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Cinacalcet Hydrochloride side effects: what 46,327 FDA adverse event reports show

Cinacalcet Hydrochloride · 1,050 reaction terms · 76,086 drug–reaction co-reports · data 2026-09-14
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Drug class

Calcium-sensing receptor agonist

FDA label, Indications wording

Who reports

46,327 reports · 37% serious · 2,518 with death outcome · 54% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Cinacalcet hydrochloride is a calcium-sensing receptor agonist indicated for: Secondary Hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on dialysis. ( 1.1 ) Limitations of Use: Cinacalcet hydrochloride tablets are not indicated for use in patients with CKD who are not on dialysis. Hypercalcemia in adult patients with Parathyroid Carcinoma (PC).

FDA label, Indications and Usage

What it is

Cinacalcet hydrochloride tablets contain the hydrochloride salt of cinacalcet, a positive modulator of the calcium sensing receptor.

FDA label, Description section

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Likely indication confounding 11Reporting / coding artifact 6Lab value / disease marker 6Not in label — unassessed 17
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 1,010 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Blood parathyroid hormone abnormal342527.4
451.0–616.6ROR 531.3 · χ² 82,054 / p <1e-300
238.9 EB05 218.4 · IC025 +7.3
3/3 methods agree
Lab value / disease markerserious n=55NCT00345839: 1/1,923 (0.1%) control (serious AE)
Parathyroid hyperplasia17194.3
109.9–343.3ROR 194.3 · χ² 2,143 / p <1e-300
118.0 EB05 78.0 · IC025 +4.0
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=17not reported in cached trials
Hungry bone syndrome54191.0
138.9–262.7ROR 191.2 · χ² 7,011 / p <1e-300
128.0 EB05 101.8 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=54 · 100% cliniciannot reported in cached trials
Unevaluable investigation48181.3
129.6–253.5ROR 181.5 · χ² 5,990 / p <1e-300
122.9 EB05 96.4 · IC025 +5.3
3/3 methods agree
Lab value / disease markerserious n=47not reported in cached trials
Parathyroid tumour malignant36174.4
118.6–256.3ROR 174.5 · χ² 4,337 / p <1e-300
117.9 EB05 89.0 · IC025 +5.0
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=36 · 100% cliniciannot reported in cached trials
Hyperparathyroidism tertiary19151.2
89.9–254.4ROR 151.3 · χ² 2,006 / p <1e-300
101.8 EB05 68.9 · IC025 +4.1
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=18NCT00345839: 2/1,938 (0.1%) on Cinacalcet; 8/1,923 (0.4%) control (serious AE)
Brown tumour10111.4
55.7–222.8ROR 111.4 · χ² 789 / p 6e-174
76.7 EB05 44.5 · IC025 +3.0
3/3 methods agree
Not in label — unassessedserious n=9NCT01896232: 1/338 (0.3%) on Cinacalcet (serious AE)
Blood parathyroid hormone increased544103.6
94.4–113.6ROR 104.8 · χ² 44,758 / p <1e-300
84.0 EB05 78.2 · IC025 +6.1
3/3 methods agree
Lab value / disease markerserious n=192NCT00345839: 1/1,923 (0.1%) control (serious AE)
Laboratory test abnormal4,22275.7
73.3–78.1ROR 83.1 · χ² 266,197 / p <1e-300
64.8 EB05 63.2 · IC025 +6.0
3/3 methods agree
Reporting / coding artifactserious PRR 3.0not reported in cached trials
