Clodronate is eliminated mainly via the kidneys. Therefore, adequate fluid intake must be maintained during clodronate treatment.
Bonefos capsules should be swallowed whole.
A daily dose of 1600 mg is recommended to be taken as a single dose. When higher daily doses are used, the part of the dose exceeding 1600 mg is recommended to be taken separately (as a second dose) as recommended as follows.
The single daily dose and the first dose of two should preferably be taken in the morning on an empty stomach together with a glass of water. The patient should then refrain from eating, drinking (other than plain water), and taking any other oral drugs for one hour.
When twice daily dosing is used, the first dose should be taken as recommended previously. The second dose should be taken between meals, more than two hours after and one hour before eating, drinking (other than plain water), or taking any other drugs.
Clodronate should in no case be taken with drinks, food or drugs containing calcium or other divalent cations because they impair the absorption of clodronate.
Safety and efficacy in pediatric patients have not been studied.
There are no special dosage recommendations for the elderly. Clinical trials have included patients over 65 years and no adverse effects specific to this age group have been reported.
Adult patients with normal renal function:
Treatment of hypercalcemia due to malignancy: Intravenous clodronate is recommended for the start of the treatment of hypercalcemia. Subsequently, an oral dosage of 1600-3200 mg clodronate daily may be used. However, if oral therapy is used, a high starting dose of 2400-3200 mg should be used and, depending on the individual response, this can be reduced gradually to 1600 mg daily.
Treatment of osteolysis due to malignancy:
When oral therapy is used to treat increased bone resorption without hypercalcemia, the recommended starting dose is 1600 mg daily. If clinically necessary, the dose may be increased, but is not recommended to exceed 3200 mg daily.
Patients with renal failure:
Clodronate is eliminated mainly via the kidneys. Therefore, it should be used with caution in patients with renal failure; daily doses exceeding 1600 mg should not be used continuously.
The clodronate dose should be reduced as follows: See Table 2.
Click on icon to see table/diagram/image