would wish Didronel Generic Name: Etidronate Disodium Class: Bone Resorption Inhibitors VA Class: HS900 CAS Number: 7414-83-7 Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings Breastfeeding Warnings User Reviews Drug Images Support Group Q & A Introduction Synthetic bisphosphonate; bone resorption inhibitor. c Uses for Didronel Paget s Disease of Bone Used in the treatment of moderate to severe symptomatic Paget s disease of bone (osteitis deformans). 125 131 132 141 142 143 144 145 146 Efficacy not established in asymptomatic patients. 125 May consider prophylactic treatment in patients with extensive involvement of the skull or spinal column and the possibility of irreversible neurologic damage or in those with extensive involvement threatening major joints or weight-bearing bones. 125 Less effective than risedronate or alendronate in the treatment of moderate to severe Paget s disease of bone. 128 129 c 170 Relapse generally tends to occur within about 3 24 months in patients most likely to relapse (e.g., higher pretreatment markers of bone turnover). c Resistance is most likely to develop in patients receiving >1 course of therapy per year or those with higher pretreatment indices of bone turnover. 107 Heterotopic Ossification Used in the prevention and treatment of heterotopic ossification (myositis ossificans, ectopic calcification, periarticular ossification, or paraosteoarthropathy) following total hip arthroplasty or resulting from spinal cord injury. 125 Efficacy not established for treatment of idiopathic heterotopic ossification or heterotopic ossification associated with conditions other than total hip arthroplasty or spinal cord injury . c Corticosteroid-induced Osteoporosis Bisphosphonates, including etidronate, have been used effectively for the prevention and treatment of corticosteroid-induced osteoporosis . 131 132 133 134 135 136 137 139 141 142 143 144 145 146 The American College of Rheumatology (ACR) currently recommends use of one of several other bisphosphonates (i.e., alendronate, risedronate, or zoledronic acid) in conjunction with lifestyle modification and calcium and vitamin D supplementation for the prevention and treatment of corticosteroid-induced osteoporosis in select postmenopausal women and men 50 years of age who are initiating or currently receiving corticosteroid therapy. 166 Slideshow Looking Ahead: New Drug Approvals for 2017 Didronel Dosage and Administration General Paget s Disease of Bone Monitor patients for recurrence of disease every 3 6 months. 125 Consider retreatment only after a drug-free interval of 90 days following the previous course of therapy if biochemical, symptomatic, or other evidence of recurrence is present. 125 Heterotopic Ossification Initiate therapy as soon as it is feasible following spinal cord injury and preferably before any radiographic evidence of heterotopic ossification. 125 Efficacy of retreatment has not been established in these patients nor in patients undergoing total hip arthroplasty. 125 Administration Oral Administration Administer as a single daily dose with a full glass (180 240 mL) of water to facilitate absorption; may divide dosage if adverse GI effects occur. 125 May be given with water 125 c or fruit juice. c Avoid lying down following oral administration. 125 Avoid food, especially calcium-rich food (e.g., milk or milk products), vitamins with mineral supplements, or antacids that contain metals such as calcium, iron, magnesium, or aluminum for 2 hours before and after administration. 125 c (See Food under Pharmacokinetics.) Dosage Available as etidronate disodium; dosage expressed in terms of the salt. 125 Adults Paget s Disease of Bone Oral Initially, 5 10 mg/kg daily for 6 months, or 11 20 mg/kg daily for 3 months, have been used. 125 Recommended initial dosage is 5 mg/kg daily for 6 months. 125 Onset of therapeutic response may be delayed, 125 and therapeutic effects may persist for months following a course of therapy. 125 (See Onset under Pharmacokinetics.) Avoid premature increases in dosage 125 since increased dosage may cause mineralization defects. 125 c Patients who require immediate suppression of Paget s disease or in whom lower dosages are ineffective: >10 mg/kg daily for 3 months. 125 Use with caution. c Dosages >20 mg/kg daily not recommended. 125 Retreatment: Dosage usually the same as initial treatment. 