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Pharmacy and Medications

Comparison of 2 Medications



What is the difference between Fortical & Calcitonin Salmon? How do they differ? Similarities?


Thank you for contacting NetWellness. Fortical® (calcitonin-salmon/rDNA origin) and calcitonin-salmon (Miacalcin®) are both synthetic polypeptide hormones used to treat postmenopausal osteoporosis in females with low bone mass who went through menopause at least five years ago. Osteoporosis is a condition that causes the bones to become weak and brittle. These medications help slow the breakdown of bone, and for a short time can help strengthen the bone. Although they are created by different methods, Fortical® and calcitonin-salmon are made up of the same sequence of 32 amino acids found in the calcitonin of salmon, and are both available as a nasal spray. These medications offer the same amount of protection from bone fractures, and are stronger than the calcitonin found in your body. 

Similar side effects that can occur with Fortical® and calcitonin-salmon include nasal symptoms (discomfort, runny nose, crusting, or bleeding), back and/or joint pain, dizziness, nausea, and headache. Allergic reactions can also occur with both of these products since they are identical to a hormone found in salmon. A skin test should be done before starting therapy on women with suspected sensitivity or fish allergy. 

Fortical® is created through the use of recombinant DNA technology and calcitonin-salmon is created through chemical synthesis. Fortical® contains different inactive ingredients than calcitonin-salmon. Fortical® replaces the benzalkonium chloride (a nasal irritant) found in calcitonin-salmon with benzyl alcohol which may potentially cause less nasal irritability. The different inactive ingredients may cause different allergic responses in women. 

Both medications should be stored in the refrigerator before opening and should be allowed to come to room temperature before priming. Once opened, the medications should stay outside the refrigerator. Fortical® should be thrown away after 30 days of opening, while calcitonin-salmon is good for 35 days. 

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Response by:

Sarah Hudson-DiSalle, PharmD, RPh
Specialty Practice Pharmacist of Outpatient Pharmacy
College of Medicine
The Ohio State University