etidronate disodium

et·i·dro·nate disodium (t-drnt)

n.

A drug that affects bone resorption and is used in the treatment of Paget's disease, heterotopic ossification, and hypercalcemia of malignancy.

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etidronate disodium

[etid′rənāt]

a regulator of calcium metabolism. Also called sodium etidronate.

indications It is prescribed in the treatment of Paget's disease and heterotopic ossification caused by injury to the spinal cord and after total hip replacement.

contraindication There are no known contraindications.

adverse effects Among the more serious adverse effects are bone pain both at pagetic sites and at previously asymptomatic sites, GI disturbances, and elevated serum phosphate concentrations.

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etidronate disodium

(ē´tdrō´nāt dīsō´dēm),
n brand name: Didronel IV;
drug class: antihypercalcemic;
action: decreases bone resorption and new bone development (accretion);
uses: Paget's disease, heterotopic ossification, hypercalemia of malignancy.

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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.

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etidronate disodium

Didronel® Metabolism An organic biphosphonate used to manage osteoporosis, Paget's disease of bone–osteitis deformans, heterotopic ossification, hypercalcemia of CA. See Coherence therapy, Osteoporosis.