disodium pamidronate
CLINICAL USE
Bisphosphonate:Hypercalcaemia Bone pain Paget’s disease
DOSE IN NORMAL RENAL FUNCTION
Hypercalcaemia: depends on serum calcium – 15–90 mg in single or divided dosesBone pain: 90 mg every 4 weeks Paget’s disease: 30 mg weekly for 6 weeks, or 30 mg first dose then 60 mg every other week
PHARMACOKINETICS
DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsNone known
ADMINISTRATION
Reconstition
15 mg in 5 mL water for injection 30 or 90 mg in 10 mL water for injection Final concentration should not exceed 30 mg per 125 mL sodium chloride 0.9%
Route
IV
Rate of Administration
Maximum 20 mg/hour in patients with impaired renal function
Comments
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OTHER INFORMATION
Rate of acute renal failure is 9.3%, can cause focal segmental glomerulosclerosis, especially at higher doses. (Markowitz GS, Appel GB, Fine PL, et al. Collapsing focal segmental glomerulosclerosis following treatment with high-dose pamidronate. J Am Soc Nephrol. 2001; 12(6): 1164–72.)If pamidronate is not excreted adequately, kidney stones may be formedIn dialysis patients there is increased risk of asymptomatic hypocalcaemia with 90 mg doses