[Multibilly]

Oral Bisphosphonates?

by Multibilly on Mon Apr 01, 2013 7:14 pm

Does anybody know why there aren't oral bisphosphonates available for use with multiple myeloma? Seems like there are quite a few bisphosphonates out on the market that are available in pill form, but when it comes to multiple myeloma, one has to take them via an IV.

[MMdaughter]

Re: Oral bisphosphonates?

by MMdaughter on Mon Apr 01, 2013 8:39 pm

The doses of drug needed to impede bone breakdown in multiple myeloma are significantly higher than that needed for osteoporosis treatment. A recent study showed that a single 5 mg dose of Zometa per year may be sufficient treatment for osteoporosis.

[Multibilly]

Re: Oral Bisphosphonates?

by Multibilly on Tue Apr 02, 2013 8:27 am

Thanks MMdaughter. But the Zometa IV dose is approx 4mg over 15 minutes every few weeks for multiple myeloma. I have no idea what 4mg of Zometa would translate to in pill form, but I would much rather take a handful of pills rather than have to go in the doc's office for an IV. Is there something in particular that prevents this drug from being offered in pill form? Does your GI tract not absorb enough of the drug or does it not absorb it quickly enough or do high doses of oral Zometa cause GI problems or ???

[Nancy Shamanna]

Re: Oral Bisphosphonates?

by Nancy Shamanna on Tue Apr 02, 2013 9:09 am

My understanding of why bisphosphonates such as zometa and aredia are administered by IV is that they need to be diluted so as not to put too much strain on the kidneys. When I first took aredia, the IV went over four hours, although it was later reduced to a 2 hour drip. This had to do with the 'protocol' regarding safety that way.

[Multibilly]

Re: Oral Bisphosphonates?

by Multibilly on Tue Apr 02, 2013 9:52 am

Thanks Nancy, that makes sense. Looks like there is one pill form of a bisphosphonate called Bonefos that is approved for use in Europe with myeloma patients, but not in the USA.

http://www.drugs.com/uk/bonefos-tablets-spc-12203.html

But IV Zometa may show better results than pill-form Bonefos based on the article below (putting aside the ONJ issue). So, at least based on the article, I guess I wouldn't opt for Bonefos even if it was available in the USA.

https://myelomabeacon.org/news/2012/06/03/asco-2012-multiple-myeloma-update-day-three-new-myeloma-treatments/

[Nancy Shamanna]

Re: Oral Bisphosphonates?

by Nancy Shamanna on Tue Apr 02, 2013 11:21 am

Hi Multibilly, I credit the aredia treatments with really helping my fractured vertebrae to heal up! I am no longer taking them because of the risk of ONJ. I took aredia for a little more than 3 years, but first at a frequency of once a month and then eventually tapering off to once every three months. Zometa is also available here...but the aredia worked well for me. Patients on Zometa like that because it is much quicker for an application of that...only 15 mins. I think. And there may be some differences in efficacy too, I think there have been a few studies done on that topic.

[Multibilly]

Re: Oral Bisphosphonates?

by Multibilly on Tue Apr 02, 2013 11:46 am

Thanks again Nancy. I found some spirited discussions on the beacon as well. Just type "Zometa" into the forum search.

[MMdaughter]

Re: Oral Bisphosphonates?

by MMdaughter on Tue Apr 02, 2013 11:49 am

Multibilly, For osteoporosis, the 4 mg Zometa is over an entire year, not weekly. My dad was put on Fosomax pills by his primary doctor when multiple myeloma was probable and before bone marrow biopsy. The multiple myeloma specialist had him stop taking Fosomax, get teeth taken care of, and then started IV Zometa.

[Nancy Shamanna]

Re: Oral Bisphosphonates?

by Nancy Shamanna on Tue Apr 02, 2013 12:00 pm

Yes, on this topic I also had Fosamax for about 8 months before starting aredia. This was because originally my osteopenia wasn't known to be caused by multiple myeloma. I was simply being treated to improve bone strength. The Fosamax was a once a week pill! Once I had fractures and my multiple myeloma was diagnosed, I was switched over to Aredia, which is a stronger drug.

[bad blood]

Re: Oral Bisphosphonates?

by bad blood on Tue Apr 02, 2013 2:29 pm

Just some questions about your topic. I have bad osteoporosis and not on any bone medication. How can someone tell the difference between myeloma osteoporosis and regular osteoporosis? What difference is there from fosamax, boniva and myeloma bone meds and how they rebuild bone?