sodium clodronate

CLINICAL USE

Bisphosphonate:(1) Management of osteolytic lesions, hypercalcaemia and bone pain associated with skeletal metastases in patients with breast cancer or multiple myeloma(2) Hypercalcaemia of malignancy

DOSE IN NORMAL RENAL FUNCTION

(1) Oral: 1.6–3.2 g daily in single or 2 divided doses Loron-520: 2–4 tablets daily(2) Slow

IV infusion

: 300 mg daily for 7–10 days or a single dose infusion of 1.5 g

PHARMACOKINETICS

Molecular weight :360.9 (as disodium salt)

%Protein binding :36

%Excreted unchanged in urine : >70

Volume of distribution (L/kg) :0.3

half-life – normal/ESRD (hrs) :1 st phase: 2; 2 nd phase: 13/51

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–50 Dose as in normal renal function 10–30 50% of normal dose

<10 : Avoid

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in GFR <10 mL/min

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

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

CAV/VVHD :Unknown dialysability. Dose as in GFR=10–30 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

None known

ADMINISTRATION

Reconstition

–

Route

Oral,

IV infusion

Rate of Administration

(1) Single infusion: 1500 mg over 4 hours (2) Multiple infusions: 300 mg over at least 2 hours

Comments

(1) Single infusion: 1500 mg sodium clodronate to 500 mL sodium chloride 0.9% or glucose 5%(2) Multiple infusions: 300 mg sodium clodronate to 500 mL sodium chloride 0.9% or glucose 5%Multiple infusions should be repeated on successive days until normocalcaemia is achieved or to a maximum of 7–10 daysWhichever method of infusion is employed, most patients will achieve normocalcaemia within 5 days

OTHER INFORMATION

Renal failure has been associated with IV use of bisphosphonates. Smaller doses (up to 300 mg daily) over 2–3 hours are less likely to be associated with renal impairment than high doses by short IV infusionReversible elevations of creatinine have been reported. Renal function should be monitored during treatmentOrally: avoid food for one hour before and after treatment, particularly calcium-containing products; also avoid iron, mineral supplements and antacids

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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