Arteriovenous fistula occlusion2574.8
49.0–114.2ROR 74.8 · χ² 1,496 / p <1e-300
61.3 EB05 43.7 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=25 · ♀ 92% (drug 54%)NCT00345839: 13/1,938 (0.7%) on Cinacalcet; 8/1,923 (0.4%) control (serious AE)
Parathyroidectomy6369.0
52.9–89.9ROR 69.1 · χ² 3,596 / p <1e-300
58.9 EB05 47.6 · IC025 +4.9
3/3 methods agree
Likely indication confounding
term in indications
serious n=62not reported in cached trials
Blood parathyroid hormone decreased18965.6
56.4–76.5ROR 65.9 · χ² 10,432 / p <1e-300
57.0 EB05 50.5 · IC025 +5.4
3/3 methods agree
Lab value / disease markerserious n=28NCT00345839: 1/1,923 (0.1%) control (serious AE)
Parathyroid tumour benign8860.6
48.5–75.7ROR 60.7 · χ² 4,489 / p <1e-300
52.9 EB05 44.3 · IC025 +5.0
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=88 · 95% clinicianNCT00345839: 1/1,938 (0.1%) on Cinacalcet; 6/1,923 (0.3%) control (serious AE)
Living in residential institution21458.0
50.3–66.9ROR 58.3 · χ² 10,559 / p <1e-300
51.2 EB05 45.7 · IC025 +5.3
3/3 methods agree
Reporting / coding artifactserious n=25not reported in cached trials
Blood phosphorus abnormal4143.7
31.7–60.2ROR 43.7 · χ² 1,520 / p <1e-300
39.2 EB05 30.1 · IC025 +4.2
3/3 methods agree
Lab value / disease markerserious n=14not reported in cached trials
Skin fibrosis4040.9
29.6–56.5ROR 40.9 · χ² 1,389 / p <1e-300
36.9 EB05 28.3 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=39not reported in cached trials
Blood calcium abnormal13339.5
33.1–47.1ROR 39.6 · χ² 4,548 / p <1e-300
36.2 EB05 31.3 · IC025 +4.7
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=46NCT00345839: 1/1,938 (0.1%) on Cinacalcet (serious AE)
Parathyroid gland enlargement1137.1
20.1–68.7ROR 37.1 · χ² 324 / p 8e-73
32.6 EB05 19.4 · IC025 +2.8
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=10NCT00345839: 2/1,938 (0.1%) on Cinacalcet; 1/1,923 (0.1%) control (serious AE)
Chronic kidney disease-mineral and bone disorder7533.9
26.8–42.8ROR 33.9 · χ² 2,193 / p <1e-300
31.3 EB05 25.8 · IC025 +4.3
3/3 methods agree
Not in label — unassessedserious n=75not reported in cached trials
Enteral nutrition3832.7
23.5–45.4ROR 32.7 · χ² 1,058 / p 2e-232
30.1 EB05 22.9 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=31 · 100% cliniciannot reported in cached trials
Gastrostomy tube insertion1332.5
18.5–57.2ROR 32.6 · χ² 342 / p 1e-76
29.2 EB05 18.1 · IC025 +2.9
3/3 methods agree
Not in label — unassessedserious n=11not reported in cached trials
Calciphylaxis11831.2
25.9–37.5ROR 31.2 · χ² 3,191 / p <1e-300
29.1 EB05 24.9 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=115 · 92% clinicianNCT00345839: 3/1,938 (0.2%) on Cinacalcet; 13/1,923 (0.7%) control (serious AE)
Hyperparathyroidism secondary15830.1
25.6–35.3ROR 30.2 · χ² 4,134 / p <1e-300
28.2 EB05 24.7 · IC025 +4.4
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=157NCT00345839: 23/1,938 (1.2%) on Cinacalcet; 86/1,923 (4.5%) control (serious AE)
Transplant14529.4
24.8–34.7ROR 29.5 · χ² 3,702 / p <1e-300
27.5 EB05 24.0 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=145NCT00345839: 6/1,938 (0.3%) on Cinacalcet; 3/1,923 (0.2%) control (serious AE)
Rehabilitation therapy20325.1
