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The following information outlines essential safety considerations regarding the use of this medication. Review these points carefully and consult your healthcare provider with any questions or concerns.

• High Calcium Levels: Excessive intake of vitamin D can result in elevated calcium levels in your blood and urine, potentially leading to severe heart rhythm disturbances, seizures, and increased risk of digitalis toxicity if you are taking digoxin (Lanoxin). This risk is heightened if you are also consuming high doses of calcium-containing medications, certain diuretics like hydrochlorothiazide (Microzide), or other vitamin D supplements. Prescription-strength vitamin D should be avoided while taking paricalcitol (Zemplar). Be aware of symptoms such as fatigue, confusion, loss of appetite, nausea, vomiting, constipation, increased thirst, frequent urination, and weight loss, and contact your healthcare provider immediately if they occur. Regular monitoring of calcium levels will be conducted by your healthcare provider. Increased risk factors include the use of digoxin (Lanoxin), high doses of calcium medications, certain diuretics, and a history of high calcium levels.

• High Aluminum Levels: Combining paricalcitol (Zemplar) with aluminum-containing medications, such as certain antacids and phosphate binders, can lead to dangerously high levels of aluminum in your body. This may result in bone and muscle pain, fractures, and bone softening. Consult your healthcare provider or pharmacist if you are unsure whether your medications contain aluminum.

• Contraindications: Do not use this medication if you have high calcium levels or high vitamin D levels (toxicity), which can cause symptoms like nausea, vomiting, weakness, and frequent urination. Discuss your medical history with your healthcare provider to determine if this medication is suitable for you.

When taking this medication, you may experience some common, mild side effects, which typically resolve on their own. These include nausea, diarrhea, symptoms of a common cold, vomiting, high blood pressure, swelling, and dizziness. If these persist or become bothersome, it's advisable to consult your healthcare provider for guidance.

There are also other side effects that some individuals may experience, which warrant attention, especially if they are severe. These include a runny nose, infections, low blood pressure, chills, trouble sleeping, vertigo, headache, rash, high fluid levels in the blood, bleeding in the stomach, stomach infections, constipation, frequent urination, flu-like symptoms, arthritis or joint pain, weakness, pink eye, asthma, lung infections such as pneumonia, and fever.

Serious side effects, though rare, require immediate medical attention. These include severe allergic reactions characterized by rash, itching, swelling, trouble breathing, and high calcium levels in the blood, which may present as tiredness, difficulty thinking clearly, loss of appetite, nausea, vomiting, constipation, increased thirst, increased urination, and weight loss. If you notice these symptoms, seek urgent medical care.

Paricalcitol (Zemplar) can interact with various medications and supplements, so it's crucial to inform your doctor and pharmacist about all the substances you are taking, including prescription, over-the-counter, and herbal products. Here are some important interactions to be aware of:

1. Burosumab: It's generally advised to avoid using Paricalcitol with burosumab, as the combination may not be recommended by your healthcare provider.

2. Vitamin D Products: Be cautious with other vitamin D supplements like ergocalciferol, as they can affect how Paricalcitol works.

3. Aluminum-containing Products: Products like some antacids and phosphate binders may interact with Paricalcitol. Check product labels for aluminum, calcium, phosphate, or vitamin D content, and consult your pharmacist about their safe use.

4. Corticosteroids: Medications such as prednisone might interact with Paricalcitol. Discuss with your doctor any potential adjustments to your treatment plan.

5. Bile Acid Sequestrants and Other Absorption Affecting Drugs: Medicines like cholestyramine, colestipol, mineral oil, and orlistat can reduce vitamin D absorption. To minimize this, space out the doses of these medications and Paricalcitol as much as possible, potentially taking Paricalcitol at bedtime. Seek advice from your doctor or pharmacist on the optimal dosing schedule.

6. Ketoconazole: This medication might increase the risk of side effects when used with Paricalcitol. Your doctor may adjust the doses or frequency of these medications if they are used together.

Additionally, Paricalcitol could interfere with certain laboratory tests, such as cholesterol tests, leading to inaccurate results. Ensure all healthcare professionals involved in your care are aware that you are taking this medication.