disodium etidronate

CLINICAL USE

Bisphosphonate:Paget’s disease of bone Vertebral osteoporosis (Didronel PMO)

DOSE IN NORMAL RENAL FUNCTION

Paget’s disease: 5–20 mg/kg daily for 3–6 monthsVertebral osteoporosis: 400 mg daily for 14 days followed by 76 days of calcium carbonate 1.25 g (= 500 mg calcium)

PHARMACOKINETICS

Molecular weight :250

%Protein binding :Depends on calcium concentration and pH

%Excreted unchanged in urine : 50

Volume of distribution (L/kg) :0.3–1.3

half-life – normal/ESRD (hrs) :1–6/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Maximum dose = 5 mg/kg/day

10 to 20 : Maximum dose = 5 mg/kg/day – use with caution. (May also use Didronel PMO for osteoporosis.)

<10 : Maximum dose = 5 mg/kg/day – use with caution. (May also use Didronel PMO for osteoporosis)

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in GFR <10 mL/min

HD :Unknown dialysability. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsDo not give iron and mineral supplements, antacids or phosphate binders within 2 hours of an etidronate

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

–

Comments

Take on an empty stomach. Recommended that patients take with water at the midpoint of a 4 hour fast (i.e. 2 hours before and 2 hours after food)Oral bioavailability is very low; only about 4% of dose is absorbed

OTHER INFORMATION

Renal clearance of etidronate is 1.2 mL/ minute/kg, whilst the total body clearance is 2.2 mL/minute/kgElimination is likely to be reduced in patients with renal impairment and elderly with reduced renal function necessitating caution. Uptake of etidronate by bone represents non-renal clearance

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