From the Guidelines
Hypercalcemia should be treated with hydration, bisphosphonates, denosumab, steroids, and/or calcitonin, with zoledronic acid being the preferred bisphosphonate for treatment of hypercalcemia. The treatment of hypercalcemia depends on the severity and cause of the condition. According to the most recent guidelines 1, first-line treatments include intravenous fluids like normal saline to increase calcium excretion, followed by bisphosphonates such as zoledronic acid (4 mg IV) or pamidronate (60-90 mg IV), which inhibit bone resorption and show effects within 2-4 days.
Some key points to consider in the treatment of hypercalcemia include:
- Calcitonin (4-8 IU/kg SC/IM every 12 hours) provides rapid but short-term relief 1.
- For severe cases, denosumab (60-120 mg SC) may be used, especially in renal impairment when bisphosphonates are contraindicated 1.
- Glucocorticoids like prednisone (40-60 mg daily) are effective for hypercalcemia caused by certain cancers or granulomatous diseases 1.
- Loop diuretics such as furosemide may be added after adequate hydration 1.
- Cinacalcet (30-90 mg daily) is useful for hyperparathyroidism-related hypercalcemia, although this is not explicitly mentioned in the most recent guidelines 1.
It is essential to tailor the treatment to the underlying cause of hypercalcemia, with monitoring of calcium levels, renal function, and electrolytes throughout therapy 1. The NCCN guidelines emphasize the importance of careful planning and monitoring in the treatment of hypercalcemia, particularly in patients with multiple myeloma 1.
From the FDA Drug Label
The primary efficacy variable was the proportion of patients having a complete response, defined as the lowering of the CSC to less than or equal to 10.8 mg/dL (2. 70 mmol/L) within 10 days after drug infusion. The results of the primary analysis revealed that the proportion of patients that had normalization of corrected serum calcium by Day 10 were 88% and 70% for zoledronic acid injection 4 mg and pamidronate 90 mg, respectively (P=0. 002) DOSAGE AND ADMINISTRATION Hypercalcemia of Malignancy Consideration should be given to the severity of as well as the symptoms of hypercalcemia. The recommended dose of pamidronate disodium in moderate hypercalcemia (corrected serum calcium* of approximately 12 to 13.5 mg/dL) is 60 to 90 mg given as a SINGLE-DOSE, intravenous infusion over 2 to 24 hours.
Meds that treat hypercalcemia include:
- Zoledronic acid: 4 mg given as a 15-minute intravenous infusion
- Pamidronate: 60 to 90 mg given as a single-dose, intravenous infusion over 2 to 24 hours 2 3
From the Research
Medications for Hypercalcemia
The following medications are used to treat hypercalcemia:
- Bisphosphonates, such as zoledronic acid or pamidronate, which are the primary treatment for severe hypercalcemia 4, 5, 6, 7
- Glucocorticoids, which are effective in hypercalcemia due to lymphoma or granulomatous diseases 4, 5
- Calcitonin, which is used for the immediate short-term management of severe symptomatic hypercalcemia 5, 7
- Loop diuretics, which may be required in individuals with renal insufficiency or heart failure to prevent fluid overload 5
- Denosumab, which may be used in patients with kidney failure 4
Treatment Approach
The treatment approach for hypercalcemia typically involves:
- Hydration, which is the first step in treating hypercalcemia 4, 5, 6, 7
- Identification and treatment of the underlying cause of hypercalcemia 4, 5
- Monitoring of serum calcium levels and adjustment of treatment as needed 4, 5, 6, 7
Specific Treatment Regimens
- For severe hypercalcemia secondary to primary hyperparathyroidism, saline hydration, furosemide, and zoledronic acid may be used 6
- For pediatric patients with severe hypercalcemia, zoledronic acid may be an effective option 8
- For patients with hypercalcemia due to vitamin D intoxication or malignancy, bisphosphonates, such as zoledronic acid, may be used 8, 7