Adult Dosing
Treatment of hypercalcemia of malignancy
- 300 mg slow IV over 2-6 hrs, then 1600-2400 mg/day PO divided bid
Osteolytic lesions from bone metastases/malignant tumors
- 300 mg slow IV over 2-6 hrs, then 1600-2400 mg/day PO divided bid
Pediatric Dosing
- Safety and effectiveness in pediatric population has not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- 50-80 mL/min: Give 75-100% of normal dose
- 12-50 mL/min: Give 50-75% of normal dose
- < 12 mL/min: Give 50% of normal dose
Hepatic Dose Adjustment
- Hepatic impairment: No dose adjustments
- Do not give as a bolus injection since severe local reactions and thrombophlebitis may occur due to high local concentrations
- Rapid bolus IV injection may precipitate renal failure; dilute and administer as a slow IV infusion over a period of minimum 2 hrs
- Do not combine mix with calcium-containing intravenous infusions
- Do not give with other biphosphonates
- Osteonecrosis of the jaw has occurred in patients with cancer receiving chemotherapy with bisphosphonates and steroids; more commonly reported in patients undergoing dental procedures such as tooth extraction. Prior to treatment, consider dental examination particularly in patients with risk factors. Avoid invasive dental procedures whenever possible
- Adequate fluid intake should be maintained during treatment
- Hypocalcemia, hyperphosphatemia, hyperparathyroidism have been reported
- Calcium levels should be monitored throughout the treatment.
- Monitor CrCl, LFTs, WBC, phosphate periodically
- Monitor renal and hepatic function
Cautions: Use cautiously in
- Mild to moderate renal impairment
- Chemotherapy
- Concurrent corticosteroids
- Avoid dental procedures
- Poor oral hygiene
Pregnancy Category: US Pregnancy category yet to be assigned. Use not recommended in women not using effective contraception.
Breastfeeding: Safety unknown. Use not recommended
