Pamidronate Disodium
Drugs affecting Bone Metabolism · Diphosphonate
Indications
Inj: Treatment of tumour induced hypercalcaemia, osteolytic lesions and bone pain due to bone metastases associated with breast cancer or multiple myeloma. Paget's disease.
Dosage
Adults: INJECTION: By slow IV infusion; max rate 60 mg/hr. Tumour induced hypercalcaemia: Total dosage to be determined by patients initial plasma calcium levels. Infuse slowly; max rate 30 mg in 2 hr. Max dose 90 mg per treatment for both initial and repeat courses. See literature. Osteolytic lesions, bone pain: 90 mg every 4 wk. In breast cancer this dose may be given every 3 wk to coincide with chemotherapy. Paget's disease: 30 mg once wkly for 6 consecutive wk; total dose 180 mg. Alternatively, 30 mg in wk 1, then 60 mg in wk 2, wk 4 and wk 6; total dose 210 mg. Increase if necessary to a max total dose 360 mg. Regimen can be repeated every 6 mth until remission and if relapse occurs. Children: Not recommended. CAPSULE: Adults: 200 mg daily. Children: Not recommended.
Administration
IV: Drug must be properly diluted before administration and slowly infused IV (over at least 2 hours). Reconstitution: Powder for injection: Reconstitute by adding 10 mL of SWFI to each vial of lyophilized pamidronate disodium powder, the resulting solution will be 30 mg/mL or 90 mg/mL. Pamidronate may be further diluted in 250-1000 mL of 0.45% or 0.9% NaCl or D5W. Stability: Powder for injection: Store below 30°C. The reconstituted solution made by adding 10 mL of SWFI to each vial of lyophilized powder (30 mg/10 mL or 90 mg/10 mL) will be stable for 24 hours stored under refrigeration at 2°C-8°C. Solution for injection: Store at 20°C-25°C.
Adverse Effects
Mild transient pyrexia. Transient lymphocytopenia. Asymptomatic hypocalcaemia. Hypomagnesaemia, infusion site reactions, transient bone pain, arthralgia, myalgia, headache. GI upset, lymphocytopenia. Rarely, leucopenia, anaemia, other biochemical disturbances, fever, flu-like symptoms, rash, insomnia, somnolence, hypertension, conjunctivitis, anorexia, hypophosphataemia, hypokalaemia, raised serum creatinine, atrial fibrillation.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Caution advised or effect undetermined. Precautions: Renal impairment, cardiac disease, previous thyroid surgery. Possibility of precipitating convulsions. Monitor serum electrolytes, calcium and phosphate. During prolonged use, monitor renal function.
Interactions
Infusions of solutions containing calcium, hypocalcaemic therapy, other diphosphonates, plicamycin, nephrotoxic drugs.
Advice to Patient
For bone pain, consult prescriber for analgesic. Contact prescriber if there is unusual muscle spasm/pain/twitching, fever, fatigue, acute bone pain, severe diarrhoea or constipation. During infusion and for 2-3 hours after completion, avoid meals high in calcium or vitamins with minerals. Regular mouth care is required during therapy. If you have to undergo a dental surgery, inform prescriber about it.
Pharmacokinetics
Onset of action: Hypercalcemia of malignancy (HCM): Reduction of albumin- corrected serum calcium: Children: Approx. 48 hours; Adults: =24 hours for decrease in albumin-corrected serum calcium; maximum effect: =7 days. Paget disease: Approx. 1 month for =50% decrease in serum alkaline phosphatase. Maximum effect: Hypercalcemia of malignancy (HCM): =7 days. Duration: HCM: 7 to 14 days; Paget disease: 1 to 372 days. Absorption: Poorly from the GI tract. Metabolism: Not metabolized. Half-life elimination: 28 ± 7 hours. Excretion: Biphasic; urine (30% to 62% as unchanged drug; lower in patients with renal dysfunction) within 120 hours.
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
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