Classifications: bone resorption inhibitor;
Therapeutic: bone resorption inhibitor
; calcium regulator
Pregnancy Category: C


25 mg/mL injection


Exerts a hypocalcemic effect by inhibition of calcium resorption from bone, possibly by reducing the rate of bone metabolism.

Therapeutic Effect

Lowers calcium serum levels by inhibiting calcium resorption from bone.


Hypercalcemia of malignancy.

Unlabeled Uses

Paget's disease, painful bone metastases, adjuvant therapy for bladder cancer and lymphomas.


Severe renal impairment (serum creatinine >2.5 mg/dL); concurrent administration of a nephrotic drug (e.g., aminoglycosides or amphotericin B); pregnancy (category C); lactation.

Cautious Use

Renal function impairment. Safety and efficacy in children are not established.

Route & Dosage

Adult: IV 100–200 mg/m2/d x 5 d

Bone Metastases
Adult: IV 200 mg/m2/d x 7 d


  • Hydrate patient with oral or IV NS to produce a urine output of 2 L/d; maintain adequate hydration throughout treatment.

PREPARE: Continuous: Dilute each daily dose with 1000 mL NS (preferred if not contraindicated) or D5W.  

ADMINISTER: Continuous: Infuse over 24 h taking care to avoid rapid infusion. Control rate with infusion pump or micro-drip device.  

INCOMPATIBILITIES Y-site: Cisplatin, cytarabine, doxorubicin, haloperidol, hydromorphone.

  • Do not administer concurrently with potentially nephrotoxic drugs.
  • Store IV solutions at 15°–30° C (59°–86° F) for 48 h or refrigerated at 2°–8° C (36°–46° F) for 7 d. Discard unused portions.

Adverse Effects (≥1%)

CNS: Fatigue, paresthesia, hyperthermia. CV: Hypotension. GI: Nausea, vomiting, diarrhea, anorexia, stomatitis, dysgeusia, mucositis, metallic taste. Hematologic: Anemia, granulocytopenia, thrombocytopenia. Metabolic: Hypocalcemia, hypophosphatemia, hypomagnesemia. Urogenital: Nephrotoxicity, acute renal failure. Other: Optic neuritis, maculopapular rash.


Drug: aminoglycosides, amphotericin B, vancomycin increase the risk of nephrotoxicity.


Onset: 48 h. Duration: 4–14 d after discontinuation of therapy. Distribution: Concentrates in tumors; distributed to lung, skin, muscle, and heart with high concentrations in liver and kidney; not known if crosses placenta or is distributed into breast milk. Metabolism: Not metabolized. Elimination: 35–71% via kidneys within first 24 h. Half-Life: 25–111 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Monitor BUN and serum creatinine throughout therapy. Notify physician if serum creatinine exceeds 2–2.5 mg/dL; discontinue drug if this occurs. Also, check baseline serum calcium and serum phosphorus; follow with assessments daily and twice weekly, respectively.
  • Note: If hypocalcemia occurs, withhold gallium nitrate and notify physician.

Patient & Family Education

  • Learn S&S of hypocalcemia (see Appendix F). Notify physician immediately if any occur.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

© 2006-2018 Last Updated On: 03/12/2018 (0)
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