Pamidronate Disodium

A to Z Drug Facts

 Action Inhibits normal and abnormal bone resorption.

 Indications Treatment of moderate to severe hypercalcemia associated with malignancy with or without bone metastases; treatment of Paget disease of bone; treatment of osteolytic bone lesions of multiple myeloma in conjunction with standard antimyeloma chemotherapy.

Treatment of postmenopausal osteoporosis; control of bone metastases from breast cancer; treatment of hyperparathyroidism; prevention of glucocorticoid-induced osteoporosis; management of immobilization-related hypercalcemia.

 Contraindications Hypersensitivity to bisphosphonates.

 Route/Dosage

Moderate to Severe Hypercalcemia of Malignancy

Adults: IV Moderate: 60 to 90 mg as an initial single-dose infusion over 2 to 24 hr. Severe: 90 mg given as an initial single-dose infusion over 2 to 24 hr. Retreatment: Same as initial therapy, on or after 7 days.

Osteolytic Bone Metastases of Breast Cancer

Adults: IV 90 mg as a 2-hr infusion q 3 to 4 wk.

Osteolytic Bone Lesions of Multiple Myeloma

Adults: IV 90 mg as a 4-hr infusion on a monthly basis.

Paget Disease

Adults: IV 30 mg/day as a 4-hr infusion on 3 consecutive days for a total dose of 90 mg. Retreatment: Same as initial therapy, when clinically indicated.

 Interactions None well documented.

Calcium-containing infusion solutions (eg, Ringer's solution). Do not mix.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Hypertension; atrial fibrillation; syncope; tachycardia. CNS: Fatigue; headache; insomnia; psychosis; drowsiness. EENT: Uveitis; iritis. GI: Abdominal pain; anorexia; constipation; diarrhea; GI hemorrhage; stomatitis; dyspepsia; nausea; vomiting. GU: UTI; uremia. HEMATOLOGIC: Anemia; leukopenia; neutropenia; thrombocytopenia. METABOLIC: Hypophosphatemia; hypomagnesemia; hypothyroidism; hypokalemia; hypocalcemia. RESPIRATORY: Upper respiratory tract infection; rales/rhinitis. OTHER: Infusion site reaction (eg, redness, swelling, or induration; pain on palpation); transient mild elevation of temperature 24 to 48 hr after administration; bone pain; fluid overload; generalized pain; back pain; arthrosis; myalgias; arthralgias; moniliasis; edema.

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: Safety and efficacy not established. Hypocalcemia: Hypocalcemia has occurred. Renal effects: Pamidronate has not been tested in patients who have class Dc renal impairment (creatinine above 5 mg/dL); use with caution. GI disorders: Use with caution in patients with active upper GI problems such as dysphagia (eg, difficulty swallowing), symptomatic esophageal diseases, gastritis, duodenitis, or ulcers.

 Administration/Storage

Hypercalcemia of malignancy

• Dilute reconstituted solution in 1000 mL saline solution or D5W. Solution is stable up to 24 hr if refrigerated.

Paget disease or osteolytic bone lesions of multiple myeloma

• Dilute recommended dose in 500 mL of 0.45% or 0.9% saline solution or D5W.

• Reconstitute powder in vial with 10 mL Sterile Water for Injection. Reconstituted pamidronate is stable for up to 24 hr when stored under refrigeration.
• Hydrate patient adequately during treatment but do not overhydrate, especially patients who have cardiac failure.
• Minimum of 7 days between treatments is recommended.

 Assessment/Interventions

• Monitor electrolytes, creatinine, CBC, and differentials.
• Carefully monitor patients with preexisting anemia, leukopenia, or thrombocytopenia in the first 2 wk after treatment.
• Obtain patient history, including drug history and any known allergies.
• Monitor hemoglobin, potassium, magnesium, and phosphate levels before and during treatment.
• Monitor temperature before and during treatment.
• In patients with hypercalcemia, perform periodic evaluations of renal function.
• If infusion site reaction develops (eg, redness, swelling induration, pain, palpations), discontinue infusion, elevate site, and apply ice pack for 15 to 20 min q 4 to 6 hr for 72 hr.
• If fluid overload develops, give diuretics as ordered.

 Patient/Family Education

• Instruct patient to adjust diet, restrict activity, and take antiemetics if nausea and vomiting develop.
• Explain that fever is a common side effect of this medication but is usually self-limiting. Fatigue or drowsiness also are common.
• Instruct patient to report the following symptoms to health care provider: tingling, numbness, stomach pain, fever, irritation or pain at the injection site, fatigue, swelling, nausea, loss of appetite, constipation, diarrhea, upset stomach, vomiting, sleeplessness, inflammation of the mouth, difficulty breathing, muscle pain, drowsiness, difficult urination.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts