Fluoride Sodium


Incorporated into bone, rendering it less soluble. Stimulates new bone formation.

Selected Indications

Osteoporosis prevention and treatment.


Absorbed from gastrointestinal tract and incorporated into bone. Adverse Reactions

Occasional gastrointestinal upset. Fluorosis, caused by chronic overexposure to fluoride, results in mottling of teeth and formation of thickened bones with poor mechanical quality (osteomalacia and osteosclerosis). Excessive doses, therefore, may result in an increased risk for fractures despite apparent improvement in bone density.


To prevent precipitation of calcium fluoride, calcium supplements and sodium fluoride are given at separate times of the day. Fluoride supplements should not be given to patients with renal insufficiency.


Tablets, 1 mg. Larger capsules and oral solution are also available in some pharmacies. Dosage

The dosage is 10 mg of elemental fluoride twice daily. Pamidronate (Aredia)


Bisphosphonate that inhibits osteoclast activity. Selected Indications

Hypercalcemia associated with malignancies, Paget's disease of bone. Metabolism

After IV administration, pamidronate is immediately retained in bone, preferentially in areas of high turnover. The drug is then slowly cleared by the kidney, with a terminal half-life of about 300 days.

Adverse Reactions

Most adverse effects appear to be dose-related. These include fatigue, somnolence, reactions at the infusion site, anorexia, nausea, gastrointestinal hemorrhage, and electrolyte abnormalities (hypocalcemia, hypokalemia, hypomagnesemia, hypophosphatemia). Cardiopulmonary effects such as hypertension, atrial fibrillation, tachycardia, syncope, and rales may occur with the highest doses. Fever occurs in about one-fifth of patients. Cytopenias may occur rarely.


Serum electrolytes should be followed closely. In patients with preexisting hematologic conditions, complete blood cell counts should also be followed. Pamidronate should not be given to women of childbearing potential.


Vials of lyophilized powder, 30 mg, 60 mg, and 90 mg, for reconstitution with sterile water. Dosage

For Paget's disease, 30 mg daily IV given over 4 hours for 3 days. Higher doses are recommended for hypercalcemia associated with malignancies.

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