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| Zoledronic acid | Disodium pamidronate | |
| Intravenous (IV) dose | 4mg | 30mg to 90mg |
| Onset of effect | <4 days | <3 days |
| Maximum effect | 4 to 7 days | 5 to 7 days |
| Duration of effect | 4 weeks | 2.5 weeks |
Management
- The aim of treatment is to improve symptoms and reduce corrected calcium* level to within the normal range.
- Normal corrected calcium value* 2.12 to 2.62mmol/l (locally defined ranges will apply).
- IV fluid replacement and IV bisphosphonates are treatments of choice.
- The choice of bisphosphonate may be determined by local policy (such as disodium pamidronate/zoledronic acid). Refer to local formulary.
- To reduce risk of renal toxicity from bisphosphonate treatment, consider withholding medication that affects the renal function (for example non-steroidal anti-inflammatory drugs, diuretics, thiazide diuretics, angiotensin-converting enzyme inhibitors).
*Corrected calcium = Measured calcium + 0.022 x (40 - serum albumin g/l). See Corrected calcium