Indications & Dose: CANCER RELATED HYPERCALCEMIA Severe IV Adult 90mg as single dose over 2h q3-4wk | HYPERCALCEMIA SECONDARY TO MALIGNANCY Severe IV Adult 90mg as single dose over 2-24h (allow at least 7 days before the use of second course), repeat Inf q2-3wk. However, can administer q2-3month based on degree of severity of hypercalcemia & type of malignancy | Moderate IV Adult 60-90mg as single dose over 2-24h (allow at least 7 days before the use of second course), repeat Inf q2-3wk. However, can administer q2-3month based on degree of severity of hypercalcemia & type of malignancy | OSTEOLYTIC BONE LESIONS WITH MULTIPLE MYELOMA IV Adult 90mg over 2-4h monthly or q3-4wk | OSTEOLYTIC BONE METASTASES IV Adult 90mg over 2h q3-4wk | PAGET’S DISEASE IV Adult 30mg over 4h daily 3 days, (total dose 90mg), may retreat at initial dose if clinically indicated

Precautions: Hypoparathyroidism, CVD

ADR: Serious: Atrial fibrillation, cardiac failure, atrial flutter, tachycardia, HTN, edema, syncope, blood disorders, uremia, myalgia, arthralgia, hypokalemia, hypocalcemia, Others: back pain, bone pain, psychosis, seizure, somnolence, dyspnea, cough, URTI, sinusitis, pleural effusion, osteonecrosis of jaw, weakness, infusion site reaction, UTI, nausea, vomiting, fatigue, fever, headache, insomnia, anorexia, abdominal pain, dyspepsia, hypophosphatemia

DDI: Serious Thalidomide increases risk of osteonecrosis

Diet:

Monitor: SeCr, serum electrolytes including Ca, Mg, phosphate & potassium, CBC, dental exam & preventative dentistry prior to therapy, patients with pre-existing anemia, leukopenia, or thrombocytopenia before & after therapy, urine albumin