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Pronunciation |
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(e
ti DROE nate dye SOW dee
um) |
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U.S. Brand
Names |
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Didronel® |
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Generic
Available |
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No |
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Synonyms |
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EHDP; Sodium Etidronate |
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Pharmacological Index |
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Bisphosphonate Derivative |
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Use |
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Symptomatic treatment of Paget's disease and heterotopic ossification due to
spinal cord injury or after total hip replacement, hypercalcemia associated with
malignancy |
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Pregnancy Risk
Factor |
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B (oral)/C (parenteral) |
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Contraindications |
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Patients with serum creatinine >5 mg/dL; hypersensitivity to
biphosphonates |
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Warnings/Precautions |
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Use with caution in patients with restricted calcium and vitamin D intake;
dosage modification required in renal impairment; I.V. form may be nephrotoxic
and should be used with caution, if at all, in patients with impaired renal
function (serum creatinine: 2.5-4.9 mg/dL) |
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Adverse
Reactions |
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1% to 10%:
Central nervous system: Fever, convulsions
Endocrine & metabolic: Hypophosphatemia, hypomagnesemia, fluid overload
Neuromuscular & skeletal: Bone pain
Respiratory: Dyspnea
<1%: Pain, angioedema, rash, abnormal taste, occult blood in stools,
increased risk of fractures, nephrotoxicity, hypersensitivity reactions
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Overdosage/Toxicology |
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Symptoms of overdose include diarrhea, nausea, vomiting, paresthesias,
tetany, coma
Antidote is calcium |
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Drug
Interactions |
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Foscarnet and plicamycin may have additive hypocalcemic
effect |
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Stability |
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Store ampuls at room temperature and avoid excess heat
(>40°C/104°F); intravenous
solution diluted in greater than or equal to 250 mL normal saline is stable for
48 hours at room temperature or refrigerated |
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Mechanism of
Action |
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Decreases bone resorption by inhibiting osteocystic osteolysis; decreases
mineral release and matrix or collagen breakdown in bone |
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Pharmacodynamics/Kinetics |
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Onset of therapeutic effect: Within 1-3 months of therapy
Duration: Can persist for 12 months without continuous therapy
Absorption: Dependent upon dose administered
Metabolism: Not metabolized
Elimination: As unchanged drug primarily in urine with unabsorbed drug being
eliminated in feces |
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Usual Dosage |
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Adults: Oral formulation should be taken on an empty stomach 2 hours before
any meal.
Initial: 5-10 mg/kg/day (not to exceed 6 months) or 11-20 mg/kg/day (not to
exceed 3 months). Doses >10 mg/kg/day are not recommended.
Retreatment: Initiate only after etidronate-free period greater than or equal
to 90 days. Monitor patients every 3-6 months. Retreatment regimens are the same
as for initial treatment.
Heterotopic ossification: Oral:
Caused by spinal cord injury: 20 mg/kg/day for 2 weeks, then 10 mg/kg/day for
10 weeks; total treatment period: 12 weeks
Complicating total hip replacement: 20 mg/kg/day for 1 month preoperatively
then 20 mg/kg/day for 3 months postoperatively; total treatment period is 4
months
Hypercalcemia associated with malignancy:
I.V. (dilute dose in at least 250 mL NS): 7.5 mg/kg/day for 3 days; there
should be at least 7 days between courses of treatment
Oral: Start 20 mg/kg/day on the last day of infusion and continue for 30-90
days
Dosing adjustment in renal impairment:
Scr 2.5-5 mg/dL: Use with caution
Scr >5 mg/dL: Not recommended |
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Dietary
Considerations |
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Administer with water, black coffee, tea, or fruit juice on an empty stomach;
avoid administering foods/supplements with calcium, iron, or magnesium within 2
hours of drug; maintain adequate intake of calcium and vitamin
D |
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Administration |
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Dilute in a minimum volume of 250 mL normal saline; infuse over at least 2
hours |
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Monitoring
Parameters |
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Serum calcium and phosphorous; serum creatinine and BUN |
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Reference Range |
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Calcium (total): Adults: 9.0-11.0 mg/dL |
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Mental Health: Effects
on Mental Status |
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None reported |
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Mental Health:
Effects on Psychiatric
Treatment |
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None reported |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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Maintain adequate intake of calcium and vitamin D; take medicine on an empty
stomach 2 hours before meals |
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Nursing
Implications |
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Ensure adequate hydration |
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Dosage Forms |
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Injection: 50 mg/mL (6 mL)
Tablet: 200 mg, 400 mg |
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References |
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Gray RE, "Severe Reaction to Diphosphonate," BMJ, 1988,
297(6655):1042.
Storm T, Thamsborg G, Steiniche T, et al,
"Effect of Intermittent Cyclical Etidronate Therapy on Bone Mass and Fracture Rate in Women With Postmenopausal Osteoporosis,"
N Engl J Med, 1990, 322(18):1265-71.
Watts NB, Harris ST, Genant HK, et al,
"Intermittent Cyclical Etidronate Treatment of Postmenopausal Osteoporosis,"
N Engl J Med, 1990, 323(2):73-9.
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