Canterbury DHB


Prescribing IV Bisphosphonate

In This Section


Zoledronic acid


30 mg in 250 ml normal saline over 1 hour, repeat every month.

Note: A copy of the prescription sheet for Pamidronate is available.

See the Pamidronate Data Sheets on Medsafe.

Patients with pre-existing renal impairment are thought to be particularly susceptible to bisphosphonate-induced renal damage.

The creatinine clearance should be determined before starting pamidronate infusions and the dose and rate determined according to the manufacturer’s instructions – slow infusion rate to 20 mg/hr if mild to moderate renal impairment; not recommended if creatinine clearance <30 mL/min.

In patients known to have renal impairment, the creatinine should be checked prior to each monthly pamidronate and the dose withheld if the creatinine has risen >10% above baseline.

Note: The table below summarises the recommended dose reductions of bisphosphonates in cases where the benefit of calcium reduction is likely to outweigh the risk of renal damage.


Zoledronic acid

Zoledronic acid is more potent than pamidronate and is registered for the treatment of hypercalcaemia of malignancy and the osteolytic lesions of multiple myeloma. However, because of its increased toxicity, discuss with Consultant before prescribing.

The recommended dose is 4 mg in 100 mL 0.9S/D5W as a 20-minute infusion. Ensure the patient is adequately hydrated and dose adjust in renal impairment.

Monitor serum calcium, phosphate, magnesium and creatinine prior to each dose.

Zoledronic acid infusions are given 4-6 weekly.

Toxicities include:

See the zoledronic acid Data Sheets on Medsafe.

About this Canterbury DHB document (6765):

Document Owner:

Amy Holmes (see Who's Who)

Last Reviewed:

September 2014

Next Review:

September 2016


Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 6765