Adult Dosing
Moderate to severe hypercalcemia associated with malignancy
- Moderate hypercalcemia (corrected serum Ca 12-13.5 mg/dL): 60-90 mg IV infusion, given as a single dose, over 2-24 hrs
- Severe hypercalcemia (corrected serum Ca >13.5 mg/dL): 90 mg IV infusion, given as a single dose, over 2-24 hrs
Notes:- Longer infusions (>2 hrs) may reduce the risk for renal toxicity, especially in patients with preexisting renal insufficiency
- Retreatment may be carried out if serum calcium does not return to normal after initial therapy; retreatment should not be attempted within 7 days of the initial dose
Paget's disease
- 30 mg IV qd over 4 hrs ×3 consecutive days for a total dose of 90 mg
Osteolytic bone lesions of multiple myeloma
- 90 mg given as a 4-hr infusion on a monthly basis
Note:
- Assess serum creatinine prior to each treatment; withhold treatment in case of renal deterioration
Osteolytic bone metastases of breast cancer
- 90 mg IV infusion over 2 hrs, q3-4 wks
Note:- Assess serum creatinine prior to each treatment; withhold treatment in case of renal deterioration
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Renal toxicity, manifested as deterioration of renal function, and potential renal failure may occur with bisphosphonates
- Do not use single doses >90 mg, due to the risk of deterioration in renal function, which may progress to renal failure. Renal deterioration, progression to renal failure, and dialysis have been reported in patients after the initial or a single dose of pamidronate
- Assess serum creatinine prior to each treatment; withhold treatment in case of renal deterioration
- Women, who get pregnant while on treatment, should be apprised of the potential harm to the fetus; women of child bearing potential should be advised to avoid pregnancy
- Asymptomatic hypophosphatemia, hypokalemia, hypomagnesemia, hypocalcemia, and occasionally symptomatic hypocalcemia (including tetany) have been reported during pamidronate therapy
- Patients with a history of thyroid surgery may have relative hypoparathyroidism that may predispose to hypocalcemia with treatment
- Pamidronate is excreted primarily by the kidney; the risk of renal adverse reactions may be increased in patients with impaired renal function
- Patients receiving treatment should have their serum creatinine assessed prior to each treatment. In patients treated for bone metastases with evidence of deterioration in renal function, pamidronate should be withheld until renal function returns to baseline. In other indications, clinical judgment should determine whether the potential benefit outweighs the risks
- Osteonecrosis of the jaw (ONJ) has been reported during therapy, predominantly in cancer patients. Patients receiving chemotherapy and corticosteroids are at an increased risk of ONJ
- Cancer patients should maintain good oral hygiene and have a dental examination with preventive dentistry prior to treatment; avoid invasive dental procedures during treatment
- Severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported during therapy in post-marketing reports
- Monitor serum calcium, electrolytes, phosphate, magnesium, CBC, differential, and hematocrit/hemoglobin in patients receiving pamidronate; assess serum creatinine prior to each treatment. Carefully monitor patients having preexisting anemia, leukopenia, or thrombocytopenia for 2 wks following treatment
- In the absence of hypercalcemia, patients with multiple myeloma or lytic bone metastases and those with Paget's disease should be given oral calcium and vitamin D supplementation in order to minimize the risk of hypocalcemia
- Bisphosphonate therapy including pamidronate may cause atypical subtrochanteric and diaphyseal femoral fractures which may further lead to thigh or groin pain
Cautions: Use cautiously in
- Renal impairment
- Concurrent nephrotoxic drugs
- Elderly patients
- Parathyroid or thyroid surgery
Pregnancy Category:D
Breastfeeding: Limited information indicates very low levels in breast milk following IV administration. Withhold nursing for 12-24 hrs after a dose to ensure that the infant is not exposed to the drug; some data indicate that breastfeeding after cessation of long-term pamidronate treatment appears to have no adverse effects on the infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 06 April 2011). Manufacturer advises caution.
