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

Molecular weight :369.1

%Protein binding :54

%Excreted unchanged in urine : 20–55

Volume of distribution (L/kg) :0.5–0.6

half-life – normal/ESRD (hrs) :0.8–27/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Serum calcium >4.0, give 60 mg. Serum calcium <4.0, give 30 mg

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in GFR <10 mL/min

HD :Dialysed. Dose as in GFR

<10 : mL/min

HDF/high flux :Dialysed. Dose as in GFR

<10 : mL/min

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

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

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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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