Adult:
Initial dose: 5 mg/kg/day up to 6 mth. For severe disease, may use up to 10 mg/kg/day for not >3 mth. Further treatment should only be given after a drug-free interval of at least 3 mth and after evidence of relapse. Subsequent treatment period should not exceed initial treatment period. Max dose: 20 mg/kg/day.
Oral
PREVENTION AND TREATMENT OF ECTOPIC OSSIFICATION COMPLICATING HIP REPLACEMENT
Adult:
20 mg/kg/day for 1 mth before and 3 mth after the operation. For ectopic ossification due to spinal cord injury: 20 mg/kg daily for 2 wk followed by 10 mg/kg daily for 10 wk.
Oral
OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN
Adult:
Given on a cyclic basis: 400 mg/day for 14 days followed by the equivalent of 500 mg of elemental calcium for 76 days. Treatment may be continued for up to 3 yr.
Intravenous
HYPERCALCAEMIA OF MALIGNANCY
Adult:
7.5 mg/kg/day via slow infusion for 3 consecutive days, up to 7 days if necessary. Dose to be diluted in 250 mL of NaCl 0.9% and infused over at least 2 hr. Ensure at least 7-day interval between treatment courses. Maintenance therapy (via oral route): 20 mg/kg/day for 30-90 days, to be started on the day after the last IV dose.
Administration
Should be taken on an empty stomach (i.e. At least one hour before food or four hours after food). (Take on an empty stomach at least 2 hr before or after meals, esp meals high in Ca such as milk or milk products, vit w/ mineral supplements or antacids containing Ca, Mg, Fe or Al.)
Precautions
In paget's disease, ensure 90 day drug-free interval between treatment courses; renal disease, children, malnutrition, patients with fractures (especially of long bones). May exacerbate asthma in asthmatics. Pregnancy, lactation.
Adverse Drug Reactions
GI symptoms like abdominal pain, constipation, diarrhoea and nausea, hypersensitivity reactions including angioedema, urticaria, rash and pruritus, increase or recurrent bone pain at pagetic sites or the onset of pain at previously asymptomatic sites, metallic, altered or loss of taste during or shortly after the treatment. Headache, paraesthesia, leucopenia, agranulocytosis.
Interactions
Calcium, iron and antacids reduce absorption. May increase prothrombin time when used with warfarin. May increase GI and/or renal side effects when used with NSAIDs.
