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Pamidronate

Class
Antiresorptive agents
Subclass
Bisphosphonates
Generic name
Pamidronate, pamidronic acid
Common formulations
Powder for parenteral solution
Dosage and administration
Adults patients
Treatment of Paget's disease
•
30 mg IV q24h for 3 days
Indications for use
Labeled indications
Adults
•
Treatment of Paget's disease
•
Treatment of humoral hypercalcemia of malignancy
Safety risks
Boxed warnings
Renal failure
•
Use extreme caution with pre-existing renal impairment.
Warnings and precautions
Bronchospasm
•
Use caution with phosphonate hypersensitivity or aspirin-sensitive asthma.
Hypocalcemia
•
Use caution with a history of thyroid surgery and electrolyte imbalance.
Hypovolemia
•
Use caution with pre-existing dehydration.
Medication-related osteonecrosis of the jaw
•
Use caution with a history of oral pain, swelling, or numbness.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-20 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR < 10 mL/min/1.73 m²
•
Reduce dose. Maximal dose of Serum calcium >4.0, give 60 mg. ;Serum calcium <4.0, give 30 mg.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Reduce dose. Dose as in eGFR < 10 mL/min/1.73 m². Maximal dose of Serum calcium >4.0, give 60 mg. ;Serum calcium <4.0, give 30 mg.
Peritoneal dialysis
•
Reduce dose. Dose as in eGFR < 10 mL/min/1.73 m². Maximal dose of Serum calcium >4.0, give 60 mg. ;Serum calcium <4.0, give 30 mg.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Use acceptable. No dose adjustment required.
Child-Pugh C (severe)
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Avoid use. Evidence of fetal harm in humans. Pamidronate is classified as FDA pregnancy risk category D.
•
If a patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus.
•
Women of childbearing potential should be advised to avoid becoming pregnant.
•
Furthermore, in those infants that are exposed to pamidronate in utero, serum calcium concentrations should be monitored for the first few days after birth.
Breastfeeding
Use with caution during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
Adverse reactions
Very common > 10%
•
Anemia, ↓ platelet count, ↓ serum calcium, ↓ serum magnesium, ↓ serum phosphate, ↓ serum potassium, pleural effusion, abdominal pain, anxiety, arthralgia, asthenia, constipation, cough, diarrhea, dyspepsia, dyspnea, fatigue, fever, injection site reactions, insomnia, loss of appetite, musculoskeletal pain, myalgia, nausea, vomiting, sinusitis
Common 1-10%
•
AF, anaphylaxis, angioedema, atrial flutter, candidiasis, ↓ WBC count, ↓ blood neutrophil count, gastrointestinal bleeding, heart failure, hypertension, hypotension, hypothyroidism, iritis, psychosis, back pain, bone pain, headache, seizure, somnolence, syncope, rhinitis, sinus tachycardia, stomatitis, uveitis
Unknown frequency
•
Acute respiratory distress syndrome, bone fracture, conjunctivitis, ↓ blood lymphocyte count, ↑ serum potassium, ↑ serum sodium, nephrotic syndrome, osteonecrosis, renal failure, eye pain, hematuria, skin erythema, visual disorder
Interactions
Drug(s)
Check Interactions
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