk (Federal Register, January 14, 2013)
EMA Article 31 referral on calcitonin-containing medicines (CHMP opinion July 19, 2012; European Commission decision February 13, 2013)
Drugs@FDA records for Calcimar (NDA 017497 and 017769), Miacalcin injection (NDA 017808) and nasal spray (NDA 020313) and Fortical (NDA 021406); FDA determinations in the Federal Register, September 9, 2019 and February 17, 2023
Calcitonin 100 IU/mL solution for injection and infusion, UK summary of product characteristics (Essential Pharma, rev. September 2024)
Chesnut et al., PROOF trial of nasal salmon calcitonin (Am J Med 2000) PMID 10996576
For the protocol details
Miacalcin injection prescribing information, sections 2, 5, 6, 12 and 14 (Mylan Institutional, DailyMed, September 2024)
Calcitonin salmon nasal spray prescribing information, sections 2, 5, 6 and 14 (Apotex, DailyMed, September 10, 2026)
Calcitonin 100 IU/mL UK summary of product characteristics, sections 4.2, 4.8 and 6.6 (Essential Pharma, rev. September 2024)
For how it works, who should avoid it and the limits of the evidence
Miacalcin injection prescribing information, sections 4, 5, 7, 8 and 12 (Mylan Institutional, DailyMed, September 2024)
Calcitonin salmon nasal spray prescribing information, sections 4, 5 and 6 (Apotex, DailyMed, September 10, 2026)
Calcitonin 100 IU/mL UK summary of product characteristics, sections 4.2–4.6 and 5.1 (Essential Pharma, rev. September 2024)
Miacalcic Australian product information, sections 4.3 and 4.4 (Chiesi, rev. March 11, 2026)
For uses, the side-effect questions, special situations, trials, identifiers and status outside the US
Miacalcin (calcitonin salmon) injection prescribing information, sections 1, 5, 6, 8, 10, 12 and 14 (Mylan Institutional, DailyMed, September 2024)
Calcitonin salmon nasal spray prescribing information, sections 6, 12 and 14 (Apotex, DailyMed, September 10, 2026)
Calcitonin 50 and 100 IU/mL UK summary of product characteristics (Essential Pharma, PL 41871/0009, rev. September 2024)
Miacalcic Australian product information (Chiesi, rev. March 11, 2026), Schedule 4
EMA Article 31 referral on calcitonin-containing medicines (2012–2013) and EMA medicines data for Forcaltonin (withdrawn October 29, 2008)
Health Canada Drug Product Database entries for calcitonin products (checked October 8, 2026)
Binkley et al., ORACAL trial of oral recombinant calcitonin (J Bone Miner Res 2012) PMID 22437792
Knopp-Sihota et al., calcitonin for pain of osteoporotic spine fractures, meta-analysis (Osteoporos Int 2012) PMID 21660557
Karsdal et al., two phase 3 trials of oral salmon calcitonin in knee osteoarthritis (Osteoarthritis Cartilage 2015) PMID 25582279
Tafazal et al., nasal salmon calcitonin in lumbar spinal stenosis (Eur Spine J 2007) PMID 16865379
Jaeger and Maier, calcitonin in phantom limb pain (Pain 1992) PMID 1738570
Eichenberger et al., calcitonin and ketamine in chronic phantom limb pain (Anesth Analg 2008) PMID 18349204
Copp et al., evidence for calcitonin, a new hormone (Endocrinology 1962) PMID 13881211
Niall et al., amino acid sequence of salmon calcitonin (Proc Natl Acad Sci U S A 1969) PMID 5261048
FDA Global Substance Registration System record (UNII 7SFC6U2VI5) and PubChem CID 16220016
ClinicalTrials.gov registry entries for the trials listed (checked October 8, 2026)