? Does anyone use Alendronate Sodium for hypercalcemia?

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Judy and Boomer

Judy and Boomer

Member Since 2014
Our Civvie, Allen, is on 10mg taken once per week to lower his calcium level. We've been told he needs to fast for 12 hours before the pill and then an additional 2 hours after the pill.

We had Allen in for blood work this morning and I was questioning Dr Larry about whether that long a fast is really necessary. He admits he doesn't know a lot about this drug so he's going by the lab's information. He does agree it seems like an unnecessarily long fast since a cat's stomach empties much quicker than 12 hours.

Does anyone have any experience with giving these meds to a kitty? It is a drug meant for human osteoporosis.

I must add that the test Allen had about 5 weeks ago after being on these meds for a month did show a great improvement in his calcium level and ionized calcium was back in normal range. So I don't mind sticking with this drug since it is helping however I hate starving Allen for 14 hours once per week.
 
http://felinecrf.org/treatments_regulation_minerals.htm#bisphosphonates

Bisphosphonate Drugs

If (and only if) ionised calcium levels are at least 25% above the normal upper limit, you could ask your vet about using bisphosphonate drugs. One drug in this family is called alendronate (Fosamax). It is commonly used to treat humans with osteoporosis, and may be recommended for CKD cats for similar reasons i.e. so the bones absorb calcium, which then reduces calcium levels in the blood.

This is a last resort treatment - Plumb's Veterinary Drug Handbook states that "because of a lack of experience, the drug is not recommended for use in human patients with severe renal dysfunction."

The usual starting dose is 10mg for cats. This is only given once a week but the cat must stay upright for at least 15 minutes after taking it so as to avoid oesophageal damage. Always follow the treatment with a water chaser. Plumb's suggests buttering the cat's lips to encourage swallowing. If you are using ranitidine (Zantac 75) intravenously for excess stomach acid (highly unlikely outside a hospital setting), be aware that it doubled the effect of alendronate in one human study. Ionised calcium levels should be checked regularly, starting four weeks after the first dose, and the dose should be adjusted if necessary .

Another bisphosphonate is pamidronate. Uses and effectiveness of pamidronate disodium for treatment of dogs and cats with hypercalcemia(2005) Hostutler RA, Chew DJ, Jaeger JQ, Klein S, Henderson D, DiBartola SP Journal of Veterinary Internal Medicine 19(1) pp29-33 found it appeared to be safe and effective. However, pamidronate has to be given intravenously and may cause electrolyte imbalances, plus it may be contraindicated for CKD cats.

Use of bisphosphonates to treat severe idiopathic hypercalcaemia in a young Ragdoll cat(2011) Whitney JL, Barrs VR, Wilkinson MR, Briscoe KA & Beatty JA Journal of Feline Medicine & Surgery 13(2) pp129-34 discusses the case of a young cat with idiopathic hypercalcaemia who became clinically normal following the use of bisphosphonate drugs. Idiopathic means no obvious cause could be found.
 
The book "Feline Internal Medicine" Volume 7 by Susan E. Little has a fairly extensive section on treatment of idiopathic hypercalcemia, but with regards to administration of alendronate recommends (1) start with a dose of 10 mg/cat by mouth once weekly (2) have cat fast for at least 12 hours (3) butter cat's lips to increase licking and salivation (4) give pill and follow with 6 mL of water by oral syringe (5) have cat fast for another 2 hours. This is intended to maximize intestinal absorption. They note that an 18 hour prior fast and 4 hour fast post pill is even better to increase oral bioavailability.

Several dietary approaches to treatment with diet are discussed, including a high fibre diet, a veterinary renal diet, a urolithiasis diet, and a low calcium diet. The bottom line seems to be that some of these work for different cats but the mechanisms are far from completely understood, and what works for one may not work for another.
 
LizzieInTexas said:
One drug in this family is called alendronate (Fosamax). It is commonly used to treat humans with osteoporosis, and may be recommended for CKD cats for similar reasons i.e. so the bones absorb calcium, which then reduces calcium levels in the blood.
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Yes that is what we are giving Allen.

I was hoping that someone else on the board may have used it and have different information about the fasting time required.
I give 2 syringes of water after the pill and a bit of butter to encourage swallowing.
 
Linda and Bear Man said:
The book "Feline Internal Medicine" Volume 7 by Susan E. Little has a fairly extensive section on treatment of idiopathic hypercalcemia, but with regards to administration of alendronate recommends (1) start with a dose of 10 mg/cat by mouth once weekly (2) have cat fast for at least 12 hours (3) butter cat's lips to increase licking and salivation (4) give pill and follow with 6 mL of water by oral syringe (5) have cat fast for another 2 hours. This is intended to maximize intestinal absorption. They note that an 18 hour prior fast and 4 hour fast post pill is even better to increase oral bioavailability.

Several dietary approaches to treatment with diet are discussed, including a high fibre diet, a veterinary renal diet, a urolithiasis diet, and a low calcium diet. The bottom line seems to be that some of these work for different cats but the mechanisms are far from completely understood, and what works for one may not work for another.
Click to expand...
Not sure where Dr Larry is getting the information but it seems to be the same as you indicated above.
 
To anyone reading this thread. I strongly suggest you DO NOT GIVE YOUR CAT FOSAMAX except as an absolute last resort. My cat (Teddy) has suffered horrible complications from this drug including BRONJ (osteonecrosis of the jaw), fractured both of his legs with minimal trauma (bilateral tibia fractures, pathologic fractures) and now has a mass in his jaw that is likely cancer. My cat was in fairly good health prior to receiving Fosamax for idiopathic hypercalcemia. BRONJ and fractures have been documented in humans that take biphosphonates like Fosamax. If we had given him an EOD (every other day) dose of prednisolone he'd likely be in good health today --although we can't predict the future. My point is---avoid Fosamax at all costs if possible. It can be a very dangerous drug and it has absolutely ruined my cat's life. He will likely need to be humanely euthanized at a very young age--Approximately 7 years old. Discuss this post with your vet. I cannot give medical advice as I am not a veterinarian.
 
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