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MUSCULO-SKELETAL SYSTEM › DRUGS FOR TREATMENT OF BONE DISEASES › DRUGS AFFECTING BONE STRUCTURE AND MINERALIZATION › Bisphosphonates
pamidronic acid
M05BA03
Forms & Strengths
- Injectable powder for reconstitution: 30 mg, 90 mg
- Intravenous solution: 3 mg/mL, 6 mg/mL, 9 mg/mL
Adult Dosing
- Hypercalcemia of malignancy: Moderate (Ca 12-13.5 mg/dL): 60-90 mg IV single dose over 2-24 hours
- Hypercalcemia of malignancy: Severe (Ca >13.5 mg/dL): 90 mg IV single dose over 2-24 hours
- Bone metastases of breast cancer / Osteolytic lesions of multiple myeloma: 90 mg IV infusion every 3-4 weeks
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
- Off-label severe osteogenesis imperfecta: 1-1.5 mg/kg/dose IV monthly or every 3 months
Indications
- Treatment of hypercalcemia associated with malignancy
- Adjunct to standard chemotherapy in osteolytic bone metastases of breast cancer
- Adjunct to standard therapy in osteolytic lesions of multiple myeloma
Mechanism of Action
- Bisphosphonate that adsorbs to calcium phosphate crystals in bone
- Inhibits osteoclast activity and osteoclast recruitment/differentiation
- Reduces bone resorption and turnover, lowering serum calcium levels
Contraindications
- Hypersensitivity to pamidronate or other bisphosphonates
- Pregnancy and lactation
Adverse Reactions
- Transient low-grade fever and flu-like symptoms (within 48 hours of infusion)
- Hypocalcemia, hypophosphatemia, hypomagnesemia, hypokalemia
- Osteonecrosis of the jaw (ONJ)
- Atypical subtrochanteric and diaphyseal femoral fractures
- Renal toxicity (deterioration of renal function, focal segmental glomerulosclerosis)
Drug Interactions
- Aminoglycosides: May increase risk of hypocalcemia and prolong hypocalcemic effect
- Nephrotoxic drugs: Increased risk of renal dysfunction
- Thalidomide: Increased risk of renal dysfunction in multiple myeloma patients
Curated Content: Needs Vetting Before Put to Clinical Use