21.8–28.9ROR 25.2 · χ² 4,424 / p <1e-300
23.8 EB05 21.1 · IC025 +4.3
3/3 methods agree
Reporting / coding artifactserious n=37not reported in cached trials
Drug dose omission8,73824.8
24.4–25.3ROR 30.4 · χ² 190,916 / p <1e-300
23.6 EB05 23.2 · IC025 +4.5
3/3 methods agree
Reporting / coding artifactserious PRR 7.9not reported in cached trials
Parathyroid disorder4224.8
18.2–33.9ROR 24.8 · χ² 887 / p 3e-195
23.3 EB05 18.0 · IC025 +3.7
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=24NCT00345839: 1/1,923 (0.1%) control (serious AE)
Arteriovenous fistula thrombosis1824.6
15.3–39.5ROR 24.6 · χ² 364 / p 2e-81
22.8 EB05 15.2 · IC025 +3.1
3/3 methods agree
Not in label — unassessedserious n=18NCT00345839: 49/1,938 (2.5%) on Cinacalcet; 43/1,923 (2.2%) control (serious AE)
Blue toe syndrome2024.5
15.6–38.4ROR 24.5 · χ² 405 / p 2e-90
22.8 EB05 15.5 · IC025 +3.2
3/3 methods agree
Not in label — unassessedserious n=20not reported in cached trials
Arteriovenous fistula site complication3124.4
17.0–35.0ROR 24.4 · χ² 638 / p 5e-141
22.9 EB05 16.9 · IC025 +3.5
3/3 methods agree
Reporting / coding artifactserious n=26 · 90% clinicianNCT00345839: 36/1,938 (1.9%) on Cinacalcet; 44/1,923 (2.3%) control (serious AE)
Blood phosphorus increased13623.7
20.0–28.2ROR 23.8 · χ² 2,790 / p <1e-300
22.5 EB05 19.5 · IC025 +4.1
3/3 methods agree
Lab value / disease markerserious n=29not reported in cached trials
Hyperparathyroidism primary1823.3
14.5–37.5ROR 23.3 · χ² 344 / p 3e-77
21.7 EB05 14.4 · IC025 +3.0
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=18NCT00345839: 23/1,938 (1.2%) on Cinacalcet; 86/1,923 (4.5%) control (serious AE)
Parathyroid tumour1322.4
12.8–39.0ROR 22.4 · χ² 233 / p 8e-53
20.6 EB05 12.4 · IC025 +2.7
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=13NCT00345839: 1/1,938 (0.1%) on Cinacalcet; 6/1,923 (0.3%) control (serious AE)
Nephrogenic systemic fibrosis14021.7
18.3–25.7ROR 21.7 · χ² 2,611 / p <1e-300
20.6 EB05 17.9 · IC025 +4.0
3/3 methods agree
Not in label — unassessedserious n=139not reported in cached trials
Hospitalisation6,92921.5
21.1–22.0ROR 25.1 · χ² 130,308 / p <1e-300
20.6 EB05 20.2 · IC025 +4.3
3/3 methods agree
Reporting / coding artifactserious PRR 33.1not reported in cached trials
Fistula repair1120.2
11.0–36.9ROR 20.2 · χ² 174 / p 5e-40
18.3 EB05 10.1 · IC025 +2.4
3/3 methods agree
Not in label — unassessedserious n=8not reported in cached trials
Renal transplant14318.6
15.8–22.0ROR 18.7 · χ² 2,274 / p <1e-300
17.9 EB05 15.6 · IC025 +3.8
3/3 methods agree
Not in label — unassessedserious n=139not reported in cached trials
Nephrogenic anaemia18218.3
15.8–21.2ROR 18.4 · χ² 2,843 / p <1e-300
17.6 EB05 15.5 · IC025 +3.8
3/3 methods agree
Not in label — unassessedserious n=182NCT00345839: 1/1,923 (0.1%) control (serious AE)
Extremity contracture2417.6
11.7–26.4ROR 17.6 · χ² 345 / p 3e-77
16.6 EB05 11.5 · IC025 +3.0
3/3 methods agree
Not in label — unassessedserious n=24not reported in cached trials
Shunt stenosis1016.7
8.9–31.4ROR 16.7 · χ² 127 / p 7e-30
14.6 EB05 7.3 · IC025 +2.2
3/3 methods agree
Not in label — unassessedserious n=10NCT00345839: 6/1,938 (0.3%) on Cinacalcet; 4/1,923 (0.2%) control (serious AE)

