Drug Index


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 :


Severe renal impairment

Hypersensitivity to pamidronate

Dosing :

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 :

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.
01/28/2024 16:01:43 Pamidronate
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