Clodronate disodium

How it works

It is incorporated into bone and taken up by osteoclasts, where it forms a cytotoxic ATP analogue that impairs osteoclast function and induces apoptosis, reducing bone resorption.

Prescribing in practice

• Ensure adequate hydration and assess renal function before and during treatment, as it can impair renal function.
• Osteonecrosis of the jaw is a recognised class risk; a dental check before starting and good oral hygiene are advisable.
• Oral absorption is reduced by food and by calcium-, iron- and other cation-containing products, which should be separated from dosing.

Monitoring

Monitor renal function and serum calcium during therapy, with dental review for jaw symptoms.

Counselling the patient

• Take oral tablets with plenty of water and avoid food, milk and calcium or iron supplements around the dose.
• Report any dental pain, swelling or non-healing of the mouth, and maintain good oral hygiene.
• Maintain a good fluid intake while on treatment.

Evidence & guidelines

Bisphosphonates reduce skeletal-related events in myeloma and metastatic bone disease; consult the SPC and current prescribing references for indication-specific use.