RESEARCH - Management of the adverse effects associated with IV bisphosphonates

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Ann Oncol. 2006 Jun;17(6):897-907. Epub 2006 Mar 17.

Management of the adverse effects associated with intravenous

bisphosphonates.

Tanvetyanon T, Stiff PJ.

H. Lee Moffitt Cancer Center and Research Institute at the University of

South Florida, Tampa, FL, USA.

Intravenous bisphosphonates are widely used to treat hypercalcemia and to

reduce skeletal-related morbidity among cancer patients. However, serious

complications, generally occurring in less than 2% of patients participated

in phase III clinical trials, including acute systemic inflammatory

reaction, ocular inflammation, renal failure, nephrotic syndrome,

electrolyte imbalance, and osteonecrosis of the maxilla and mandible have

all been increasingly reported. Yet, strategies to deal with these

complications are becoming clear. Acute systemic inflammatory reaction is

often self-limited and becomes less intense during subsequent treatments.

For patients who develop ocular symptoms, prompt ophthalmologic evaluation

is crucial to determine the safety of a subsequent bisphosphonate therapy.

Patients who receive long-term pamidronate should be evaluated at intervals

for early sign of nephritic syndrome as timely cessation of the agent may

result in a full recovery. To reduce the risk of severe electrolyte

abnormalities, particularly hypocalcemia, correcting any pre-treatment

electrolyte abnormality and supplementing vitamin D and calcium may be

helpful. Finally, to reduce the risk of osteonecrosis of the maxilla and

mandible, obtaining a full dental evaluation before treatment and avoidance

of invasive dental procedures is suggested. The three commonly used

intravenous bisphosphonates (pamidronate, zoledronic acid, and ibandronate),

are generally safe; ibandronate has to date been the least reported to be

associated with renal side effects. As clinical indications of intravenous

bisphosphonates continue to expand, prescribing clinicians should be

familiar with these possible adverse effects and discuss them with patients

before commencing or continuing on therapy.

PMID: 16547070

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16547070

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