Etidronate (oral)

Etidronate is used in the treatment of Paget's disease, hypercalcemia and bone problems occurring from surgery or injury.

Overview

Etidronate is a bisphosphonate medication that works by slowing the breakdown of old bone cells and the formation of new bone cells. It is used in the treatment of conditions of the bone including paget's disease.

Paget's disease of the bone is a condition in which the bones are soft, deformed, weak and easily broken. Etidronate helps to strengthen the bones in patients suffering from this condition.

Etidronate can also be used after hip replacement surgery or following a spinal injury. In these cases the treatment helps to prevent the development of bone cells on materials other than the skeleton. This prevents the calcification of artificial hips and spinal implants which can otherwise restrict movement and cause further problems.

Etidronate can also be used to treat hypercalcemia in patients suffering from some forms of cancer.

Etidronate is available only when prescribed by a doctor and is taken in the form of a tablet prescribed as Didronel.

Condition treated

  • Paget's disease of the bone
  • Hip replacement
  • Spinal injury
  • Hypercalcemia

Type Of Medicine

  • Bisphosphonate

Side Effects

The use of Etidronate can have a wide range of unwanted side effects in the patient. While not all of the following side effects may occur, the patient may need to seek urgent medical attention in some cases where they do occur.

You should contact your doctor immediately if you experience any of the following side effects:

Occurring more commonly:

  • Bone pain
  • Bone tenderness

Occurring less commonly:

  • Bone fracturing (most likely occurring to the thigh bone)

Occurring only rarely:

  • Abdominal pain
  • Black stools with a tarry appearance
  • Bloody stools
  • Burning of the stomach
  • Chest pains
  • Chills experienced when warm
  • Coughing or hoarseness
  • Feverishness
  • General feeling of tiredness
  • General feeling of weakness
  • Hives
  • Itching of the skin
  • Lower back pain
  • Pain or difficulty experienced during urination
  • Paleness of the skin
  • Side pain
  • Skin rash
  • Soreness of the throat
  • Sores or ulceration of the mouth or lips
  • Stomach pain
  • Swelling of the glands
  • Swollen arms, legs, face, lips, tongue or throat
  • Tightness across the chest
  • Unusual bleeding
  • Unusual bruising
  • Unusually audible breathing
  • White spots appearing on the lips or mouth

Frequency of incidence not known:

  • Blistering or peeling of the skin
  • Bone, joint, or muscle pain (this may be physically disabling)
  • Burning or tingling feelings on the skin
  • Difficulty when moving
  • Difficulty when swallowing
  • Discoloration of the skin or blemishes
  • Discouragement or loss of confidence
  • Feeling of sadness or emptiness
  • Heartburn
  • Heavy jaw
  • Irritability
  • Lack of interest or pleasure
  • Loosening of the skin
  • Loosening of tooth
  • Loss of appetite
  • Pain or burning felt in the throat
  • Rash with lesions on the skin
  • Red eyes
  • Red skin lesions with a purple center
  • Seeing, hearing or feeling things that not experienced by others
  • Swelling of the:
  • Eyelids
  • Face
  • Feet
  • Hands
  • Legs
  • Lips
  • Sex organ
  • Throat
  • Tongue
  • Swelling or numbness in the mouth or jaw
  • Trouble in concentrating
  • Trouble in sleeping
  • Trouble with memory
  • Unusual tiredness
  • Unusual weakness
  • Vomiting

Other side effects may also occur that would not normally require you to seek medical attention. These side effects may be mild, may abate over time and would not normally indicate a wider medical problem. If they become bothersome or are ongoing then you can report them to your doctor and seek advice. The following side effects may occur but are not normally serious:

Occurring more commonly:

  • Diarrhea
  • Nausea

Frequency of incidence not known:

  • Burning feeling in the chest
  • Burning feeling in the stomach
  • Hair loss
  • Headaches
  • Indigestion
  • Leg cramping
  • Stomach upset
  • Tenderness of the stomach
  • Thinning of the hair

Overdose may also occur from the use of this treatment. If you believe that you or someone else is suffering from an overdose of this treatment then you should contact the emergency services immediately. The following symptoms of overdose may occur:

  • Abdominal cramps
  • Confusion or disorientation
  • Convulsions or seizures
  • Difficulty with breathing
  • Irregularity of heartbeats
  • Mental changes
  • Mood swings
  • Muscle cramping in the hands, arms, feet, legs or face
  • Numbness or tingling experienced in or around the mouth
  • Numbness or tingling of the fingertips or feet
  • Shortness of breath without exertion
  • Stomach cramps
  • Tremors

Other side effects that are not listed herein may also occur. If you experience other side effects then you should contact your doctor for advice. If you believe your immediate health to be at risk, however, then you should always contact the emergency services.

