Di·dro·nel (d -dr  n l) A trademark for the drug etidronate disodium. |
Didronel,
etidronate disodium
Didronel
Pharmacologic class: Bisphosphonate
Therapeutic class: Bone resorption inhibitor, hypocalcemic agent
Pregnancy risk category B (oral use), C (I.V. use)
Action
Blocks calcium absorption, slowing bone metabolism and reducing bone resorption and formation
Availability
Injection: 300 mg/ampule in 6-ml ampules
Tablets: 200 mg, 400 mg
⊘Indications and dosages
➣ Paget's disease
Adults: 5 to 10 mg/kg P.O. daily as a single dose for up to 6 months, or 11 to 20 mg/kg P.O. daily for up to 3 months
➣ Heterotopic ossification after hip replacement
Adults: 20 mg/kg P.O. daily for 1 month before and 3 months after surgery
➣ Heterotopic ossification in spinal cord injury
Adults: Initially, 20 mg/kg P.O. daily for 2 weeks, decreased to 10 mg/kg P.O. daily for 10 weeks
➣ Hypercalcemia related to cancer
Adults: 7.5 mg/kg/day I.V. infused over at least 2 hours for 3 consecutive days; may continue infusion for up to 7 days if necessary. P.O. dosing may begin after last infusion.
Contraindications
• Hypersensitivity to drug or its components
• Severe renal impairment
• Osteomalacia (tablets)
Precautions
Use cautiously in:
• moderate renal impairment, long bone fractures, heart failure, hypocalcemia, hypovitaminosis D
• pregnant or breastfeeding patients
• children (safety not established).
Administration
• For I.V. use, dilute with 250 ml of normal saline solution. Infuse slowly over at least 2 hours.
• Give oral dose with water or juice 2 hours before meals.
• Make sure patient doesn't eat for 2 hours after receiving dose.
• Know that therapy longer than 3 months is not recommended.
| Route | Onset | Peak | Duration |
| P.O. (Paget's) | 1 mo | Unknown | 1 yr |
| P.O. (ossif.) | Unknown | Unknown | Several mo |
| I.V. (hypercalc.) | 24 hr | 3 days | 11 days |
Adverse reactions
All reactions occur only with I.V. use unless otherwise noted.
CNS: seizures
GI: nausea, constipation, stomatitis
Hematologic: anemia
Metabolic: hypomagnesemia, hypophosphatemia, fluid overload
Musculoskeletal: bone pain and tenderness, fractures (all with oral use)
Respiratory: dyspnea
Skin: rash (with oral use)
Other: taste loss, metallic taste, fever
Interactions
Drug-drug. Antacids; buffers containing aluminum, calcium, iron, or magnesium; mineral supplements: decreased etidronate absorption
Calcitonin: additive hypocalcemic effect
Warfarin: increased prothrombin time
Drug-diagnostic tests. Blood urea nitrogen (BUN), creatinine: increased levels
Calcium, magnesium: decreased levels
Liver function tests: elevated values
Drug-food. Foods high in aluminum, calcium, iron, or magnesium: decreased etidronate absorption
Patient monitoring
• Monitor fluid intake and output.
☞ Watch for seizures.
• Monitor patient for GI discomfort. Divide doses as needed to ease symptoms.
• Assess bowel pattern. If constipation occurs, increase fluids and administer stool softeners, as prescribed.
• Monitor calcium, phosphorus, magnesium, creatinine, and BUN levels; liver function tests; and bone scans.
Patient teaching
• Instruct patient not to take drug with food because of decreased drug absorption.
• Tell patient not to consume high-calcium products, such as milk or antacids, within 2 hours of taking dose.
• Stress importance of eating a diet high in vitamin D and calcium.
• Advise patient to report bone pain or decreased range of motion.
• As appropriate, review all other significant adverse and life-threatening reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.
Didronel®
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