• Moderate to severe hypercalcemia associated with malignancy.
• Osteolytic bone lesions associated with multiple myeloma or breast cancer.
• Moderate to severe Paget’s disease.

Contraindicated in:

• Hypersensitivity to pamidronate, other bisphosphonates, or mannitol
• OB: Pregnancy
• Lactation: Lactation.

Use Cautiously in:

• Underlying cardiovascular disease, especially HF (initiate saline hydration cautiously)
• Invasive dental procedures, cancer, receiving chemotherapy or corticosteroids, poor oral hygiene, periodontal disease, dental disease, anemia, coagulopathy, infection, or poorly fitting dentures (may ↑ risk of jaw osteonecrosis)
• History of thyroid surgery (may be at ↑ risk for hypocalcemia)
• Renal impairment (dose ↓ recommended)
• Pedi: Safety and effectiveness not established in children.

CV: arrhythmias, hypertension, syncope, tachycardia.

EENT: blurred vision, conjunctivitis, eye pain/inflammation, rhinitis.

Endo: hypothyroidism.

F and E: hypocalcemia, hypokalemia, hypomagnesemia, hypophosphatemia, fluid overload.

GI: nausea, abdominal pain, anorexia, constipation, vomiting.

GU: nephrotoxicity.

Hemat: leukopenia, anemia.

Local: phlebitis at injection site.

MS: muscle stiffness, pain, femur fractures, osteonecrosis (primarily of jaw).

Neuro: fatigue.

Resp: rales.
Misc: fever.

Drug-Drug:

• Hypokalemia and hypomagnesemia may ↑ risk of digoxin toxicity.
• Calcium and vitamin D will antagonize the beneficial effects of pamidronate.
• Concurrent use of thalidomide may ↑ risk of renal impairment.

(Generic available)

• Solution for injection: 3 mg/mL; 6 mg/mL; 9 mg/mL;

Hypercalcemia of Malignancy

• IV (Adults): Moderate hypercalcemia: 30–90 mg; may be repeated after 7 days.

Osteolytic Lesions from Multiple Myeloma

• IV (Adults): 90 mg monthly.

Osteolytic Lesions from Metastatic Breast Cancer

• IV (Adults): 90 mg every 3–4 wk.

Paget’s Disease

• IV (Adults): 90–180 mg/treatment; may be given as 30 mg daily for 3 days up to 30 mg/wk for 6 wk. Single doses of 60–90 mg may also be effective.

• Inhibits resorption of bone.

• Decreased serum calcium.
• Decreased skeletal destruction in multiple myeloma or breast cancer.
• Decreased skeletal complications in Paget’s disease.

Therapeutic Classification: bone resorption inhibitors

Pharmacologic Classification: hypocalcemics

Absorption: IV administration results in complete bioavailability.

Distribution: Rapidly absorbed by bone. Reaches high concentrations in bone, liver, spleen, teeth, and tracheal cartilage. Approximately 50% of a dose is retained by bone and then slowly released.

Metabolism/Excretion: 50% is excreted unchanged in the urine.

Half-life: Elimination half-life from plasma is biphasic — 1st phase 1.6 hr, 2nd phase 27.2 hr. Elimination half-life from bone is 300 days.

(effect on serum calcium)

• Advise patient to report signs of hypercalcemic relapse (bone pain, anorexia, nausea, vomiting, thirst, lethargy) or eye problems (pain, inflammation, blurred vision, conjunctivitis) to health care professional promptly.
• Advise patient to notify nurse of pain at the infusion site.
• Encourage patient to comply with dietary recommendations. Diet should contain adequate amounts of calcium and vitamin D.
• Advise patient to notify health care professional if bone pain is severe or persistent.
• Advise patient to maintain good oral hygiene and have regular dental examinations. Instruct patient to inform health care professional of pamidronate therapy prior to dental surgery.
• Emphasize the need for keeping follow-up exams to monitor progress, even after medication is discontinued, to detect relapse.
• May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy. May impair female and male fertility.

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