Pharmacologic class: Bisphosphonate
Therapeutic class: Bone resorption inhibitor, hypocalcemic agent
Pregnancy risk category B
Blocks calcium absorption, slowing bone metabolism and reducing bone resorption and formation
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
• Decreased glomerular filtration rate
• Hypersensitivity to drug or its components
• Abnormalities of esophagus, such as stricture or achalasia, that delay esophageal emptying
Use cautiously in:
• renal impairment, long bone fractures, active upper GI condition (such as Barrett's esophagus, dysphagia, other esophageal diseases, gastritis, duodenitis, or ulcers)
• pregnant or breastfeeding patients
• children (safety not established).
• Give with 6 to 8 oz of water 2 hours before first meal.
• Make sure patient doesn't eat for 2 hours after receiving dose.
• Know that therapy longer than 3 months is not recommended.
GI: nausea, constipation, stomatitis, diarrhea, esophageal irritation
Musculoskeletal: bone pain and tenderness, fractures, osteonecrosis of the jaw
Drug-drug. Warfarin: increased prothrombin time
Drug-diagnostic tests. Serum phosphorus: increased level
• Monitor fluid intake and output.
• 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.
• Closely monitor renal function tests and serum phosphorus level.
• Instruct patient to take drug first thing in morning on an empty stomach, with 6 to 8 oz of water only and to stay upright for at least 30 minutes afterward.
• Instruct patient not to take drug with food because of decreased drug absorption.
• Tell patient not to consume highcalcium products, such as milk or antacids, or vitamins and mineral supplements high in calcium, iron, magnesium, or aluminum, within 2 hours of taking dose.
☞ Tell patient to immediately discontinue drug and notify prescriber if severe chest pain, difficulty or painful swallowing, or new or worsening heartburn occurs.
• Advise patient to report bone pain or decreased range of motion.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.