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Cinacalcet as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (19 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Drug dose omission8,73824.8
24.4–25.3ROR 30.4 · χ² 190,916 / p <1e-300
23.6 EB05 23.2 · IC025 +4.5
3/3 methods agree
Reporting / coding artifactserious PRR 7.9not reported in cached trials
Hospitalisation6,92921.5
21.1–22.0ROR 25.1 · χ² 130,308 / p <1e-300
20.6 EB05 20.2 · IC025 +4.3
3/3 methods agree
Reporting / coding artifactserious PRR 33.1not reported in cached trials
Laboratory test abnormal4,22275.7
73.3–78.1ROR 83.1 · χ² 266,197 / p <1e-300
64.8 EB05 63.2 · IC025 +6.0
3/3 methods agree
Reporting / coding artifactserious PRR 3.0not reported in cached trials
Off label use (used outside approved label)2,5001.3
1.3–1.4ROR 1.3 · χ² 185 / p 2e-42
1.3 EB05 1.3 · IC025 +0.3Reporting / coding artifactserious PRR 0.5 · 76% consumernot reported in cached trials
Nausea2,2841.3
1.3–1.4ROR 1.3 · χ² 175 / p 4e-40
1.3 EB05 1.3 · IC025 +0.3Labeled adverse reaction
exact term
serious PRR 0.9NCT00345839: 20/1,938 (1.0%) on Cinacalcet; 16/1,923 (0.8%) control (serious AE)
Intentional product misuse2,08411.1
10.6–11.6ROR 11.6 · χ² 18,764 / p <1e-300
10.9 EB05 10.5 · IC025 +3.4
3/3 methods agree
Reporting / coding artifactserious PRR 1.6not reported in cached trials
Death1,8321.0
0.9–1.0ROR 1.0 · χ² 3 / p 0.050
1.0 EB05 0.9 · IC025 -0.1
PRR-only: not supported by EBGM or IC
Outcome field, not a reactionserious PRR 1.5NCT00345839: 38/1,938 (2.0%) on Cinacalcet; 38/1,923 (2.0%) control (serious AE)
Malaise (feeling unwell)1,5631.6
1.5–1.7ROR 1.6 · χ² 369 / p 2e-82
1.6 EB05 1.5 · IC025 +0.6Not in label — unassessedserious PRR 1.1NCT00345839: 4/1,938 (0.2%) on Cinacalcet; 4/1,923 (0.2%) control (serious AE)
Vomiting1,5461.5
1.4–1.6ROR 1.5 · χ² 257 / p 4e-58
1.5 EB05 1.4 · IC025 +0.5Labeled adverse reaction
exact term
serious PRR 0.9NCT00345839: 33/1,938 (1.7%) on Cinacalcet; 23/1,923 (1.2%) control (serious AE)
Adverse drug reaction1,4607.5
7.1–7.9ROR 7.7 · χ² 8,108 / p <1e-300
7.4 EB05 7.1 · IC025 +2.8
3/3 methods agree
Reporting / coding artifactserious PRR 0.9NCT00345839: 1/1,938 (0.1%) on Cinacalcet; 1/1,923 (0.1%) control (serious AE)
Diarrhoea (diarrhea)1,1340.8
0.8–0.8ROR 0.8 · χ² 60 / p 5e-15
0.8 EB05 0.8 · IC025 -0.4
PRR-only: not supported by EBGM or IC
Labeled adverse reaction
exact term
serious PRR 0.6NCT00345839: 32/1,938 (1.7%) on Cinacalcet; 24/1,923 (1.2%) control (serious AE)
Decreased appetite (loss of appetite)8281.6
1.5–1.7ROR 1.6 · χ² 198 / p 4e-45
1.6 EB05 1.5 · IC025 +0.6Labeled adverse reaction
exact term
serious PRR 0.7NCT00345839: 3/1,938 (0.2%) on Cinacalcet (serious AE)
Abdominal discomfort7752.1
2.0–2.3ROR 2.1 · χ² 449 / p 6e-100
2.1 EB05 2.0 · IC025 +0.9Not in label — unassessedserious PRR 1.1NCT00345839: 1/1,938 (0.1%) on Cinacalcet; 3/1,923 (0.2%) control (serious AE)
Muscle spasms6001.5
1.4–1.6ROR 1.5 · χ² 94 / p 2e-22
1.5 EB05 1.4 · IC025 +0.4Labeled adverse reaction
exact term
serious PRR 0.8NCT00345839: 2/1,938 (0.1%) on Cinacalcet; 3/1,923 (0.2%) control (serious AE)
Hypotension (low blood pressure)5771.3
1.2–1.4ROR 1.3 · χ² 41 / p 7e-11
1.3 EB05 1.2 · IC025 +0.2Labeled adverse reaction
exact term
serious PRR 1.2NCT00345839: 10/1,938 (0.5%) on Cinacalcet; 2/1,923 (0.1%) control (serious AE)

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Cinacalcet ↔ Hypocalcaemia.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Cinacalcet?

In FDA FAERS, the most frequently co-reported reaction terms for Cinacalcet are nausea, malaise, vomiting, diarrhoea, decreased appetite, abdominal discomfort. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Cinacalcet have an FDA boxed warning?

No. The FDA label retrieved for Cinacalcet has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Cinacalcet causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.