125 Consider increasing dosage within the recommended range if inadequate response with original dosage. 125 (See General: Paget s Disease of Bone under Dosage and Administration.) Heterotopic Ossification Prevention and Treatment Oral Spinal cord injury: Initially, 20 mg/kg daily for 2 weeks followed by 10 mg/kg daily for an additional 10 weeks (12 weeks total). 125 Total hip arthroplasty: Initially, 20 mg/kg daily administered preoperatively for 1 month and postoperatively for an additional 3 months (4 months total). 125 Corticosteroid-Induced Osteoporosis Prevention and Treatment Oral 400 mg daily for 2 weeks every 3 months has been used, usually in conjunction with calcium (e.g., 500 mg daily) and vitamin D supplementation during the remaining 10 11 weeks of each cycle or continuously. 141 142 143 144 145 146 147 ACR recommends that bisphosphonate therapy be administered for as long as corticosteroid therapy continues. 166 Prescribing Limits Adults Paget s Disease of Bone Oral Maximum 20 mg/kg daily. 125 Treatment duration: 6 months; continuous therapy for >6 months may increase the risk of fracture and osteomalacia. 125 Special Populations Renal Impairment Reduce dosage in patients with reduced glomerular filtration; monitor such patients closely. 125 Geriatric Patients Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. 125 Cautions for Didronel Contraindications Esophageal abnormalities that delay esophageal emptying (e.g., stricture, achalasia). 125 Known hypersensitivity to etidronate disodium. 125 Warnings/Precautions Warnings Upper GI Effects Possible severe adverse esophageal effects (e.g., esophagitis, esophageal ulcers, erosions, strictures, perforation). 125 (See Oral Administration under Dosage and Administration.) Monitor for any manifestations and discontinue if dysphagia, odynophagia, new or worsening heartburn, or retrosternal pain occurs. 125 Risk of severe adverse esophageal effects greater in patients who do not drink 180 240 mL of water with etidronate, do not avoid lying down for 30 minutes following oral administration, and/or continue to take drug after developing symptoms suggesting esophageal irritation. 125 Instruct patients carefully about proper administration and give copy of patient instructions provided by the manufacturer. 125 Use with caution in patients with history of upper GI disease (e.g., Barrett s esophagus, dysphagia, other esophageal diseases, gastritis, duodenitis, ulcers). 125 Gastric and duodenal ulcers (some severe and with complications) reported during postmarketing experience. 125 General Precautions Metabolic Effects Maintain an adequate intake of calcium and vitamin D during therapy. 125 Hyperphosphatemia may occur, especially with dosages of 10 20 mg/kg daily. 125 (See Actions.) Usually returns to pretreatment values 2 4 weeks after treatment discontinuance. 125 Diarrhea Therapy has been withheld in some patients with enterocolitis since diarrhea may occur, especially with high dosages. 125 Musculoskeletal Effects Impairs mineralization of new osteoid, principally in pagetic lesions and to a lesser extent in normal bone at dosages of 10 20 mg/kg daily. 125 c Also may delay mineralization of ectopic bone. c Mineralization occurs normally following completion of therapy. 125 Long bones affected mainly by lytic pagetic lesions, particularly in patients whose disease is unresponsive to therapy, may be especially prone to fractures. 125 Monitor patients with predominantly lytic lesions closely, both radiographically and biochemically, to permit timely discontinuance of therapy in those whose disease is unresponsive. 125 If fractures occur, may be advisable to delay or withhold therapy until callus is evident. 125 Osteonecrosis and osteomyelitis of the jaw reported, principally in cancer patients receiving bisphosphonates, usually when given IV. 125 147 148 149 150 151 Associated mostly with dental procedures (e.g., tooth extraction), but some cases occurred in patients with postmenopausal osteoporosis receiving oral therapy. 125 Known risk factors include cancer, chemotherapy, radiation therapy, corticosteroids, poor oral hygiene, preexisting dental disease, anemia, coagulopathy, and infection. 125 If osteonecrosis of the jaw develops, consult an oral surgeon for treatment. 125 Dental surgery may exacerbate condition. 