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Zoledronic acid by subcutaneous infusion in palliative medicine
  1. Hena Ramdany1,2,
  2. John Curtin2,3 and
  3. Paul Howard1,2
  1. 1 Palliative Care Team, Isle of Wight NHS Trust, Newport, UK
  2. 2 Mountbatten Hospice, Newport, UK
  3. 3 Isle of Wight NHS Trust, Newport, UK
  1. Correspondence to Dr Paul Howard, Earl Mountbatten Hospice, Newport PO30 2ER, UK; paul.howard1{at}

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Hypercalcaemia, bone pain and pathological fractures are potentially distressing complications of cancer, and increase the likelihood of unwanted admissions to hospital. Bisphosphonates are one of several possible treatment options.1 Although they can be given orally, intravenous administration is required for malignant hypercalcaemia, or for other indications if swallowing is burdensome.

At the start of the COVID-19 pandemic, when attempts were made to limit risks associated with attending healthcare facilities for procedures, we discussed alternative options with patients who had been receiving intravenous zoledronic acid at our palliative care day centre. However, intravenous cannulation was not always feasible in the home setting. Therefore, we discussed switching to either subcutaneous denosumab or subcutaneous pamidronate2 as alternatives. The subcutaneous administration of clodronate is also reported,3 but clodronate is not available in the UK.

However, a patient who had previously responded well to intravenous zoledronic acid asked whether this too could be administered subcutaneously. Having found no reports of extravasation reactions and discussed the uncertainties and possible risks, we proceeded, and it was well tolerated. This led to cautious discussions with other patients wishing to remain at home or with inpatients with fragile veins or expressing a clear preference to avoid cannulation due to pain. Because it appeared …

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  • Contributors HR, PH and JC jointly conceived the audit. HR collected and analysed the audit data. HR, PH and JC jointly wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.