In the "Spread Thread" the other day, I included the following information about Zometa, which can be linked to here:
http://neurotalk.psychcentral.com/sh...t=24167&page=2 (There are a couple of articles attached to that post which are worth checking out.)
In conversation with Frogga on that thread, I made the point that it didn't work for me until the third monthly infusion, and that the drug is not for everyone, specifically for those needing significant dental work. However, response to her additional inquiries I have done some more work. Turns out that Zometa is in fact a new and improved pamidromate, approximately two to three times more effective than the original. That and the infusion time is a fraction of the original model:
Bisphosphonates
Bisphosphonates are analogues of inorganic pyrophosphate that inhibit osteoclast activity and, consequently, reduce bone resorption in a variety of illnesses. The analgesic efficacy of these compounds, particularly pamidronate (Aredia®; Novartis Pharmaceuticals Corp.), has been well established.
Pamidronate has been extensively studied in populations with bone metastases [108]. Its analgesic effects have been shown in breast cancer [109-111] and multiple myeloma [112]. The dose usually recommended is 60-90 mg i.v. (infused over 2-4 hours) every 3-4 weeks [111]. There are dose-dependent effects, and a poor response at 60 mg can be followed by a trial of 90 or 120 mg. The reduction of skeletal morbidity (pathological fractures, need for bone radiation or surgery, spinal cord compression, hypercalcemia)described with the administration of pamidronate in multiple myeloma and breast cancer patients is another incentive to use it as an adjuvant [113-114]. Adverse effects, including hypocalcemia and a flu-like syndrome, are dose related and typically transitory. Nephrotoxicity occurs rarely, usually following relatively rapid infusions, and typically is transitory; the drug can be used in those with impaired renal function.
Zoledronic acid (Zometa®; Novartis Pharmaceuticals Corp.) is a new bisphosphonate that is approximately two to three times more potent than pamidronate. It has been shown to reduce pain and the occurrence of skeletalrelated events in breast cancer [112, 115, 116], prostate cancer [117], and multiple myeloma [112], as well as a variety of solid tumors, including lung cancer [118]. It is effective in both osteoblastic and osteolytic lesions [116]. It is as effective as pamidronate [112, 116], and its use is more convenient, as it can be infused safely over 15 minutes at a dose of 4 mg every 3 weeks. The side effects are similar to those encountered with pamidronate, and the dose does not have to be adjusted in patients with mild-to moderate renal failure [119].
Data on the analgesic effect of clodronate are conflicting, but it has been shown to be effective in prostate cancer and multiple myeloma [108]. The main advantage of clodronate over pamidronate is its good oral bioavailability, which avoids the need for i.v. administration. An oral dose of 1,600 mg daily seems to be optimal [108]. Clodronate is not available in the U.S.
Scarce data exist on the efficacy of the other newer bisphosphonates alendronate (Fosamax®; Merck and Company, Inc.; West Point, PA) and ibandronate (Boniva™; Hoffman-La Roche Inc.). These drugs, which are very potent, are likely to be analgesic.
"Adjuvant analgesics in cancer pain management," Lussier D, Huskey AG, Portenoy RK,
Oncologist, 2004; 9(5): 571-91 at 583. A copy of that article is attached.
Moral of the story: accept no substitutes. That, and it might be worthwhile talking to your doctors about
Fosamax and
Boniva as well. (I am sending the article on to my pain guy for what it's worth.)
Mike