Paricalcitol - ZEMPLAR oral capsules, adult renal regimens

Adult CKD stages 3-4: at baseline iPTH <=500 pg/mL, the initial oral dose is 1 mcg daily or 2 mcg three times weekly; above 500, use 2 mcg daily or 4 mcg three times weekly. Three-times-weekly dosing must be no more frequent than every other day. Adult stage 5: the source initial-dose formula is iPTH (pg/mL) / 80, yielding mcg per dose three times weekly, only after baseline calcium is <=9.5 mg/dL. Individualize subsequent treatment to iPTH, calcium and phosphorus. These are adult capsule instructions, not the injection or pediatric regimen, and do not establish that every CKD patient needs an activated vitamin D analog.

KDIGO 2017 recommendation 4.2.2 suggests against routine calcitriol or vitamin D analogue use in adults with nondialysis CKD G3a-G5 (2C). It reserves consideration for CKD G4-G5 with severe, progressive hyperparathyroidism (ungraded). For persistently elevated or rising PTH, assess modifiable phosphate, calcium, dietary and vitamin D factors rather than treating a single elevated measurement. These treatment-selection principles qualify whether to use an active vitamin D analogue; they do not replace the product-specific dose once therapy is selected. Dialysis patients have a separate PTH-lowering recommendation, so the nondialysis restriction is not transferred wholesale to G5D.