Clodronate

Bones are living and constantly renew themselves. This helps bones keep their strength and shape.

Inside the bones, there are 2 types of bone cell:

• osteoclasts, which break down and remove old bone
• osteoblasts, which build new bone.

When we are children and young adults our bones keep getting thicker and stronger. But, as we get older, osteoclasts begin to remove more bone than osteoblasts make. This means our bones slowly become thinner (less dense). In some people, too much bone is lost and they have an in-creased risk of bone fractures.

Myeloma and some secondary bone cancers make chemicals that cause osteoclasts to destroy more bone. This means that more bone is destroyed than rebuilt. The affected bone becomes weak and painful and can break more easily.

Bones contain calcium, which gives them strength. A bone affected by secondary cancer or mye-loma may lose calcium from the bones into the blood. A raised level of calcium in the blood is called hypercalcaemia. This may cause you to have symptoms including:

• feeling sick (nausea)
• vomiting
• tiredness
• irritability
• confusion.

Clodronate is taken by mouth as capsules or tablets. You usually take it once or twice a day. Clodronate should be swallowed whole with tap water. Never take it with milk because this reduces the amount of clodronate your body can absorb.

You need to drink plenty of fluids, such as water, while you are taking clodronate treatment.

Always take clodronate tablets exactly as you are told to. This is to make sure they work as well as possible for you. If you are not sure how to take them, check with your doctor or pharmacist. 

Take your tablets:

• in the morning
• on an empty stomach
• with a glass of tap water.

After taking clodronate, do not eat, drink (other than tap water) or take any other medicines by mouth for 1 hour.

Take the first dose as above. Take the second dose between meals. Take it at least 2 hours after eating, drinking (other than tap water) or taking any other medicines by mouth.

You should then wait at least 1 hour before eating, drinking (other than tap water) or taking any other medicines by mouth.

• Keep them in the original package.
• Keep them safe and out of sight and reach of children.
• If your treatment is stopped, return any unused clodronate to the pharmacist.
• After taking the tablets or capsules, do not lie down. You can sit or stand. This is to avoid you getting tummy pain.

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

You may feel sick or be sick (vomit) during treatment. This is usually mild. Your doctor can prescribe anti-sickness tablets to help.

Take the drugs exactly as your nurse or pharmacist tells you to. It is easier to prevent sickness than treat it after it has started.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

This may be a sign that the drug is irritating your throat or gullet (the tube between the mouth and the stomach). Tell your doctor before having any more clodronate if:

• swallowing is painful or difficult
• you have indigestion that is new or getting worse.

Some clodronate tablets contain lactose. If you have a lactose intolerance, talk to your doctor before you start taking this treatment.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Ask your doctor or pharmacist for advice before taking this medicine if you:

• are pregnant
• think you may be pregnant
• are planning to have a baby.

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.