Hypercalcaemia
Remember to calculate the corrected serum calcium level if the albumin is low. After an intravenous dose of bisphosphonate, it will take 24 to 48 hours to start lowering calcium levels and the maximum effect will be seen five days after the dose.
Pamidronate: the dose of pamidronate may need to be reduced in renal failure; renal function should be assessed before each dose.
Zoledronic acid is used to reduce bone damage in advanced malignancies involving bone and to treat hypercalcaemia of malignancy. Renal function should be monitored before each dose and patients should be adequately hydrated before treatment. Treatment has been associated with renal impairment.