Granal

Granal is a prescription oral medication that contains the active ingredient alfacalcidol, a vitamin D analog. The product’s strength and specific dosage form are not disclosed in the available information, but it is marketed in the European Union for use under medical supervision. Alfacalcidol is converted in the body to calcitriol, the active form of vitamin D, to help regulate calcium and phosphate metabolism in patients with certain conditions.

Granal is indicated for several disorders that involve impaired calcium and phosphate balance.

- Treatment of hypocalcemia associated with vitamin D deficiency or renal disease. - Management of osteomalacia in adults. - Therapy for renal osteodystrophy in patients with chronic kidney disease. - Control of secondary hyperparathyroidism in dialysis patients. - Support of bone health in conditions requiring calcium metabolism regulation.

Side effects of alfacalcidol may vary in frequency and severity.

Common: - Nausea or vomiting. - Constipation or abdominal discomfort. - Mild headache or dizziness. - Transient increase in serum calcium levels. - Skin rash or pruritus. - Fatigue.

Serious: - Severe hypercalcemia with symptoms such as polyuria, polydipsia, or cardiac arrhythmia. - Hyperphosphatemia leading to vascular calcification. - Acute kidney injury. - Allergic reactions including angioedema or anaphylaxis. - Persistent elevation of serum calcium despite dose adjustment.

When prescribing Granal, clinicians should consider several safety precautions.

- Baseline and periodic monitoring of serum calcium, phosphate, and renal function. - Avoid use in patients with known hypercalcemia or hyperphosphatemia. - Adjust dose or discontinue if marked increases in calcium occur. - Use with caution in pregnant or breastfeeding women, as safety data are limited. - Assess vitamin D status before initiating therapy. - Consider drug interactions that may affect calcium balance. - Educate patients on signs of hypercalcemia and when to seek medical attention.

Alfacalcidol can interact with other medicines, requiring attention to avoid adverse outcomes.

Avoid: - Concomitant high-dose calcium supplements or calcium‑containing antacids. - Other vitamin D analogues or calcitriol preparations. - Thiazide diuretics that may increase calcium reabsorption. - Lithium therapy, which can alter calcium metabolism.

Use with caution: - Loop diuretics, which may affect calcium excretion. - Corticosteroids, which can reduce vitamin D effectiveness. - Anticonvulsants such as phenytoin or phenobarbital that accelerate vitamin D metabolism. - Bisphosphonates, as combined effects on bone turnover need monitoring. - Antifungal agents like ketoconazole that may interfere with vitamin D activation.