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Indication & Dosage
 
 
Intravenous
PAGET'S DISEASE
Adult:

30 mg daily (over 4 hr) for 3 consecutive days or 30 mg wkly for 6 wk (total dose: 180 mg). Alternatively, 30mg in the 1st wk, then 60 mg every other wk for 6 wk (total dose: 210 mg). Max total dose of 360 mg (in divided doses of 60 mg) can be repeated 6 mthly until remission of the disease is achieved, or relapse occurs. Max infusion rate: 60 mg/hr.
 

Elderly: Initiate with lower doses.

 
Intravenous
HYPERCALCAEMIA OF MALIGNANCY
Adult:

15-90 mg by slow infusion in single or divided doses over 2 hr-4 days. Allow min of 7 days before repeating dose. Normal frequency is every 2-3 wk, may be as much as 2-3 mth. Max infusion rate: 60 mg/hr. Manufacturers recommend that patients are rehydrated with normal saline before or during treatment.
 

Elderly: Initiate with lower doses.

 
Intravenous
BONE METASTASES
Adult:

With multiple myeloma: 90 mg mthly. With breast cancer: 90 mg every 3-4 wk. Max infusion rate: 20 mg/hr.
 

Elderly: Initiate with lower doses.

   
Precautions May increase the risk of heart failure in patients with cardiac disease. Lactation. Infuse slowly to reduce risk of adverse effects (e.g. infusion site reactions, renal impairment). Do not give as a bolus inj. Risk of neurotoxicity: Each dose should not >90mg (max concentration: 60 mg/250ml). CBC should be performed (patients with preexisting anemia, leukopenia or thrombocytopenia should be closely monitored within the 1st 2 wk of therapy). Bone, myalgia and/or arthralgia (possibly incapacitating) may develop days, mth, or yr after starting bisphosphonate; pain is distinctly different to the acute bone pain, myalgia or arthralgia which may follow administration and normally improves within several days; symptoms normally stop once therapy is discontinued; do not administer to patients with a history of these reactions associated with bisphosphonate therapy. Monitor creatinine before each dose, especially in those predisposed to renal impairment (withhold dose in patients with bone metastases whose renal function declines).
   
Potentially Life-threatening 
Adverse Drug Reactions
Ocurrence and severity of reactions depend on dose and duration of infusion. Anorexia, dyspepsia, nausea, abdominal pain, vomiting; metastases; fatigue; arthralgia, myalgia; anxiety, headache, insomnia, fever; flu-like symptoms; transient bone pain, hypocalcaemia; leucopenia; local reactions at infusion site; somnolence, dizziness, hypotension, rash; hypophosphataemia, hypokalaemia, hypomagnesaemia; osteonecrosis of the jaw (especially in cancer patients); vein irritation and thrombophlebitis; candidiasis; UTI; dyspnoea, cough, upper respiratory tract infections, sinusitis, pleural effusion; atrial fibrillation, hypertension, syncope, tachycardia; psychosis; constipation, GI bleed; uremia; rales, rhinitis.
   
Adverse Drug Reactions Acute renal and heart failure.
   
Interactions Additive hypocalcaemic effect with aminoglycosides; decreased absorption with antacids (containing aluminium, calcium or magnesium), administer at a different time of day; decreased absorption with calcium salts; increases risk of GI adverse/toxic effects (especially GI ulcers) with NSAIDs; may increase hypocalcaemic effect of phosphate supplements.
   
   
 

 

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