Hypercalcemia drug-related

Pamidronate can cause asymptomatic hypocalcemia (SEDA-20, 440). In a study of the use of pamidronate to treat immobilization hypercalcemia after acute spinal cord injury in nine patients, one patient had transient drug-related fever and four had asymptomatic hypocalcemia (28). 

Hypercalcemia Carefully monitor standard hypercalcemia-related metabolic parameters, such as serum levels of calcium, phosphate, and magnesium, as well as serum creatinine. Do not use loop diuretics until the patient is adequately rehydrated use with caution in combination with zoledronic acid in order to avoid hypocalcemia. Use zoledronic acid with caution with other nephrotoxic drugs. Concomitant use with estrogen/hormone replacement therapy (alendronate) Two clinical studies have shown that the degree of suppression of bone turnover (as assessed by mineralizing surface) was significantly greater with the combination than with either component alone. 

Plicamycin is a cytotoxic antibiotic (see Chapter 54) that has been used clinically for two disorders of bone mineral metabolism Paget s disease and hypercalcemia. The cytotoxic properties of the drug appear to involve its binding to DNA and interruption of DNA directed RNA synthesis. The reasons for its usefulness in the treatment of Paget s disease and hypercalcemia are unclear but may relate to the need for protein synthesis to sustain bone resorption. The doses required to treat Paget s disease and hypercalcemia are about one tenth the amounts required to achieve cytotoxic effects. 

Gallium nitrate is approved for treating cancer-related hypercalcemia. It showed antitumor activity fur putienb with lymphoma in phase II trials. - Gallium nitrate probably works in hypercalcemia by inhibiting calcium resorption from bone, although the precise mechanism is unknown. Major side effects include hypocalcemia and nephrotoxicity. On continuous infusion, the drug exhibits biphasic elimination with an a half-life of 8.3 to 26 minutes and a half-life of 6.3 to 95 hours. Between 69 and 91% of the dnsc was recovered in the urine. ... 

---