Etelcalcetide
An intravenous peptide that lowers parathyroid hormone in people with kidney failure on dialysis
Etelcalcetide is a synthetic peptide that activates the calcium-sensing receptor on the parathyroid glands. Approved as Parsabiv in 2017, it is injected into the dialysis line three times a week to treat secondary hyperparathyroidism.
What is it?
Secondary hyperparathyroidism, a common complication of chronic kidney disease, is marked by high parathyroid hormone. It contributes to calcification outside the skeleton and is associated with higher overall and cardiovascular mortality. Calcimimetics make the parathyroid glands' calcium-sensing receptor more sensitive to calcium, so the glands release less hormone.
Cinacalcet is a calcimimetic taken as a daily tablet. Etelcalcetide, developed as velcalcetide or AMG 416, is a peptide given into the dialysis circuit, so the dose is given by staff rather than remembered at home. In a head-to-head trial it lowered parathyroid hormone more often than cinacalcet; lower blood calcium was its most common effect.
Parsabiv is approved for adults on hemodialysis only; the label says it has not been studied in parathyroid cancer, primary hyperparathyroidism or kidney disease not on dialysis.
At a Glance
Every value in this table is printed from the Grey Peptides dataset, the same record the compound explorer and comparison tool read, so the three can never disagree.
Educational information, not medical advice. The doses on this page come from approved labels, published studies and, where no study exists, amounts reported by users. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose. Full medical disclaimer.
Half-Life: How Much Remains
The dataset records a half-life of 3 to 4 days (effective half-life in hemodialysis patients) for Etelcalcetide. After each half-life, half of what was in the circulation is gone, so about 3% remains after five. Real clearance varies with the person, the dose, the route and kidney or liver function; this is arithmetic on a published figure, not a dosing tool.
Published Research
The studies behind etelcalcetide, read from their PubMed abstracts.
First doses in healthy men
Single intravenous doses of 0.5 to 10 mg lowered parathyroid hormone within 30 minutes and FGF23 by 24 hours, with no nausea, vomiting or diarrhoea; the terminal half-life was 18.4 to 20.0 hours in people with normal kidneys.
Against cinacalcet, 683 patients
Over 26 weeks, 68.2% on etelcalcetide reduced parathyroid hormone by more than 30% against 57.7% on cinacalcet, meeting criteria for both non-inferiority and superiority; 52.4% against 40.2% reduced it by more than half. Decreased blood calcium was the most common adverse effect (68.9% against 59.8%).
Against placebo: five trials pooled
Across 1,268 participants, etelcalcetide made a 30% fall in parathyroid hormone far more likely than placebo (relative risk 8.64) and lowered phosphate, with more hypocalcaemia, nausea and vomiting.
One year of treatment
In a 52-week open-label extension, about 68% kept a fall of more than 30% in parathyroid hormone; decreased blood calcium (43.3%) was the most common event, and symptomatic hypocalcaemia occurred in 3.7%.
Pooled safety across five trials
In over 3,000 patient records from placebo-controlled, active-controlled and extension trials, the common events were calcium- and gut-related; hypocalcaemia led to stopping in 1% or fewer.
Effect on FGF23
Etelcalcetide lowered the phosphate hormone FGF23 by a median 56% against a 2% rise on placebo, and by 68% against 41% on cinacalcet; the fall tracked calcium and phosphate rather than parathyroid hormone.
Side Effects & Contraindications
Reported Side Effects
From the studies above.
Contraindications & Cautions
Warnings from the Parsabiv label (DailyMed, effective March 8, 2026).
Legal Status
Etelcalcetide is approved in the US as Parsabiv.
Frequently Asked Questions
?What is etelcalcetide?
A synthetic peptide that activates the calcium-sensing receptor and lowers parathyroid hormone. It is sold as Parsabiv for secondary hyperparathyroidism in adults on hemodialysis.
?How is it different from cinacalcet?
Cinacalcet is a daily tablet; etelcalcetide is injected into the dialysis line three times a week. Head to head, it lowered parathyroid hormone by more than 30% in 68.2% of patients against 57.7%.
?What is the dose?
The label starts at 5 mg three times a week at the end of dialysis, adjusted between 2.5 and 15 mg by parathyroid hormone and calcium levels.
References
- [fda] US FDA, Drugs@FDA (openFDA): PARSABIV (etelcalcetide), NDA 208325, original approval February 7, 2017, prescription. Read October 2, 2026.
- [fda-pi] FDA. Parsabiv (etelcalcetide) injection US prescribing information (DailyMed set cd270093-c6a8-4596-a4ab-e6aa0a2c8a0c, effective March 8, 2026). Read October 2, 2026.
- [clinical-trial] Block GA, et al. "Effect of Etelcalcetide vs Cinacalcet on Serum Parathyroid Hormone in Patients Receiving Hemodialysis With Secondary Hyperparathyroidism: A Randomized Clinical Trial." JAMA, 2017;317(2):156-164. PMID: 28097356.
- [pubmed] Zhu Y, et al. "Etelcalcetide versus placebo for secondary hyperparathyroidism in patients receiving hemodialysis: A meta-analysis of randomized controlled trials." Clin Nephrol, 2020;94(4):173-180. PMID: 32729818.
- [clinical-trial] Bushinsky DA, et al. "One-year safety and efficacy of intravenous etelcalcetide in patients on hemodialysis with secondary hyperparathyroidism." Nephrol Dial Transplant, 2020;35(10):1769-1778. PMID: 30859218.
- [pubmed] Block GA, et al. "An integrated analysis of safety and tolerability of etelcalcetide in patients receiving hemodialysis with secondary hyperparathyroidism." PLoS One, 2019;14(3):e0213774. PMID: 30875390.
- [clinical-trial] Martin KJ, et al. "Velcalcetide (AMG 416), a novel peptide agonist of the calcium-sensing receptor, reduces serum parathyroid hormone and FGF23 levels in healthy male subjects." Nephrol Dial Transplant, 2014;29(2):385-92. PMID: 24235081.
- [pubmed] Wolf M, et al. "Effects of etelcalcetide on fibroblast growth factor 23 in patients with secondary hyperparathyroidism receiving hemodialysis." Clin Kidney J, 2020;13(1):75-84. PMID: 32082556.
Sources & Citations
Studies were read from their PubMed records; regulatory sources are listed below, read October 2, 2026.
Medical Disclaimer: This content is for educational and informational purposes only. It is not medical advice, and nothing here is an instruction to obtain or use any compound. Consult a licensed healthcare provider before making health decisions.