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etidronate (Oral route, Intravenous route)

e-ti-DROE-nate

Commonly used brand name(s):

In the U.S.

Didronel
Didronel I.V.

Available Dosage Forms:

Solution
Kit
Tablet

Therapeutic Class: Calcium Regulator

Chemical Class: Bisphosphonate

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Uses For etidronate

Etidronate is used to treat Paget's disease of bone. It may also be used to treat or prevent a certain type of bone problem that may occur after hip replacement surgery or spinal injury.

Etidronate is also used to treat hypercalcemia (too much calcium in the blood) that may occur with some types of cancer.

etidronate is available only with your doctor's prescription.

Before Using etidronate

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For etidronate, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to etidronate or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Some changes in bone growth may occur in children, but will usually go away when the medicine is stopped.

Geriatric

When etidronate is given by injection along with a large amount of fluid, older people tend to retain (keep) the excess fluid.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use of etidronate

Make certain your health care professional knows if your diet includes large amounts of calcium, such as milk or other dairy products, or if you are on any special diet, such as a low-sodium or low-sugar diet. Calcium in the diet may prevent the absorption of oral etidronate.

Take etidronate with water on an empty stomach at least 2 hours before or after food (mid-morning is best) or at bedtime. Food may decrease the amount of etidronate absorbed by your body.

Take etidronate only as directed. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

In some patients, etidronate takes up to 3 months to work. If you feel that the medicine is not working, do not stop taking it on your own. Instead, check with your doctor.

It is important that you eat a well-balanced diet with an adequate amount of calcium and vitamin D (found in milk or other dairy products). Too much or too little of either may increase the chance of side effects while you are taking etidronate. Your doctor can help you choose the meal plan that is best for you. However, do not take any food, especially milk, milk formulas, or other dairy products, or antacids, mineral supplements, or other medicines that are high in calcium or iron (high amounts of these minerals may also be in some vitamin preparations), magnesium, or aluminum within 2 hours of taking etidronate. To do so may keep etidronate from working properly.

Dosing

The dose of etidronate will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of etidronate. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (tablets):
- For treating Paget's disease of bone:
  - Adults—Dose is based on body weight and must be determined by your doctor. The dose to start is 5 milligrams (mg) per kilogram (kg) (2.3 mg per pound) of body weight a day, usually as a single dose, for not more than six months. Some people may need 6 to 10 mg per kg (2.7 to 4.6 mg per pound) of body weight a day for not more than six months. Others may need 11 to 20 mg per kg (5 to 9.1 mg per pound) of body weight a day for not more than three months. Your doctor may change your dose depending on your response to treatment.
  - Children—Dose must be determined by your doctor.
- For treating or preventing a certain type of bone problem that may occur after hip replacement:
  - Adults—Dose is based on body weight and must be determined by your doctor. The usual dose is 20 mg per kg (9.1 mg per pound) of body weight a day for one month before surgery, and for three months after surgery.
  - Children—Dose must be determined by your doctor.
- For treating or preventing a certain type of bone problem that may occur after spinal injury:
  - Adults—Dose is based on body weight and must be determined by your doctor. The usual dose is 20 mg per kg (9.1 mg per pound) of body weight a day for two weeks, beginning as soon as possible after your injury. Your doctor may then decrease your dose to 10 mg per kg (4.5 mg per pound) of body weight for an additional ten weeks.
  - Children—Dose must be determined by your doctor.
- For treating hypercalcemia (too much calcium in the blood):
  - Adults—Dose is based on body weight and must be determined by your doctor. The usual dose is 20 mg per kg (9.1 mg per pound) of body weight a day for thirty days. Treatment usually does not continue beyond ninety days.
  - Children—Dose must be determined by your doctor.
For injection dosage form:
- For treating hypercalcemia (too much calcium in the blood):
  - Adults—Dose is based on body weight and must be determined by your doctor. The usual dose is 7.5 milligrams (mg) per kilogram (kg) (3.4 mg per pound) of body weight, injected slowly into your vein over 2 hours. This dose is repeated for two more days. Your doctor may repeat the treatment after at least seven days.
  - Children—Dose must be determined by your doctor.

Missed Dose

If you miss a dose of etidronate, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using etidronate

It is important that your doctor check your progress at regular visits even if you are between treatments and are not taking etidronate. If your condition has improved and your doctor has told you to stop taking etidronate, your progress must still be checked. The results of laboratory tests or the occurrence of certain symptoms will tell your doctor if more medicine must be taken. Your doctor may want you to begin another course of treatment after you have been off the medicine for at least 3 months.

It is important that you check with your doctor before having any dental procedures or surgeries done while you are receiving etidronate. Tell your doctor right away if you experience jaw tightness, swelling, numbing, or pain or a loose tooth. It could be the sign of a serious jaw disease.

If etidronate causes you to have nausea or diarrhea and it continues, check with your doctor. The dose may need to be changed.

If bone, joint or muscle pain occurs, or worsens during treatment, check with your doctor.

etidronate Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

Bone pain or tenderness (increased, continuing, or returning—in patients with Paget's disease)

Less common

Bone fractures, especially of the thigh bone

Rare

Hives
skin rash or itching
swelling of the arms, legs, face, lips, tongue, and/or throat

Incidence not known

Bone, joint, or muscle pain that is severe and occasionally disabling
heavy jaw feeling
loosening of a tooth
pain, swelling, or numbness in the mouth or jaw

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common - at higher doses

Diarrhea
nausea

Less common - with injection

Loss of taste or metallic or altered taste

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

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