Etidronate Brand Name– Didronel
What is Etidronate
Etidronate is an injectable and oral bisphosphonate and a synthetic analog of pyrophosphate.
Etidronate is indicated for the treatment of Paget’s disease and prevention and treatment of heterotopic ossification following total hip replacement or due to spinal cord injury.
As a first-generation bisphosphonate, etidronate is associated with a lower potency and lower selectivity than the newer second- and third-generation bisphosphonates.
In Paget’s disease, etidronate therapy has largely been replaced by newer bisphosphonates (e.g., zoledronic acid) that are easier to use and have greater antiresorptive potency relative to their inhibition of mineralization.
Etidronate was the first bisphosphonate to be used in Paget’s disease and it was more effective than calcitonin; however, the doses necessary to produce biochemical remission often caused untoward gastrointestinal effects when given orally and both oral and intravenous forms were associated with the development of osteomalacia over time.
Etidronate is not recommended by guidelines for the prevention or treatment of osteoporosis; the drug is costly and lacks efficacy data proving reductions in hip, nonvertebral, and spine fractures versus other available bisphosphonates; etidronate has never received FDA approval for osteoporosis treatment or prevention.
Heterotopic ossification is effectively treated or prevented with the drug, but treatment is costly.
Etidronate was first approved by the FDA in 1977.
Indications
- heterotopic ossification
- hypercalcemia
- Paget’s disease
For the treatment of moderate to severe Paget’s disease
Side Effects
- agranulocytosis
- alopecia
- amnesia
- angioedema
- anuria
- arthralgia
- arthropathy
- atrial fibrillation
- azotemia
- bone fractures
- bone pain
- colitis
- confusion
- conjunctivitis
- depression
- diarrhea
- dysgeusia
- dysphagia
- esophageal stricture
- esophageal ulceration
- esophagitis
- gastritis
- GI perforation
- glossitis
- hallucinations
- headache
- hyperphosphatemia
- leukopenia
- maculopapular rash
- metallic taste
- muscle cramps
- musculoskeletal pain
- myalgia
- nausea
- ocular inflammation
- ocular pain
- odynophagia
- osteomalacia
- osteonecrosis
- pancytopenia
- paresthesias
- peptic ulcer
- pruritus
- pyrosis (heartburn)
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- urticaria
- uveitis
- visual impairment
- vomiting
Monitoring Parameters
- serum 25(OH)hydroxyvitamin D concentrations
- serum alkaline phosphatase
- serum calcium
- serum creatinine/BUN
- serum electrolytes
- serum magnesium
- serum phosphate
Contraindications
- achalasia
- anemia
- asthma
- breast-feeding
- chemotherapy
- children
- coagulopathy
- colitis
- corticosteroid therapy
- dental disease
- dental work
- dysphagia
- esophageal stricture
- esophagitis
- gastritis
- gastroesophageal reflux disease (GERD)
- geriatric
- GI disease
- GI perforation
- hiatal hernia
- hyperparathyroidism
- hypocalcemia
- inability to stand or sit upright
- infection
- osteomalacia
- peptic ulcer disease
- phosphonate hypersensitivity
- pregnancy
- renal failure
- renal impairment
- vitamin D deficiency
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Amlodipine; Celecoxib
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Calcium
- Calcium Acetate
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Calcium Chloride
- Calcium Gluconate
- Calcium; Vitamin D
- Celecoxib
- Chromium
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Esomeprazole; Naproxen
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Etodolac
- Famotidine; Ibuprofen
- Fenoprofen
- Flurbiprofen
- food
- Hetastarch; Dextrose; Electrolytes
- Hydrocodone; Ibuprofen
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Iron
- Iron Salts
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Lanthanum Carbonate
- Magnesium
- Magnesium Citrate
- Magnesium Salts
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nonsteroidal antiinflammatory drugs
- Omeprazole; Sodium Bicarbonate
- Oxaprozin
- Piroxicam
- Polycarbophil
- Polysaccharide-Iron Complex
- Rofecoxib
- Sodium Bicarbonate
- Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
- Sulindac
- Tolmetin
- Valdecoxib
- Warfarin
