Calcitonin (salmon) Nasal

kal-si-TOE-nin (SA-man)

Commonly used brand name(s):

In the U.S.

  • Fortical
  • Miacalcin

In Canada

  • Miacalcin Ns

Available Dosage Forms:

  • Spray

Therapeutic Class: Calcium Regulator

Pharmacologic Class: Calcitonin

Uses For calcitonin (salmon)

Calcitonin is used to treat women with postmenopausal osteoporosis (bone loss). It is used together with calcium and vitamin D.

calcitonin (salmon) is available only with your doctor's prescription.

Before Using calcitonin (salmon)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For calcitonin (salmon), the following should be considered:


Tell your doctor if you have ever had any unusual or allergic reaction to calcitonin (salmon) or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.


There is no specific information comparing the use of calcitonin in children with use in older age groups.


Calcitonin nasal solution has been tested in elderly patients and has not been found to cause different side effects or problems in older people than it does in younger adults.


Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Using calcitonin (salmon) with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Lithium

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use of calcitonin (salmon)

calcitonin (salmon) usually comes with patient directions. Read them carefully before using calcitonin (salmon). If you have any questions about using the pump spray, ask your doctor, nurse, or pharmacist.

Use calcitonin (salmon) only as directed by your doctor. Do not use more of it and do not use it more often or for a longer time than directed.

To assemble the pump:

  • If your medicine and its pump were not already assembled by the pharmacist, carefully follow the instructions provided:
  • Remove the bottle of solution from the refrigerator and let it sit until it warms to room temperature (less than 77 °F).
  • Lift the plastic tab and pull the metal safety seal off the bottle.
  • Hold the bottle upright and carefully pull the rubber stopper out of the bottle.
  • Hold the spray pump unit and remove the plastic cap from the bottom of the unit.
  • Hold the bottle upright and place the spray pump unit into the bottle.
  • Turn the spray pump unit clockwise and tighten it until it is securely fastened.

To prepare calcitonin (salmon):

  • Before you use a new bottle of calcitonin spray, the spray pump will need to be primed (started). If your pharmacist assembled the unit for you, check to see if it has already been primed by pumping the unit once. If a full spray comes out, the unit has already been primed; if not, you must prime the pump.
  • To prime, hold the bottle upright and away from you, then pump it several times until you see a faint spray.
  • Do not prime the pump again before each daily use.

To use the nose spray:

  • Before using the spray, blow your nose gently.
  • Keeping your head in an upright position, carefully place the nozzle into one nostril.
  • Press the pump toward the bottle one time. Do not spray more than once.
  • Do not inhale while spraying.
  • To keep the nosepiece clean, wipe it with a clean tissue and replace the dust cap after use.


The dose of calcitonin (salmon) will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of calcitonin (salmon). If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For nasal dosage form (nose spray):
    • For treatment of women with osteoporosis after menopause:
      • Adults—One spray into one nostril once a day. It is best to spray into the nostril on one side one day and the other side the next day.

Missed Dose

If you miss a dose of calcitonin (salmon), take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.


Keep the bottle closed when you are not using it. Keep it in the refrigerator. Do not freeze.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

After the bottle is opened, it may be kept at room temperature (no more than 77 °F) until the medicine is gone. Opened or unopened bottles left at room temperature for more than 30 days must be discarded.

calcitonin (salmon) Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common
  • Crusting, patches, or sores inside the nose
  • dryness, itching, redness, swelling, tenderness, or other signs of nasal irritation not present before use of calcitonin (salmon)
  • headaches (severe or continuing)
  • nosebleeds
  • runny nose
Less common
  • Bloody or cloudy urine
  • breathing difficulty or wheezing (severe)
  • difficult, burning, or painful urination
  • dizziness
  • frequent urge to urinate
  • loss of sense of smell
  • swollen glands
  • upper respiratory infection, with chest pain, chills, cough, ear congestion or pain, fever, head congestion, hoarseness or other voice changes, nasal congestion, runny nose, sneezing, or sore throat
  • Hair loss
  • hives, itching, or skin rash
  • increased thirst
  • taste disturbances

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Back pain
  • joint pain
Less common or rare
  • Abdominal pain
  • burning, dry, or itching eyes
  • constipation
  • diarrhea
  • flu-like symptoms (fever with or without chills, headache, body ache)
  • flushing
  • mental depression
  • muscle pain
  • nausea
  • unusual tearing of eyes
  • unusual tiredness or weakness
  • upset stomach

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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