Risk for gastrointestinal adverse events in the form of nausea and vomiting motivates vigilance against insufficient intake of food, especially of carbohydrate.

Common adverse reactions of cinacalcet that can be confused with an acute porphyric attack are nausea and vomiting. These side effects may potentially be porphyrinogenic if leading to a decrease in carbohydrate intake.

Cinacalcet is a not an inducer or a mechanism-based inhibitor of CYP enzymes and is therefore probably not porphyrinogenic.

Cinacalcet is a trifluorometyl phenyl propyl naphthalene methanamine.

Cinacalcet is a calcimimetic drug indicated for patients with secondary hyperparathyroidism (HPT) in advanced renal insufficiency under treatment in chronic dialysis, parathyroid carcinoma or primary HPT where operation is unsuitable or contraindicated. It is administered orally and has a terminal elimination half-life of 30 to 40 hours.

Cinacalet is metabolized by multiple CYP enzymes, primarily CYP3A4, CYP1A2 and CYP2D6. The major routes of metabolism are N-dealkylation, leading to carboxylic acid derivatives, and oxidation of the naphthalene ring system to form dihydrodiols. The oxidative metabolites are conjugated before elimination (Pandhi 2009). Strong, competitive inhibition of CYP 2D6 is shown in vitro and in vivo (Harris 2007, Nakashima 2007, SPC). Based on in vitro data cinacalcet does not inhibit other CYP enzymes at concentrations achieved clinically, including CYP1A2, CYP2C8, CYP2C9, CYP2C19, and CYP3A4 and it does not induce CYP1A2, CYP2C19 and CYP3A4 (SPC). In vivo data indicates that cinacalcet does not affect the metabolism of substrates of CYP3A4, CYP1A2 or CYP2C9 (pandhi 2009, SPC).