I have looked at comments posted on the Osteoporosis Foundation discussion forum. One person repeated helpful information about avoiding the acute phase reaction. It includes recommendations about Tylenol and vitamin D. Others have included suggestions about serious hydration before hand and adequate Calcium supplements:
'Here is part of a post entered by a member called Endodoc some time ago. :
"I'm pleased that your physician's recommended Tylenol; (acetaminophen) in addition to being well hydrated when you have your Reclast infusion. I always instruct the infusion nurses to provide 2 acetaminophen tablets (total 650 mg) to patients before the start of the infusion, and instruct the patients to then take the same dose with dinner & at bedtime the day of the infusion, with all 3 meals and at bedtime the following day, and a final dose at breakfast the 2nd morning after the infusion. Taking these 7 doses of "Tylenol" reduces the risk of a symptomatic APR (acute phase response, e.g., fever & muscle/bone aches & pains) from about a 20% (1 in 5) chance down to less than 1%. Also, it is imperative to know your vitamin D level before getting the infusion (assuming it hasn't been checked in the past couple of years). As the treatment is rarely (if ever) an emergency, i always make sure my patients have vitamin D levels in the mid-optimal range (around 40-50 ng/mL) prior to bisphosphonate therapy (especially Reclast). Even if one's level is 18, 5-6 weeks of replacement can bring it up to > 30 ng/mL."'