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General and Risk Management, Patient Safety (including: medication errors, quality control)
Zoledronic dose adjustment in cancer patients
  1. M. Merchante,
  2. A. Alfaro,
  3. A. Zorzano,
  4. M. Esteban,
  5. S. Martinez,
  6. C. Sainz de Rozas,
  7. P. Aibar
  1. 1Hospital San Pedro, Hospital Pharmacy, Logroño, Spain


Background Zoledronic acid (ZA) is used in the prevention of skeletal related events in patients with advanced malignancies involving bone as well as in the treatment of tumour-induced hypercalcaemia. Due to its renal uptake and elimination, ZA can cause nephrotoxicity, especially when given in high doses or over short infusion times, meaning a significant potential limiting factor to its use. When initiating treatment with ZA, serum creatinine and creatinine clearance (CLcr) should be determined, and if necessary, make a dose adjustment, but regrettably this is not such a common practice.

GRP055 Table 1

Patients' classification in the different CLcr levels and its corresponding ZA dose adjustment. Prescriber doctors accepted 100% of dose adjustments.

Purpose The authors aimed to implement and develop a working method that allows detecting patients undergoing treatment with ZA that show CLcr<60 ml/min. For those patients with CLcr< 60 ml/min, a dose adjustment will be suggested and released to the doctor in order to assess the dose reduction.

Materials and methods It was an observational, three-months prospective research in a general hospital with 630 beds. All ZA prescriptions achieved in the hospital between April and June, 2011 were looked through: 125 prescriptions corresponding to 113 patients (61 women and 52 men). For each patient, serum creatinine was measured and CLcr was determined by means of MDRD-4 formula. If need be, a dose adjustment was suggested following the technical data sheet instructions.

Results Average age of patients: 63 years; Average CLcr value: 75.3±4.8 ml/min.; 19 (16.8%) of the 113 patients required a ZA dose adjustment.

Conclusions ZA dosage should be considered only after evaluating the patients' CLcr. The authors recognise the need of determining this parameter as part of routine work in the oncological pharmacy unit. An important percentage of patients treated with ZA show low baseline CLcr values, threatening even more their renal function when using this medicine.

Moreover, the dose adjustment suggestions are properly considered by oncologists.

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