This section gives an overview of the commonly used drugs (excluding opioids) to manage symptoms in patients with terminal illnesses. The information includes basic dosage information as well as indications for use and potential side effects. Please note that non-opioid drugs commonly used in palliative care in Singapore are shown here but the list is NOT exhaustive and neither are the side effects nor indications. Doses are for adults only. Please check with pharmacy colleagues for dose adjustments (if any) in renal or liver impairment. Unless otherwise indicated, use water for injection for dilution in continuous subcutaneous infusions.

*For information on opioids, please search and refer to the drugs with their given context.

Zoledronic Acid

Route, Dosage and Frequency

ROUTE

DOSAGE AND FREQUENCY
IV (OVER 15-30MIN) 4mg every 4-6 weeks (Dilute in 100ml 0.9% saline)

Other Information

Indications

Reduction of skeletal-related events in patients with myeloma or bony metastases, Bone pain, Hypercalcaemia.

Side-Effects

Transient pyrexia and flu-like symptoms, Fatigue, Headache, Renal impairment, Jaw osteonecrosis (if long term use, poor dental health or dental procedures during treatment with Zoledronic acid).

Remarks

More potent bisphosphonate than Pamidronate. Repeat every 4 to 6 weeks as long as benefit maintained for bone pain; repeat in a week if calcium levels not better. No dose adjustment in mild to moderate renal impairment. Add oral supplements of elemental calcium and Vitamin D unless treated for hypercalcaemia.

Reference 

  • Watson M. Oxford Handbook of Palliative Care. Oxford, NY: Oxford University Press; 2009.