A new PowerPlan for hypercalcemia of malignancy (HOM) has been approved. The PowerPlan (screenshot attached) will be used by physicians to guide them in management of HOM based on severity of hypercalcemia and presence of severe symptoms, which include AKI, altered mental status, and arrhythmias. This protocol includes restrictions on calcitonin prescribing for this indication as well as guidance for the bisphosphanates (zoledronic acid and pamidronate).
*Note: the corrected calcium equation should be utilized for calcium levels.*

Below is the checklist pharmacists should follow when verifying these orders for HOM:
Bisphosphonates:
- Treatment for moderate (12 - 13.9 mg/dL) to severe (>/=14 mg/dL) hypercalcemia
- Dosed at strengths of pamidronate 60 to 90 mg or zoledronic acid 4 mg
- Administered once in a 7 day period

Calcitonin:
- Presence of at least 1 severe symptom (AKI, altered mental status, or arrhythmias) with hypercalcemia (>/= 10.5 mg/dL)
- Dosed at strengths no greater than 4 units/kg (TBW)
- Administered no more than 4 doses over 48 hours

As pharmacists, we can play a major role in cost-savings for the institution. With calcitonin being $2,653.65 per each 400iu / 2mL vial, each single use vial provides ONE dose. The hospital had 76 inappropriate administrations in a year costing approximately $200,000 annually. Please let me know if you have any questions or want to know more about the results of this project. I am happy and thankful to have all of your support!