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Endocrine Drugs
 
 
 

Bisphosphonates

 
 
  •  
    Oral
    Alendronate
    Fosamax 
     
    Once weekly dosing
  •  
    IV
    Pamidronate
    Aredia 
     
    Used to treat lytic lesions / hypercalcaemia of malignancy
  •  
    Oral
    Risedronate
    Actonel 
     
    Daily, weekly or monthly dosing
  •  
    IV
    Zolendronic Acid
    Aclasta, Zometa

Overview

    • Mechanism of Action

    • Structural analogues of pyrophosphate that bind to the resorptive surface of osteoclasts and are internalised. Disruption of key regulatory proteins results in inhibition of osteoclastic function and reduction in bone resorption.
    • Pharmacology

    • Patients should remain upright for at least 20 minutes after taking oral bisphosphonates, in order to reduce risk of oesophagitis / gastritis.
    • Often given in combination with calcium carbonate and cholecalciferol.

Clinical Use

    • Indications

    • Osteoporosis
    • Paget’s disease of bone
    • Lytic lesions (pamidronate) – breast cancer metastasis, multiple myeloma
    • Hypercalcaemia of malignancy (pamidronate, zoledronic acid)
    • Contraindications

    • Hypocalcaemia
    • Delayed oesophageal emptying – stricture, achalasia
    • Inability to stand / sit upright
    • Adverse Effects

    • Headache
    • Oesophagitis / gastritis
    • Nausea / vomiting / diarrhea
    • Muscle / bone / joint pain
    • Atypical femoral fractures
    • Osteonecrosis of the jaw
  • Patients should have a dental review prior to commencing bisphosphonates and have any required dental extractions, as the risk of jaw osteonecrosis increases with dental procedures.
Last updated on January 1st, 2017
 
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The information in this section has been adapted in part from the Australian Therapeutic Goods Association website's repository of product information documents, which are available at https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI.
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