Table 4.

Modified bisphosphonate dosing schedules for renal impairment

Creatinine clearance, mL/min	Dose adjustment
	Pamidronate, mga	Zoledronic acid, mgb	Ibandronate, mgc
90–60	60–90	4	6
60–50	60–90	3.5	6
50–40	60–90	3.3	4
40–30	60–90	3.0	4
<30 or patients receiving hemodialysis	Not recommended	Not recommended	2 or not recommendedd

Notes:

^aPamidronate formulations: 90 mg/10 mL, 60 mg/10 mL, or 15 mg/5 mL;²⁶,⁸⁶

^bzoledronic acid formulation: 4 mg/5 mL;¹¹

^cibandronate formulations: 6 mg/6 mL, or 2 mg/2 mL;⁸⁷

^dSwiss summary of product characteristics.⁸⁸ Updated from Launay- Vacher et al⁸⁶ and printed in Aapro M, Abrahamsson PA, Body JJ, et al. Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel. Ann Oncol. 2008;19(3):420–432, by permission of Oxford University Press.⁶⁹