Intravenous treatment with zoledronate (zoledronic acid) is usually the first consideration, as it acts quicker and lasts longer, however, alternatives can be found below.
Alternatives to zoledronate
Bisphosphonates can also be given as tablets; these are slightly less effective than an infusion of zoledronic acid, at reducing bone remodelling, and the effect doesn’t last quite as long.
The most commonly used oral treatment is 30mg of risedronate sodium, taken daily, for two months. If necessary, the course can be repeated.
For risedronate to be effective, it is important that you do not take it with food, other medicines or drinks (other than plain water). If taken at the same time, medicines containing any of the following lessen the effect of risedronate: calcium, magnesium, aluminium (e.g. some indigestion mixtures) or iron. To ensure risedronate is absorbed properly, it should be taken with a full glass of water, on an empty stomach, first thing in the morning. These tablets can irritate your oesophagus (the tube that takes food into your stomach) therefore, sit upright or stand for at least 30 minutes after taking it. Wait at least 30 minutes before eating or drinking (other than water), and before taking other medication.
Pamidronate is an effective treatment but has largely been superseded by zoledronate, which lasts longer and is easier to administer. Pamidronate is given in several doses, intravenously (an infusion into the bloodstream), and repeated when necessary, dependant on symptoms. Doses can vary, but commonly 60mg is given by an infusion over a period of four hours and this is repeated on three consecutive days.
In cases where bisphosphonates are not recommended, calcitonin injections may be considered to treat bone pain in Paget’s disease.
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