Adult Dosing
Hypercalcemia of malignancy
- Start 300 mg/day slow IV over 2-6 hrs
- 1600 - 2400 mg/day PO divided daily-bid; may be increased to desired response
- Max: 3200 mg/day
Osteolytic lesions from bone metastases/malignant tumors
- 1600 mg/day PO divided daily-bid; may be increased to desired response
- Max: 3200 mg/day
- Note: Take with fluid other than milk, at least 2 hrs before or after food
Pediatric Dosing
- Safety and effectiveness in pediatric population have not been established
Renal Dose Adjustment (Based on CrCl)
- 30-50 mL/min: Reduce dose by 25%
- 10-30 mL/min: Reduce dose by 50%
- <10 mL/min: Contraindicated
Hepatic Dose Adjustment
- Hepatic impairment: No dose adjustments
- 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 has 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
