Granal (Alfacalcidol)

Granal is indicated for several disorders that involve impaired calcium and phosphate balance.

• Treatment of hypocalcemia associated with vitamin D deficiency or renal disease.
• Management of osteomalacia in adults.
• Therapy for renal osteodystrophy in patients with chronic kidney disease.
• Control of secondary hyperparathyroidism in dialysis patients.
• Support of bone health in conditions requiring calcium metabolism regulation.

Side effects of alfacalcidol may vary in frequency and severity.

Common

• Nausea or vomiting.
• Constipation or abdominal discomfort.
• Mild headache or dizziness.
• Transient increase in serum calcium levels.
• Skin rash or pruritus.
• Fatigue.

Serious

• Severe hypercalcemia with symptoms such as polyuria, polydipsia, or cardiac arrhythmia.
• Hyperphosphatemia leading to vascular calcification.
• Acute kidney injury.
• Allergic reactions including angioedema or anaphylaxis.
• Persistent elevation of serum calcium despite dose adjustment.

When prescribing Granal, clinicians should consider several safety precautions.

• Baseline and periodic monitoring of serum calcium, phosphate, and renal function.
• Avoid use in patients with known hypercalcemia or hyperphosphatemia.
• Adjust dose or discontinue if marked increases in calcium occur.
• Use with caution in pregnant or breastfeeding women, as safety data are limited.
• Assess vitamin D status before initiating therapy.
• Consider drug interactions that may affect calcium balance.
• Educate patients on signs of hypercalcemia and when to seek medical attention.

Alfacalcidol can interact with other medicines, requiring attention to avoid adverse outcomes.

Avoid

• Concomitant high-dose calcium supplements or calcium‑containing antacids.
• Other vitamin D analogues or calcitriol preparations.
• Thiazide diuretics that may increase calcium reabsorption.
• Lithium therapy, which can alter calcium metabolism.

Use with caution

• Loop diuretics, which may affect calcium excretion.
• Corticosteroids, which can reduce vitamin D effectiveness.
• Anticonvulsants such as phenytoin or phenobarbital that accelerate vitamin D metabolism.
• Bisphosphonates, as combined effects on bone turnover need monitoring.
• Antifungal agents like ketoconazole that may interfere with vitamin D activation.