Discontinue use if severe symptoms of incapacitating bone, joint &/or muscle pain develops. Osteonecrosis of the jaw has been reported. Perform preventive dental exam before starting treatment. Avoid invasive dental procedures while on treatment. Adequately rehydrate patients w/ hypercalcemia of malignancy prior to administration of treatment & monitor electrolytes during treatment. Patients must be adequately supplemented w/ Ca & vit D. Aspirin-sensitive patients may have bronchoconstriction. Factors predisposing to renal deterioration eg, dehydration or use of nephrotoxic drugs should be identified & managed if possible. Carefully monitor the standard hypercalcemia-related metabolic parameters eg, serum levels of Ca, phosphate & Mg as well as serum creatinine following therapy initiation. Short-term supplementary therapy may be necessary if hypocalcemia, hypophosphatemia or hypomagnesemia occur. Monitor serum creatinine before each dose. Do not use loop diuretics until patient is adequately rehydrated. Caution w/ nephrotoxic drugs. Renal toxicity may be greater in patients w/ renal impairment. Not recommended in patients w/ bone metastases w/ severe renal impairment. Patients w/ hepatic insufficiency. Women of childbearing potential should be advised of the potential hazard to the fetus & to avoid becoming pregnant. Not to be used during pregnancy as it can cause fetal harm.
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