Drug Index

Pamidronate

 
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Synonyms :

Aminohydroxypropylidene Diphosphonate, Disodium Pamidronate

Mechanism :

Lowers serum calcium concentration by binding to the bone and inhibiting osteoclast mediated calcium resorption, it has no effect on renal tubular calcium handling.


Indication :

• Hypercalcemia

• Osteogenesis imperfecta

• Steroid induced Osteoporosis

• Idiopathic Juvenile Osteoporosis

• Paget’s disease


Contraindications :

Pregnancy

Severe renal impairment

Hypersensitivity to pamidronate


Dosing :

Hypercalcemia:

0.5 to 1 mg/kg slow IV infusion over 24 hours one time. A second dose, identical to the first one is given if significant hypercalcemia persists or recurs. A minimum of 7 days should elapse between doses.

Osteogenesis Imperfecta:

14 days-23 months: 0.5 mg/kg IV once a day x 3 days every 2 months.

For first cycle on Day 1: 0.25 mg/kg IV.

2-3 years: 0.75 mg/kg IV once a day x 3 days every 3 months.

For first cycle on Day 1: 0.38 mg/kg IV.

4 years and older: 1 mg/kg IV once a day for 3 days every 4 months.

For first cycle on Day 1: 0.5 mg/kg IV.

Maximum dose: 90 mg/dose, 9 mg/kg total annual dose. Give for 1-4 years.

Osteopenia and Osteoporosis:

3 years and older: 0.4-1 mg/kg IV once a day x 3 days every 3-6 months for 1-4 years. Maximum dose: 90 mg/dose.


Adverse Effect :

Common: Hypocalcemia, hypomagnesemia, hypophosphatemia, hypokalemia. anemia, hypertension, fever, abdominal cramps, bone pain, nausea/vomiting, injection site reactions and cough.

Rare: Osteonecrosis of the jaw, reactivation of herpes zoster and simplex, rash and allergies, renal disorders, hematuria, dizziness, paresthesia, neutropenia, thrombocytopenia, visual disturbance, seizures, uveitis, scleritis.


Interaction :

Contraindicated:
Cidofovir, streptozocin.



Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Dose as in normal renal function
<10Serum calcium >4.0, give 60 mg. Serum calcium <4.0, give 30 mg

Dose in Patients undergoing Renal Replacement Therapies
CAPDUnknown dialysability. Dose as in GFR<10 mL/min
HDDialysed. Dose as in GFR<10 mL/ min
HDF/High fluxDialysed. Dose as in GFR<10 mL/ min
CAV/VVHDUnknown dialysability. Dose as in normal renal function

Hepatic Dose :

No dose adjustments in mild to moderate impairment. Dose adjustment in severe impairment not studied.
04/11/2020 15:02:13 Pamidronate
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