125 In patients requiring dental procedures, no data are available to suggest whether discontinuance of therapy prior to procedure reduces the risk of osteonecrosis of the jaw. 125 170 Base management of patients requiring dental treatment on an individual assessment of risks and benefits. 125 170 Severe and occasionally incapacitating bone, joint, and/or muscle pain reported infrequently with bisphosphonate therapy. 125 128 148 153 154 Time to onset varied from 1 day to years (mean onset about 3 months) after treatment initiation. 125 128 148 153 154 Such pain generally improves following discontinuance, but may recur upon subsequent rechallenge with the same drug or another bisphosphonate. 125 128 148 153 154 Atrial Fibrillation Although data are conflicting, possible increased risk of atrial fibrillation with use of bisphosphonates. 155 FDA analysis of data from long-term (6 months to 3 years) controlled trials identified a higher rate of atrial fibrillation in patients receiving bisphosphonates (alendronate, ibandronate, risedronate, or zoledronic acid) versus placebo; however, only a few events reported in each study. 155 FDA is continuing to monitor this safety concern. 155 Potential Risk of Esophageal Cancer Some evidence (from postmarketing experience and observational studies) suggests a possible association between use of oral bisphosphonates and an increased risk of esophageal cancer. 156 160 161 However, because of conflicting data, 161 162 163 additional study needed to confirm such findings. 160 FDA states that benefits of oral bisphosphonates continue to outweigh their potential risks in patients with osteoporosis; it is important to consider that esophageal cancer is rare, especially in women. 160 161 Avoidance of oral bisphosphonates in patients with Barrett s esophagus, a known precursor to esophageal adenocarcinoma, has been recommended. 156 Specific Populations Pregnancy Category C. 125 Lactation Not known whether etidronate is distributed into milk. 125 Use with caution. 125 Pediatric Use Safety and efficacy in children not established. 125 Has been used in children for the prevention of heterotopic ossification or soft tissue calcification at weight-adjusted dosages recommended for adults. 125 Rachitic syndrome reported infrequently in children receiving dosages of 10 mg/kg daily for approximately 1 year or longer. 125 Epiphyseal radiographic changes associated with retarded mineralization of new osteoid and cartilage and associated occasional symptoms were reversible following discontinuance of the drug. 125 Geriatric Use Insufficient experience in patients 65 years of age to determine whether geriatric patients respond differently than younger adults; select dosage with caution. 125 (See Geriatric Patients under Dosage and Administration.) Possible age-related impaired renal function and risk of toxic reactions; use with care. 125 (See Renal Impairment under Cautions and under Dosage and Administration.) Renal Impairment Monitor patients with impaired renal function carefully. 100 125 (See Renal Impairment under Dosage and Administration.) Common Adverse Effects Paget s disease of bone: Bone pain, diarrhea, nausea. 125 Heterotopic ossification: Diarrhea, nausea. 125 Interactions for Didronel Specific Drugs Drug Interaction Comments Warfarin Increases in PT, mostly without clinically important sequelae 125 Monitor PT when etidronate added to therapy 125 Didronel Pharmacokinetics Absorption Bioavailability Approximately 3% of a dose is absorbed. 125 Onset Paget s disease of bone: Reduced urinary excretion of hydroxyproline occurs after 1 3 months of therapy. c Reductions in markers of bone turnover reach a plateau in about 6 months. c Duration Paget s disease of bone: May persist for 1 year following discontinuance of therapy. 125 In patients whose disease is most likely to relapse, relapse generally tends to occur within about 3 24 months. c Heterotropic ossification: Persists for 9 months following drug discontinuance. 125 Food Food decreases extent of absorption. c Distribution Extent Following oral administration, about 50% of absorbed drug distributed almost exclusively into bone. 125 c Eliminated slowly (weeks to years) via bone turnover. 100 101 106 125 Drug does not cross blood-brain barrier in animals. 125 Not known whether etidronate is distributed into milk. 125 Elimination Metabolism No evidence of metabolism. 