ASK DIS: IV Dexamethasone for Treatment of Hypercalcaemia

[The bisphosphonates represent the best studied and most efficacious to treat hypercalcemia. Straying from these agents should be considered only when they are contraindicated, in severe circumstances, or after the patient has failed to respond]

Prednisone, dexamethasone, and methylprednisolone all carry FDA indications for hypercalcemia, but data are lacking and contradictory

Despite this, glucocorticoids likely retain a limited role for treatment in specific cases, including hypercalcemia induced by lymphomas elevating levels of 1,25(OH)2 vitamin D (as this interacts with a steroid-regulated receptor), or multiple myelomas where they potentially impact disease progression

Corticosteroids may lower serum calcium if they have an antineoplastic effect on the underlying malignancy. They should be reserved for situations in which bisphosphonates are not easily accessible or are ineffective or in which other indication for corticosteroids (pain or nausea) exist

Dosing:

Most reference recommended Prednisone 20-40mg/daily. Some suggest Prednisone 40 to 100 mg daily for up to one week

Hydrocortisone 100 mg I.V. q6h

Dexamethasone 4 mg S.C. q6h for 3 to 5 days.

Steroids are particularly useful for hypercalcemia seen with lymphomas

Recommendations:

only to use corticosteroids if indicated. Common agent used within guides are predisolone. However, as dexamethasone is also indicated for hypercalcaemia in cancer, it can also be used. Based on limited data, Dexamethasone can be used as the recommendation above or based on steroid dose equivalence.

Additional Information

(i) Hypercalcaemia symptoms presentations