Table 1.

Treatment options for hypercalcemia of malignancy.

Agent	Regimen	Mechanism of action	Onset	Duration	Side Effects
0.9% saline	2-4 l/day or 200-500 ml/h	Enhance renal excretion of Ca2+	Immediate	1-3 days (depends on cardiovascular and renal status)	Volume overload
Zoledronic acid or Pamidronate	4 mg IV over 15 to 30 minutes in a solution of 50-100 ml NS or D5W 60 to 90 mg IV over 4 to 24 hours	Inhibits osteoclastic bone resorption	48 hours	Every 3-4 weeks May be additional	Renal toxicity, acute-phase reactions, gastrointestinal toxicity, hypocalcemia and osteonecrosis of the jaw
Denosumab	120 mg SQ	İnhibits the binding of RANKL with its receptor RANK and decreases OC activity	7-10 days	Every 4 weeks and additional on days 8 and 15 for first month	Allergic reactions, hypocalcemia, osteonecrosis
Calcitonin	4 units/kg SQ repeated every 6-12 hours	Increases renal calcium excretion reduce bone resorption by interfering with OC function	4-6 hours	24 to 48 hours	Pain at the injection site and cutaneous flushing, anaphylactic reactions
Glucocorticoids	200-400 mg/day of hydrocortisone 10-20 mg/day of prednisone	Inhibit 1,25(OH)2 D synthesis and thus calcium absorption from the intestine	7 days	3-10 days (unclear)	Myopathy, immunosuppression, elevated blood glucose
Gallium Nitrate	100 to 200 mg/m2 IV over 24 hours for 5 days	inhibits osteoclast activity	4 days	2 weeks	Nephrotoxicity, bone marrow supression

Ca²⁺ calcium ions; SQ subcutaneously; D5W 5% dextrose in water; NS normal saline; OC osteoclastic; RANK receptor activator of nuclear factor kappa-B ligand.