125 Elimination Route Excreted unchanged in urine (approximately half of an absorbed dose) 101 within 24 hours. 125 Unabsorbed drug is excreted intact in feces. 125 Half-life Plasma elimination half-life is 1 6 hours. 125 Terminal half-life estimated to be 394 days. 173 Stability Storage Oral Tablets 25 C (may be exposed to 15 30 C). 125 Actions Adsorbs to hydroxyapatite crystals and their amorphous precursors in bone matrix and inhibits their aggregation, growth, mineralization, and dissolution. 125 c Heterotopic ossification: Prevents or slows the formation of heterotopic bone during the active stage. 125 c Paget s disease of bone: Reduces the number of osteoclasts and osteoblasts. 125 Paget s disease of bone: Reduces rate of bone turnover as evidenced by decreases in markers of bone turnover and reduced radionuclide uptake at pagetic lesions. 125 c Paget s disease of bone: Reduces vascularity of pagetic bone, skin temperature over superficially located pagetic lesions, and cardiac output. 125 c Can increase serum phosphate concentration by increasing renal tubular reabsorption of phosphate. 125 c No immunosuppressive activity in animal studies. 104 Advice to Patients Importance of proper administration (e.g., avoiding food, vitamins with mineral supplements, or antacids that contain metals for 2 hours before and after administration). 125 Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses. 125 Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed. 125 Importance of informing patients of other important precautionary information. 125 (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Etidronate Disodium Routes Dosage Forms Strengths Brand Names Manufacturer Oral Tablets 200 mg Didronel Warner-Chilcott 400 mg Didronel (scored) Warner-Chilcott AHFS DI Essentials. Copyright 2017, Selected Revisions March 21, 2012. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use is not currently included in the labeling approved by the US Food and Drug Administration. References Only references cited for selected revisions after 1984 are available electronically. 100. MGI Pharma. Didronel I.V. Infusion (etidronate disodium) prescribing information. Minnetonka, MN; 1998 Jan. 101. Norwich Eaton Pharmaceuticals, Inc. Didronel I.V. Infusion (etidronate disodium) background data for review by pharmacy and therapeutic committees. Publication No. 2326-70. Norwich, NY; 1987 Apr. 102. Kanis JA, Urwin GH, Gray RES et al. Effects of intravenous etidronate disodium on skeletal and calcium metabolism. Am J Med . 1987; 82(Suppl 2A):55-70. [PubMed 3103437] 103. Guaitani A, Polentarutti N, Filippeschi S et al. Effects of disodium etidronate in murine tumor models. Eur J Cancer Clin Oncol . 1984; 20:685-93. [PubMed 6428894] 104. Garattini S, Guaitani A, Mantovani A. Effect of etidronate disodium on the interactions between malignancy and bone. Am J Med . 1987; 82(Suppl 2A):29-33. [PubMed 3103435] 105. Jacobs TP, Gordon AC, Silverberg SJ et al. Neoplastic hypercalcemia: physiologic response to intravenous etidronate disodium. Am J Med . 1987; 82(Suppl 2A):42-50. [PubMed 3030098] 106. Powell JH, DeMark BR. Clinical pharmacokinetics of diphosphonates. In: Garattini S, ed. Bone resorption, metastasis, and diphosphonates. New York: Raven Press; 1985:41-9. 107. Altman RD. Long-term follow-up of therapy with intermittent etidronate disodium in Paget s disease of bone. Am J Med . 1985; 79:583-90. [PubMed 3933343] 108. Perry HM III, Droke DM, Avioli LV. Alternate calcitonin and etidronate disodium therapy for Paget s bone disease. Arch Intern Med . 1984; 144:929-33. [PubMed 6424594] 109. Charhon S, Chapuy MC, Valentin-Opran A et al. Intravenous etidronate for spinal cord dysfunction due to Paget s disease. Lancet . 1982; 1:391-2. [PubMed 6120363] 110. Meunier PJ, Chapuy MC, Delmas P et al. Intravenous disodium etidronate therapy in Paget s disease of bone and hypercalcemia of malignancy: effects on biochemical parameters and bone histomorphometry. Am J Med . 1987; 82(Suppl 2A):71-8. [PubMed 3103438] 111. Ryzen E, Martodam RR, Troxell M et al. Intravenous etidronate in the management of malignant hypercalcemia. Arch Intern Med . 1985; 145:449-52. 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Am J Med . 1999; 106:513-20. [PubMed 10335722] 130. Plotkin LI, Weinstein RS, Parfitt AM et al. Prevention of osteocyte and osteoblast apoptosis by bisphosphonates and calcitonin. J Clin Invest . 