Dosage

This medication should only be taken as directed by your doctor. You should never take an increased dose, take it more frequently than directed, nor use it for longer than advised. Doing so may increase the severity and likelihood of side effects.

Your doctor should be informed if your diet contains high levels of calcium. Calcium in the diet can prevent the treatment from being absorbed properly, so you should discuss your consumption of milk and other dairy products with your doctor before use.

Etidronate should be taken with a full glass of water when you have an empty stomach. You should then wait at least 2 hours before eating. Food in the stomach can reduce the effective absorption of this treatment into the body.

You should not lie down for at least 30 minutes after taking this treatment and you should endeavor to eat before lying down after taking it too.

Etidronate can take up to 3 months to become effective in some patients. You should not stop treatment unless you are advised to by your doctor, even if you don't think it is working. Always check with your doctor before changing use.

It is important that you maintain a healthy diet when using this treatment. Consuming too much or too little vitamin D will affect the use of this treatment. Your doctor will be able to provide you with an appropriate meal plan and you should avoid supplements and other treatments that can be high in calcium, iron or vitamin D, particularly in the 2 hours either side of taking the treatment.

This medication may upset your stomach. In this case your doctor may be able to split the dose into two doses to make them easier to cope with. Do not do this without consulting your doctor, however.

When treating Paget's disease of the bone you may be required to take this treatment for up to 6 months. After a short break of 90 days you may then be required to follow another additional course of treatment with the medication. Your body may continue to benefit from this treatment for several months after use, but it may also take several months before a noticeable difference is realized.

The dose of this treatment prescribed will differ for each patient. The following information is a guideline only and will not take your personal condition into account. Do not change your dose unless directed to by your doctor and ensure that you follow directions closely for use.

When taking an oral dose for the treatment of paget's disease of the bone:

  • Adults'The dose is based on the weight of the patient and must be calculated by a doctor. The initial dose will be 5mg/kg taken daily. This is usually administered as a single dose and taken for no more than 6 months. Patients may have their dose increased to 6-10mg/kg for a maximum of 6 months or to 11-20mg/kg for a maximum of 3 months. Your dose may be adjusted depending on the results of the treatment within this period.
  • Children 'The use of this treatment in children must be determined by the prescribing doctor.

When taking an oral dose following a hip replacement:

  • Adults 'The dose given will be calculated by the doctor depending on the weight of the patient. The usual starting dose is 20mg/kg taken daily for 1 month following the hip replacement surgery.
  • Children ' Use and dose must be determined by the doctor in each case.

When taking an oral dose following spinal injury:

  • Adult ' The dose prescribed will be calculated based on the body weight of the individual patient by the doctor. The usual dose is 20mg/kg taken daily for a period of 2 weeks. The dose can then be reduced to 10mg/kg taken daily for an additional period of 10 weeks.

When taking an oral dose for the treatment of hypercalcemia:

  • Adults In each case the dose will be determined by the prescribing doctor based on the body weight of the individual. The usual dose will be 20mg/kg taken daily for 30 days. Treatment can be extended but would not normally continue beyond 90 days.
  • Children 'Use and dose of this medication should be determined by the doctor in each case.

If a dose of this medication is missed it should be taken as soon as possible unless you are then close to your next dose being due. You should not ever take a double dose of this medication.

Interactions

The use of medications should always be carried out with caution when you are already taking other treatments. Some medications can interact with one another in the body and can have severe side effects. In other cases drugs can stop other treatments from working and can increase the risk of side effects occurring. In the case of Etidronate it is particularly important that you inform your doctor of all treatments that you are taking as some supplements and vitamins may prevent the absorption of the treatment. Ensure that your doctor is aware of all treatments, herbal remedies and supplements that you take before beginning this treatment.

Certain foods and drinks can also impact the use of this treatment. In particular milk and other dairy products may impact the body's ability to absorb the treatment. You should discuss your diet with your doctor before use and should follow the diet plan determined by your doctor.

