| Hyperparathyroidism, Secondary
Zemplar vs Parsabiv
Side-by-side clinical, coverage, and cost comparison for hyperparathyroidism, secondary.Deep comparison between: Zemplar vs Parsabiv 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 signalsParsabiv has a higher rate of injection site reactions vs Zemplar based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Parsabiv but not Zemplar, including UnitedHealthcare
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Category
Zemplar
Parsabiv
At A Glance
Oral
Daily or three times weekly
Vitamin D analog
IV injection
Three times per week
Calcimimetic agent
Indications
- Hyperparathyroidism, Secondary
- Hyperparathyroidism, Secondary
Dosing
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.
Hyperparathyroidism, Secondary Starting dose 5 mg IV bolus three times per week at end of hemodialysis; maintenance dose individualized by titration, range 2.5 to 15 mg three times per week.
Contraindications
- Hypercalcemia
- Vitamin D toxicity
- Known hypersensitivity to etelcalcetide or any of its excipients
Adverse Reactions
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
Most common (>=5%) Blood calcium decreased, muscle spasms, diarrhea, nausea, vomiting, headache, hypocalcemia, paresthesia
Serious Hypocalcemia, worsening heart failure, upper gastrointestinal bleeding, adynamic bone
Postmarketing Anaphylactic reaction, hypocalcemia with concomitant calcium-lowering agents, seizures secondary to hypocalcemia
Pharmacology
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.
Etelcalcetide is a calcimimetic agent that allosterically modulates the calcium-sensing receptor (CaSR), enhancing activation by extracellular calcium to decrease PTH secretion from parathyroid chief cells.
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Most Common Insurance
Anthem BCBS
Zemplar
- Covered on 5 commercial plans
- PA (9/12) · Step Therapy (0/12) · Qty limit (0/12)
Parsabiv
- Covered on 5 commercial plans
- PA (9/12) · Step Therapy (0/12) · Qty limit (0/12)
UnitedHealthcare
Zemplar
- Covered on 4 commercial plans
- PA (2/8) · Step Therapy (0/8) · Qty limit (0/8)
Parsabiv
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Zemplar
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Parsabiv
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Zemplar.
Cost estimate not availableAmgen Safety Net Foundation
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
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ZemplarView full Zemplar profile
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.