| Hyperparathyroidism, Secondary
Rayaldee vs Zemplar
Side-by-side clinical, coverage, and cost comparison for hyperparathyroidism, secondary.Deep comparison between: Rayaldee vs Zemplar with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsZemplar has a higher rate of injection site reactions vs Rayaldee based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Zemplar but not Rayaldee, including UnitedHealthcare
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Category
Rayaldee
Zemplar
At A Glance
Oral
Daily
Vitamin D3 analog
Oral
Daily or three times weekly
Vitamin D analog
Indications
- Hyperparathyroidism, Secondary
- Hyperparathyroidism, Secondary
Dosing
Hyperparathyroidism, Secondary Initial dose 30 mcg orally once daily at bedtime; increase to 60 mcg once daily after approximately 3 months if intact PTH remains above the desired therapeutic range.
Hyperparathyroidism, Secondary (CKD Stages 3-4, Adults) Initial: 1 mcg orally daily or 2 mcg three times weekly if iPTH <=500 pg/mL; 2 mcg orally daily or 4 mcg three times weekly if iPTH >500 pg/mL. Titrate: Increase by 1 mcg daily or 2 mcg three times weekly if iPTH unchanged or changed <30%; maintain dose if iPTH decreased 30-60%; decrease by 1 mcg daily or 2 mcg three times weekly if iPTH decreased >60% or iPTH <60 pg/mL.
Hyperparathyroidism, Secondary (CKD Stage 5, Adults) Initial: Dose (mcg) = baseline iPTH (pg/mL) divided by 80, administered orally three times weekly (no more frequently than every other day). Ensure baseline serum calcium <=9.5 mg/dL. Titrate: Dose (mcg) = most recent iPTH (pg/mL) divided by 80; decrease by 2-4 mcg if serum calcium is elevated.
Hyperparathyroidism, Secondary (CKD Stages 3-4, Pediatric 10-16 years) Initial: 1 mcg orally three times weekly, no more frequently than every other day. Titrate: Increase each dose by 1 mcg three times weekly every 4 weeks or decrease by 1 mcg three times weekly at any time based on iPTH, serum calcium and phosphorus levels.
Hyperparathyroidism, Secondary (CKD Stage 5, Pediatric 10-16 years) Initial: Dose (mcg) = baseline iPTH (pg/mL) divided by 120 (round down), administered orally three times weekly, no more frequently than every other day. Titrate: Increase each dose by 1 mcg three times weekly every 4 weeks or decrease by 2 mcg three times weekly at any time based on iPTH, serum calcium and phosphorus levels.
Contraindications
—
- Hypercalcemia
- Vitamin D toxicity
Adverse Reactions
Most common (>=1.4%) Anemia, Nasopharyngitis, Blood creatinine increased, Dyspnea, Cough, Cardiac failure congestive, Constipation, Bronchitis, Hyperkalemia, Osteoarthritis, Hyperuricemia, Contusion, Pneumonia, Chronic obstructive pulmonary disease
Serious Hypercalcemia, Adynamic Bone Disease
Most common (>=5%) in CKD Stages 3-4 Vertigo (5%), diarrhea (7%), nausea (6%), vomiting (5%), edema (6%), hypersensitivity (6%), viral infection (7%), arthritis (5%), dizziness (5%), headache (5%), hypertension (7%), hypotension (5%)
Most common (>=5%) in CKD Stage 5 Diarrhea (11%), nasopharyngitis (8%), dizziness (7%), vomiting (7%), peritonitis (5%), fluid overload (5%), insomnia (5%), constipation (5%)
Postmarketing Angioedema (including laryngeal edema), blood creatinine increased
Pharmacology
Calcifediol is a prohormone of vitamin D3 that is converted by CYP27B1 in the kidney to calcitriol, which binds to the vitamin D receptor and activates pathways that increase intestinal absorption of calcium and phosphorus and reduce parathyroid hormone synthesis.
Paricalcitol is a synthetic vitamin D2 analog that binds to the vitamin D receptor (VDR), selectively activating vitamin D responsive pathways, inhibiting PTH synthesis and secretion, thereby reducing parathyroid hormone levels in secondary hyperparathyroidism.
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Most Common Insurance
Anthem BCBS
Rayaldee
- Covered on 5 commercial plans
- PA (9/12) · Step Therapy (0/12) · Qty limit (10/12)
Zemplar
- Covered on 5 commercial plans
- PA (9/12) · Step Therapy (0/12) · Qty limit (0/12)
UnitedHealthcare
Rayaldee
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (1/8)
Zemplar
- Covered on 4 commercial plans
- PA (2/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Rayaldee
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (2/3)
Zemplar
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: Secondary Hyperparathyroidism
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
No savings programs available for Zemplar.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.