1999; 104:1363-74. [PubMed 10562298] 131. Adachi JD, Bensen WG, Brown J et al. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med . 1997; 337:382-7. [PubMed 9241127] 132. Roux C, Oriente P, Laan R et al. Randomized trial of the effect of cyclical etidronate in the prevention of corticosteroid-induced bone loss. J Clin Endocrinol Metab . 1998; 83:1128-33. [PubMed 9543129] 133. Adachi JD, Saag KG, Delmas PD et al. Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial. Arthritis Rheum . 2001; 44:202-11. [PubMed 11212161] 134. Reid DM, Hughes RA, Laan RF et al. Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. J Bone Miner Res . 2000; 15:1006-20. [PubMed 10841169] 135. Diamond T, McGuigan L, Barbagallo S et al. Cyclical etidronate plus ergocalciferol prevents glucocorticoid-induced bone loss in postmenopausal women. Am J Med . 1995; 98:459-63. [PubMed 7733124] 136. Cohen S, Levy RM, Keller M et al. Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum . 1999; 42:2309-18. [PubMed 10555025] 137. Wallach S, Cohen S, Reid DM et al. Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int . 2000; 67:277-85. [PubMed 11000340] 138. American College of Rheumatology Task Force on Osteoporosis Guidelines. Recommendations for the prevention and treatment of gluococorticoid-induced osteoporosis. Arthritis Rheum . 1996; 39:1791-801. [PubMed 8912500] 139. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-induced Osteoporosis. Recommendations for the prevention and treatment of gluococorticoid-induced osteoporosis: 2001 update. Arthritis Rheum . 2001; 44:1496-503. [PubMed 11465699] 140. Sambrook PN. Corticosteroid osteoporosis: practical implications of recent trials. J Bone Miner Res . 2000; 15:1645-9. [PubMed 10976984] 141. Jenkins EA, Walker-Bone KE, Wood A et al. The prevention of corticosteroid-induced bone loss with intermittent cyclical etidronate. Scand J Rheumatol . 1999; 28:152-6. [PubMed 10380836] 142. Hanley DA, Ioannidis G, Adachi JD. Etridronate therapy in the treatment and prevention of osteoporosis. J Clin Densitom . 2000; 3:79-95. [PubMed 10745305] 143. 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FDA Alert: Information on bisphosphonates (marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa). 2008 Jan 7. From FDA website. Accessed 2008 Oct 28. 154. Wysowski DK, Chang JT. Alendronate and risedronate: reports of severe bone, joint, and muscle pain. Arch Intern Med . 2005; 165:346-7. [PubMed 15710802] 155. Center for Drug Evaluation and Research, Food and Drug Administration. Update of safety review follow-up to the October 1, 2007 early communication about the ongoing safety review of bisphosphonates. Bisphosphonates: alendronate (Fosamax, Fosamax plus D) etidronate (Didronel), ibandronate (Boniva), Pamidronate (Aredia), risedronate (Actonel, Actonel w/calcium), tiludronate (Skelid), and zoledronic acid (Reclast, Zometa). 2008 Nov 12. From FDA website. Accessed 2008 Nov 21. 156. Wysowski DK. Reports of esophageal cancer with oral bisphosphonate use. N Engl J Med . 2009; 360:89-90. Letter. [PubMed 19118315] 157. 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Next Interactions Print this page Add to My Med List More about Didronel (etidronate) Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Images Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: bisphosphonates Consumer resources Didronel Didronel (Advanced Reading) Professional resources Didronel (FDA) Etidronate Disodium (AHFS Monograph) Related treatment guides Heterotopic Ossification, Spinal Cord Injury Heterotopic Ossification, Total Hip Arthroplasty Hypercalcemia of Malignancy Osteoporosis Paget's Disease} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug 10 + years Approval History FDA approved 1977 Drug Class Bisphosphonates Related Drugs Osteoporosis hydrochlorothiazide , alendronate , calcium carbonate , estradiol , Fosamax , More... Paget's Disease alendronate , Fosamax , Actonel , Reclast , Zometa , risedronate , More... Hypercalcemia of Malignancy prednisone , dexamethasone , Reclast , Zometa , Xgeva , Sensipar , More... Heterotopic Ossification, Spinal Cord Injury etidronate , More... 1 more conditions... Didronel Rating No Reviews - Be the first! 7.0 /10 No Reviews - Be the first! 7.0 Rate it! Didronel Images Didronel 200 mg (P&G 402) View larger images} } tremendous
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