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Bone & mineral

Calcitonin (salmon)

Also called Miacalcin, salmon calcitonin, calcitonin-salmon, Fortical

Salmon calcitonin is a thyroid-type hormone taken from salmon that lowers blood calcium and slows bone breakdown. It is an older FDA-approved drug for Paget's disease, high blood calcium, and postmenopausal osteoporosis, now used much less because of a small cancer signal and better alternatives.

FDA-approvedApproved by the FDA for at least one use after large human trials.

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Drawn from its published sequence: 32 residues, one bead each. Dashed arcs are ring bonds.

Overview

Salmon calcitonin is a thyroid-type hormone taken from salmon that lowers blood calcium and slows bone breakdown. It is an older FDA-approved drug for Paget's disease, high blood calcium, and postmenopausal osteoporosis, now used much less because of a small cancer signal and better alternatives.

How it works

Established: calcitonin binds calcitonin receptors on osteoclasts (the cells that break down bone) and quickly reduces their activity. This lowers bone resorption and blood calcium. The salmon form is used because it is more potent and longer-acting in humans than human calcitonin.

What research shows

  • A meta-analysis of 21 trials (mostly nasal spray) found malignancies in 4.1% of calcitonin users vs 2.9% on placebo (FDA injection label).
  • An unpublished meta-analysis of 18 nasal-spray studies put cancer risk at 1.54 times control (95% CI 1.06-2.23), presented at the 2013 FDA advisory committee meeting (Medical Letter 2013).
  • For osteoporosis, the injection label states that fracture reduction has not been shown (FDA label).

Doses studied in people

Study or labelDose usedSource
FDA label (Miacalcin injection), Paget's disease of bone100 USP units daily, subcutaneous or intramuscular1
FDA label (Miacalcin injection), hypercalcemia4 USP units/kg every 12 hours, may increase up to 8 USP units/kg every 6 hours1
FDA label (Miacalcin injection), postmenopausal osteoporosis100 USP units daily1
FDA label (Miacalcin nasal spray), postmenopausal osteoporosis200 IU (one spray) intranasally once daily, alternating nostrils2

Doses come from the FDA labels; the labels advise reassessing ongoing use from time to time because of the malignancy signal.

Read this first: these are the amounts given to participants in published studies or written on official prescribing labels, reported for reference. They are not recommendations. Trial doses were chosen for specific patients under medical supervision, and a dose that is safe in one person can be harmful in another.

Safety

  • Malignancy: 4.1% vs 2.9% in a pooled analysis; continued use should be reassessed periodically (FDA label).
  • Serious hypersensitivity, including fatal anaphylaxis; contraindicated with known allergy to calcitonin-salmon (FDA label).
  • Hypocalcemia with tetany and seizures has been reported (FDA injection label).
  • Antibodies can form and reduce response (FDA label).
  • Injection: nausea about 10%, injection-site inflammation about 10%, flushing 2-5%. Nasal spray: rhinitis 12.0% vs 6.9%; nasal ulcers can occur, and nasal exams are recommended (FDA labels).
  • May lower lithium levels (FDA label).

Report side effects of any drug or product to the FDA through MedWatch. For a possible poisoning in the US, call Poison Control at 1-800-222-1222.

Storage and stability

Nasal spray: refrigerate unopened bottles at 2-8°C; once in use, keep upright at room temperature for up to 35 days (FDA label).

General lab handling, not instructions for personal use. See Storage and stability.

History

Calcitonin was discovered in the early 1960s as a calcium-lowering hormone. Miacalcin injection was first approved in the US in 1975, and a nasal spray followed for postmenopausal osteoporosis. In 2013, FDA advisory committees reviewed a cancer signal from pooled trials and concluded that women should stop using the nasal spray for osteoporosis; the label now carries a malignancy warning.

Common questions

Is salmon calcitonin FDA-approved?

Yes. Miacalcin injection is approved for Paget's disease of bone, high blood calcium and postmenopausal osteoporosis 1. A nasal spray is approved for postmenopausal osteoporosis 2.

Is there a cancer risk with calcitonin?

A pooled analysis of 21 trials found cancers in 4.1% of users vs 2.9% on placebo, and the label advises reassessing ongoing use 1. In 2013, FDA advisory committees concluded the nasal spray should no longer be used for osteoporosis 3.

Does calcitonin prevent fractures?

The injection label states that fracture reduction has not been shown for osteoporosis 1.

What doses are on the FDA labels?

The injection label lists 100 units daily for Paget's disease and osteoporosis 1. The nasal spray label lists one 200-unit spray daily, alternating nostrils 2. These are label figures, not advice.

What are the side effects?

By injection, nausea and injection-site inflammation each affect about 10% 1. The nasal spray causes runny nose in 12.0% vs 6.9% on placebo and can cause nasal ulcers 2.

Why is it made from salmon?

Salmon calcitonin is more potent and longer-acting in humans than the human form 1.

Related compounds

Bone & mineralFDA-approvedFlashcard

Teriparatide

Forteo · rhPTH(1-34)

Teriparatide is a lab-made copy of the first 34 amino acids of human parathyroid hormone.

Bone & mineralFDA-approvedFlashcard

Abaloparatide

Tymlos · Eladynos

Abaloparatide is a lab-made peptide modeled on parathyroid hormone-related protein (PTHrP).

Sources

  1. Miacalcin (calcitonin salmon) injection prescribing information FDA label
  2. Miacalcin (calcitonin-salmon) Nasal Spray label FDA label
  3. The Medical Letter: Salmon calcitonin and cancer (Apr 15, 2013) Journal
  4. ChEBI: calcitonin (CHEBI:3306) Journal
  5. WADA 2026 Prohibited List Regulatory

Last reviewed 2026-10-25 · How we research · Found an error? See our corrections policy.