Other medical problems can also affect the use of this medication. Certain medications can make other medical conditions worse or side effects can be worsened by use. You should inform your doctor of all medical conditions from which you suffer and of all conditions that you have suffered from in the past. This is especially important in the following cases

Serious jaw problems may occur in patients with the following conditions:

  • Anemia
  • Blood clotting problems
  • Cancer
  • Dental problems
  • Tooth problems
  • Tooth extraction
  • Infection
  • Poor oral hygiene
  • Recent dental surgery

The following conditions may be worsened by the use of Etidronate:

  • Enterocolitis
  • Hyperphosphatemia
  • Stomach problems
  • Bowel problems

Patients with the following conditions should not be treated with Etidronate:

  • Esophagus problems
  • Osteomalacia
  • Difficulty swallowing

Side effects may be increased due to an decreased ability to remove the treatment from the body in patients suffering from the following condition:

  • Kidney disease

Other medical conditions may also impact the use of this treatment. You should ensure that your doctor is aware of your full medical history before use.

Warnings

Before beginning use of this treatment you should consider the good that it will do in relation to the risks that may occur from use. This is a decision that you should make with your doctor. Before making this decision you should ensure that you have considered all of the following factors:

Allergies ' If you have ever had an unusual reaction to medication in the past then you must inform your doctor. Allergies may prohibit the use of this treatment. You should also inform the doctor of any other allergies from which you suffer.

Pediatric ' The safety and efficiency of use in young people has not been established. You should discuss the risks and potential benefits with your doctor before use. Use in children must be determined by the prescribing doctor.

Geriatric 'No known limitations for use in the geriatric population exist. Elderly patients are, however, more likely to have conditions such as kidney disease that may limit the safe and effective use of the treatment. Caution should be taken.

Pregnancy ' You should inform your doctor if you are pregnant or are likely to get pregnant during use of this treatment. Other treatments may be prescribed instead and risks should be considered.

Breastfeeding ' The risks of taking this treatment when nursing an infant are unknown. Discuss this with your doctor before beginning treatment with Etidronate.

When undergoing this treatment you will need to make regular visits to your doctor. This will remain the case even if you are between courses of the treatment so that your condition can be monitored. Your progress will need to be checked even once your doctor has told you to stop taking the treatment as the medication can continue to work for up to 3 months after use.

This medication can cause an irritation of the esophagus. This can be very serious and you should stop use and contact your doctor if you believe this to be the case. The following symptoms can indicate problems of the esophagus:

  • Heartburn
  • Pain when swallowing
  • Pain in the center of your chest
  • Trouble with swallowing
  • Feeling of sticking when swallowing

Ensure that you inform all healthcare professionals that you visit that you are taking Etidronate. The use of this treatment may prohibit dental procedures and other treatments. Undergoing such treatments while taking Etidronate can lead to the development of serious problems of the jaw.

Your doctor should be made aware of any oral problems that you have before you begin treatment. You should also inform them straight away if you develop any severe pain of the bones, joints or muscles from the use of this treatment.

This medication may need to be changed if you suffer ongoing nausea or diarrhea. Inform your doctor if these side effects occur and are ongoing.

The occurrence of fractures may increase from the use of this treatment, particularly when used for a long period of time. Check with your doctor straight away if you experience any dull or aching pains in the arms, legs or thighs. These may indicate fractures that will need to be treated before they worsen.

Do not take any other treatments in conjunction with this medication unless approved by your doctor. This includes all supplements and over the counter medications that you may take for the treatment of other conditions as well as any other medications that you have been prescribed.

Storage

This medication should be kept at room temperature at all times. Keep it away from heat, moisture, direct light and away from the reach of children at all times.

This medication should be safely disposed of when it is no longer needed or has become outdated.

Summary

Etidronate is a bisphosphonate medicine that works by slowing the process of breaking down old bone tissue and making new bone tissue. It can be used in the treatment of a few conditions. Primarily it is used for the treatment of Paget's disease of the bone which is a condition causing the bones to be brittle, deformed and soft. Patients will also be prescribed Etidronate following hip replacement surgery or a spinal injury to prevent unwanted bone growth from occurring that is not connected to the skeleton. Etidronate can also be used in the treatment of hypercalcemia caused by certain types of cancer.

The treatment is prescribed as a Didronel tablet. The dose of Didronel is usually taken daily and needs to be taken on an empty stomach with a glass of water. It should be taken at least 2 hours before eating and patients should avoid lying down after taking the medication until they have eaten.

The diet of the patient can impact the use of this treatment and in particular a high calcium diet can prevent the absorption of the medication into the system. Patients will need to control their diet when undergoing this treatment to ensure the best possible outcome.

This treatment can have no noticeable effect for several months. Patients should continue use unless directed to stop by the prescribing doctor. The treatment may also continue to have an effect for several months after cessation of treatment.