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This document outlines crucial safety warnings and contraindications associated with the use of Hectorol (doxercalciferol). It is important to carefully review this information and discuss any questions or concerns with your healthcare provider.

• High Calcium Levels: Hectorol (doxercalciferol) can sometimes cause elevated calcium levels in the blood, which may pose serious health risks, including heart and blood vessel problems, as well as seizures. You are at an increased risk if you consume high doses of calcium-containing products, certain diuretics (commonly known as "water pills"), or other vitamin D supplements alongside this medication. Avoid additional intake of vitamin D or calcium products unless explicitly advised by your healthcare provider. Conditions that may increase this risk include disorders causing high calcium levels, excessive vitamin D intake, excessive calcium intake, and the use of thiazide diuretics.

• Allergic Reactions: There is a potential for serious and potentially life-threatening allergic reactions to Hectorol (doxercalciferol). Symptoms can include anaphylaxis, swelling of the face, lips, or airways, chest discomfort, and shortness of breath. Seek immediate medical attention or call emergency services if you experience any signs of an allergic reaction while taking this medication.

• Bone Fractures: Hectorol (doxercalciferol) may excessively lower parathyroid hormone (PTH) levels, which can weaken bones and increase the risk of fractures. Regular monitoring of PTH levels through blood tests is essential, and your healthcare provider will adjust your dosage as necessary to maintain healthy PTH levels.

Contraindications: Hectorol (doxercalciferol) should not be used under the following conditions, as it may lead to serious health complications. It is crucial to consult your healthcare provider if any of these apply to you:

• Presence of high calcium levels in the blood (hypercalcemia).
• Vitamin D toxicity.

Please ensure you adhere to these guidelines to minimize risks and discuss any concerns with your healthcare provider.

Common side effects:

• Headache
• Constipation
• Nausea
• Vomiting
• Tiredness
• Runny nose
• Cough
• "Pins and needles" feeling in the arms or legs
• Shortness of breath
• Weakness
• Dizziness
• Overall feeling of not being well

Less common but important to monitor:

• Infections
• Swelling
• Metallic taste in the mouth

Serious side effects:

• Bone, joint, or muscle pain
• Loss of appetite
• Increased thirst and urination
• Fast or irregular heartbeat
• Mental or mood changes
• Unexplained weight changes
• Chest pain
• Severe itchiness
• Sleep problems
• Very serious allergic reaction

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• burosumab

Interactions with low risk that usually do not require a change in therapy:

• bile acid sequestrants (e.g., Cholestyramine, Colestipol)
• Mineral Oil
• Orlistat
• Calcium
• Magnesium
• phosphate
• Vitamin D