Adult Dosing
Paget’s Disease
- Initial: 5-10 mg/kg/day PO x 6 months
- Alternate: 11-20 mg/kg/day PO x 3 months
- Max: 20 mg/kg/day
- May repeat after 90 days if biochemical, symptomatic or other evidence of active disease process is present
Heterotopic Ossification
Total Hip Replacement
- 20 mg/kg/day PO, 1 month before and 3 month after surgery
Spinal Cord Injury
- 20 mg/kg/day PO x 2 wks, then 10 mg/kg/day x 10 wks
Hypercalcemia Associated with Malignant Neoplasms
- 20 mg/kg/day x 30 days; may extend therapy for a maximum of 90 days
Note:
- Calcium and vitamin D supplementation recommended
Pediatric Dosing
- Safety and effectiveness in pediatric patients has not been established
[Outline]
See Supplemental Patient Information
- Etidronate like other bisphosphonates causes local irritation of the upper gastrointestinal mucosa, further leading to esophagitis, esophageal ulcers, esophageal erosions, occasionally with bleeding and rarely esophageal stricture or perforation, use cautiously in patients with active upper gastrointestinal problems
- Advise patients to follow the dosing instructions. Instruct the patient to discontinue the drug and seek medical attention if any sign of esophageal reaction like dysphagia, odynophagia, retrosternal pain or new or worsening heartburn occurs
- In Paget's diseases as the onset of response is slow and continue for months after withdrawal of therapy, dose increment should not be done prematurely and should follow at least 90 day drug-free interval between courses of therapy
- Patients should be advised to maintain an adequate intake of calcium and vitamin D during therapy
- Withheld the therapy in patients with enterocolitis as it can cause diarrhea at higher dose
- As etidronate suppresses bone turnover, and retard mineralization of osteoid laid down during the bone accretion process, it is advisable to delay or interrupt treatment until callus is evident especially in patients with fracture of long bones
- Osteonecrosis of the jaw (ONJ) has been reported with bisphosphonate therapy, generally associated with invasive dental procedures, and/or local infection, poor oral hygiene, co-morbid disorders (e.g., periodontal and/or other pre-existing dental disease, anemia, coagulopathy, infection, ill-fitting dentures, cancer). Discontinuation of bisphosphonate therapy should be considered based on individual benefit/risk assessment
- Severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported postmarkedly in patients on bisphosphonate therapy
- Exceeding the recommended daily maximum dose of 20 mg/kg or continuous use for greater than 6 months is associated with osteomalacia and an increased risk of fracture in Paget's patients particularly in patients unresponsive to etidronate therapy. Monitor the patient with predominantly lytic lesions radiographically and biochemically to permit termination of therapy
Cautions: Use cautiously in
- Renal impairment
- Active upper gastrointestinal problems
- Invasive dental procedure
- Long bone fracture
- Enterocolitis
- Malnutrition
Supplemental Patient Information
- Patients should be instructed to follow the dosing instructions i.e. swallowed the tablet with a full glass of water (6 to 8 oz), not to lie down after taking the medication and avoid food high in calcium, vitamins with mineral supplements or antacids which are high in metals within two hours of dosing. Avoid eating for at least 2 hours before and after taking etidronate
Pregnancy Category:C
Breastfeeding: Absorption of etidronate by a breastfed infant is unlikely. As no information is available on the use of etidronate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 3 February 2011). However manufacturer advises caution while administering the nursing women.
Pricing data from www.DrugStore.com in U.S.A.
- Didronel 200 MG TABS [Bottle] (WARNER CHILCOTT PHARMA)
30 mg = $115.99
90 mg = $335.97 - Didronel 400 MG TABS [Bottle] (WARNER CHILCOTT PHARMA)
30 mg = $246.5
90 mg = $699.59
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
