• Advise patient to take calcitonin as directed. If dose is missed and medication is scheduled for twice a day, take only if possible within 2 hr of correct time. If scheduled for daily dose, take only if remembered that day. If scheduled for every other day, take when remembered and restart alternate day schedule. If taking 1 dose 3 times weekly (Mon, Wed, Fri), take missed dose the next day and set each injection back 1 day; resume regular schedule the following week. Do not double doses.

» Instruct patient in the proper method of self-injection and care and disposal of equipment.

» Advise patient to report signs of hypercalcemic relapse (deep bone or flank pain, renal calculi, anorexia, nausea, vomiting, thirst, lethargy) or allergic response promptly.

» Reassure patient that flushing and warmth following injection are transient and usually last about 1 hr.

» Explain that nausea following injection tends to decrease even with continued therapy.

» Instruct patient to follow low-calcium diet if recommended by health care professional (see Food Sources for Specific Nutrients). Women with postmenopausal osteoporosis should adhere to a diet high in calcium and vitamin D.

• Osteoporosis: Advise patients receiving calcitonin for the treatment of osteoporosis that exercise has been found to arrest and reverse bone loss. The patient should discuss any exercise limitations with health care professional before beginning program.

• Intranasal: Instruct patient on correct use of nasal spray. Demonstrate procedure for use. Before first use, activate pump by holding upright and depressing white side arms down toward bottle 5 times until a full spray is emitted. Following activation, place nozzle firmly in nostril with head in an upright position and depress the pump toward the bottle. The pump should NOT be primed before each daily use. Discard bottle 30 days after first use.

» Advise patient to notify health care professional if significant nasal irritation occurs.