Reducing Reclast dosage.

Posted by karenjaninaz @karenjaninaz, Jun 6, 2025

After 2 doses of Prolia from which I felt unwell I researched the medical literature and found 3 studies which suggested a lower dose of Reclast is as effective as 5 mgm. I sent the articles to my endo and she called me today with the news she is lowering the dose to 4 mgm.
Hopefully I will have less chance of feeling miserable. I am 83 with osteopenia but have been on steroids since 2014 for polymyalgia rheumatica. She and my primary doc are allowing me to take strontium citrate as well plus dietary calcium.
Retired nurse anesthetist .

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

Profile picture for jozer @jozer

I also have been told to try reclast - but I've asked to remain on Fosomax (taken for a year; a bit better dexa and very little seriously uncomfortable side effects for me). Doc isn't answering me when email if I can start back on Fosamax; we discussed this at a question and answer appointment in May (he was ok with it) when we had an appointment to talk about reclast, which he really wants me to do and scares me to death. I understand that really bad and long lasting side effects are unusual; but many people seem to have life altering problems with it. Would LOVE to try a lower dose; I see twice a year lower doses; a low trial dose to see how your body handles etc. Doubt my doc would be on board with this, so also very interested in anyone who has had any type of lower dose of reclast.

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I had my first Reclast dose last year, and expecting to do the 2nd this summer... I'm 74 and I just had a laminectomy, and currently have osteoporosis in my back. I always seem to have so many aches and pains, get injections in my neck twice a year, ... and I have continuing hair loss despite taking Nutrafol every day for years... I don't know if any of my complaints are actually related to the Reclast... but I'm curious what are the negative side effects that anyone experiences? Reduced energy? (perhaps it is my age?) I am a very active person, and quite petite...has anyone had visual issues? I seem to have decreasing ability to type without transposing letters! I never had this so severely before!~

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Profile picture for susanjohnston @susanjohnston

When will you have the Reclast infusion? And we would be so grateful if you could share your experience.

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Scheduled for beginning of July.
Actually I will be getting Zometa which is the same drug that comes in 4 mg.

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Profile picture for karenjaninaz @karenjaninaz

Scheduled for beginning of July.
Actually I will be getting Zometa which is the same drug that comes in 4 mg.

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I had the Zometa infusion 4mg with absolutely no problems. The expected flu feeling lasted one day and was mitigated with tylenol.
Now, almost 6 weeks later no problem. Felt better than the 2 Prolia shots.

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Profile picture for berniebrooks3 @berniebrooks3

I am soon to finish my 12 month series of Evenity and Reclast is an option for the next medication. Would you be so kind as to share your sources of information regarding the lower dosage as I would love to also read them. Best of luck to you and take care.

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Profile picture for jozer @jozer

I also have been told to try reclast - but I've asked to remain on Fosomax (taken for a year; a bit better dexa and very little seriously uncomfortable side effects for me). Doc isn't answering me when email if I can start back on Fosamax; we discussed this at a question and answer appointment in May (he was ok with it) when we had an appointment to talk about reclast, which he really wants me to do and scares me to death. I understand that really bad and long lasting side effects are unusual; but many people seem to have life altering problems with it. Would LOVE to try a lower dose; I see twice a year lower doses; a low trial dose to see how your body handles etc. Doubt my doc would be on board with this, so also very interested in anyone who has had any type of lower dose of reclast.

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I had Zometa which is the same medication as Reclast just 4 mgm instead of 5.
I researched this and came up with 2 scholarly articles, which I gave to her, discussing the lower dose. The bone results were the same in this study as with Reclast. I brought the articles to my endocrinologist; she read them and prescribed the lower dose.
I did fine; it's been 6 weeks.
I'm a retired nurse anesthetist so I was able to educate her a little. I am 83 and was concerned about the higher dose.

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Profile picture for karenjaninaz @karenjaninaz

I had the Zometa infusion 4mg with absolutely no problems. The expected flu feeling lasted one day and was mitigated with tylenol.
Now, almost 6 weeks later no problem. Felt better than the 2 Prolia shots.

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That's wonderful! My doc wanted me to do the 5mg the first time, but he is not opposed to lowering the dosage down the road. I honestly think the key with Reclast may end up being giving patients a lower "maintenance" dosage, if possible, that they could stay on longer. More people would take it if they didn't have such terrible side effects.

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Profile picture for karenjaninaz @karenjaninaz

I had Zometa which is the same medication as Reclast just 4 mgm instead of 5.
I researched this and came up with 2 scholarly articles, which I gave to her, discussing the lower dose. The bone results were the same in this study as with Reclast. I brought the articles to my endocrinologist; she read them and prescribed the lower dose.
I did fine; it's been 6 weeks.
I'm a retired nurse anesthetist so I was able to educate her a little. I am 83 and was concerned about the higher dose.

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Went for the Reclast week and a half ago, no lower dose, no slow drip. Saw 4 different doctors who treat osteoporosis they all said to do it. Read a lot of articles about a lower dose; even 2.5mg once/year or perhaps every 6 months. Found out how to prep from websites such as this, I asked my doctor how to prep, and he said to ask the infusion center, and they said maybe some Tylenol after. Got no direction about drinking 16oz. water before the infusion, per the direction from Novartis. Luckily no side effects to speak of probably because I prepped according to the information on this website. Will really have to think long and hard about doing it again due to the lack of information from the medical community. thanks for your info!

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Profile picture for jozer @jozer

Went for the Reclast week and a half ago, no lower dose, no slow drip. Saw 4 different doctors who treat osteoporosis they all said to do it. Read a lot of articles about a lower dose; even 2.5mg once/year or perhaps every 6 months. Found out how to prep from websites such as this, I asked my doctor how to prep, and he said to ask the infusion center, and they said maybe some Tylenol after. Got no direction about drinking 16oz. water before the infusion, per the direction from Novartis. Luckily no side effects to speak of probably because I prepped according to the information on this website. Will really have to think long and hard about doing it again due to the lack of information from the medical community. thanks for your info!

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I agree. My doctor and nurse from hospital where i’m getting Reclast just said, “Ohhh just take some tylenol the day before and the day of, and drink lots of water. You should be fine”. They make it sound like “no problem, I don’t know what you’re worried about?. It’s been a year since my 1st Reclast. I was very tired for a couple months after my infusion. Now 2nd infusion is next month. I hesitate, but don’t feel i have other options.

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Profile picture for vgen @vgen

I agree. My doctor and nurse from hospital where i’m getting Reclast just said, “Ohhh just take some tylenol the day before and the day of, and drink lots of water. You should be fine”. They make it sound like “no problem, I don’t know what you’re worried about?. It’s been a year since my 1st Reclast. I was very tired for a couple months after my infusion. Now 2nd infusion is next month. I hesitate, but don’t feel i have other options.

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Good luck to you vgen ; maybe even zero fatigue this time! My exact experience with my questions when I called the infusion center; if you have slight flu like symptoms, take a Tylenol! And "stay hydrated" (2 glasses of water or 10??) No big deal I was told I'd be fine. These are all powerful drugs for osteo, it is a big deal.

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Thank you for sharing this and how very informative.
It is sure sad to know that after 10 years on the market the dosing is still being refined..

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