Pharmacologic Options for Hypercalcemia Associated with Cancer

Rehydration with NS followed by loop diuretics

 • IV normal saline - Enhances GFR and renal excretion of Ca2+

 • Furosemide - Inhibits Ca2+ resorption in the renal tube

First-line medications: intravenous bisphosphonate

 • Pamidronate, Zoledronic acid - Inhibits osteoclast activity; decreases bone resorption

 • Denosumab - Inhibits RANKL to decrease osteoclast activity

Second-line medications

 • Glucocorticoids - Inhibits vitamin D conversion to calcitriol

 • Calcitonin - Inhibits bone resorption

 • Gallium nitrate - Inhibits osteoclast activity



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