→Appendix 1: bisphosphonates
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▶Common or very common Appetite decreased. chills.
flushing
▶Uncommon Anaphylactic shock. anxiety. arrhythmias.
chest pain. circulatory collapse. cough. drowsiness. dry
mouth. dyspnoea. haematuria. hyperhidrosis.
hypertension. hypotension. leucopenia. muscle spasms.
proteinuria. respiratory disorders. sensation abnormal.
sleep disorder. stomatitis. syncope. thrombocytopenia.
tremor. vision blurred. weight increased
▶Rare or very rare Confusion. Fanconi syndrome acquired.
pancytopenia
▶Frequency not known Acute phase reaction
SIDE-EFFECTS, FURTHER INFORMATION Renal impairment
and renal failure have been reported; ensure patient is
hydrated before each dose and assess renal function.
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Contra-indicated in
women of child-bearing potential.
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Avoid—toxicity in animal studies.
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Avoid—no information available.
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Manufacturer advises caution in
severe hepatic impairment (limited information available).
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Avoid in tumour-induced
hypercalcaemia if serum creatinine above
400 micromol/litre. Avoid in advanced malignancies
involving bone if eGFR less than 30 mL/minute/1.73 m2 (or
if serum creatinine greater than 265 micromol/litre). Avoid
in Paget’s disease, treatment of postmenopausal
osteoporosis and osteoporosis in men if eGFR less than
35 mL/minute/1.73 m2.
Dose adjustments In advanced malignancies involving
bone, if eGFR 50–60 mL/minute/1.73 m2 reduce dose to
3.5 mg every 3–4 weeks; if eGFR 40–50 mL/minute/1.73 m2
reduce dose to 3.3 mg every 3–4 weeks; if eGFR
30–40 mL/minute/1.73 m2 reduce dose to 3 mg every
3–4 weeks; if renal function deteriorates in patients with
bone metastases, withhold dose until serum creatinine
returns to within 10% of baseline value.
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▶Correct disturbances of calcium metabolism (e.g. vitamin
D deficiency, hypocalcaemia) before starting. Monitor
serum electrolytes, calcium, phosphate and magnesium.
▶Monitor renal function in patients at risk, such as those
with pre-existing renal impairment, those of advanced
age, those taking concomitant nephrotoxic drugs or
diuretics, or those who are dehydrated.
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