Pamidronate Brand Name– Aredia
What is Pamidronate
Pamidronate is a parenteral, second-generation pyrophosphate bisphosphonate.
Pamidronate is more potent than clodronate or etidronate and less potent than other bisphosphonates such as risedronate and zoledronic acid.
Pamidronate is indicated for the treatment of moderate to severe Paget’s disease, hypercalcemia associated with malignant neoplasms, and osteolytic metastases in patients with multiple myeloma or breast cancer.
Generally, IV zoledronic acid and pamidronate are considered to be equally effective in treating hypercalcemia of malignancy and both are considered acceptable treatments; however, one pooled analysis found zoledronic acid to be more potent than pamidronate.
Clinical practice guidelines support the use of bisphosphonates for the treatment of bone metastases in patients with multiple myeloma and breast cancer; IV pamidronate and zoledronic acid are generally considered equally effective in reducing skeletal-related adverse events.
Pamidronate has also been used off-label for the treatment of hyperparathyroidism (primary or secondary) and ankylosing spondylitis.
The newer, more potent bisphosphonates have more convenient dosing schedules (oral use, annual IV administration, etc.) and have largely replaced pamidronate in the treatment of Paget’s disease in adults.
In pediatric patients, pamidronate is very effective in treating children with osteogenesis imperfecta.
Pamidronate was originally approved by the FDA in 1991.
Indications
- bone metastases
- hypercalcemia
- hyperparathyroidism
- multiple myeloma
- osteogenesis imperfecta
- Paget’s disease
For the treatment of hypercalcemia
for hypercalcemia associated with malignancy
Side Effects
- abdominal pain
- acute respiratory distress syndrome (ARDS)
- anaphylactic shock
- anemia
- angioedema
- anorexia
- anxiety
- arthralgia
- asthenia
- atrial fibrillation
- atrial flutter
- back pain
- bone fractures
- bone pain
- candidiasis
- conjunctivitis
- constipation
- cough
- diarrhea
- drowsiness
- dyspepsia
- dyspnea
- edema
- erythema
- fatigue
- fever
- GI bleeding
- headache
- heart failure
- hematuria
- hyperkalemia
- hypernatremia
- hypertension
- hypocalcemia
- hypokalemia
- hypomagnesemia
- hypophosphatemia
- hypotension
- hypothyroidism
- injection site reaction
- insomnia
- iritis
- leukopenia
- lymphopenia
- musculoskeletal pain
- myalgia
- nausea
- nephrotic syndrome
- neutropenia
- ocular inflammation
- ocular pain
- osteonecrosis
- pleural effusion
- psychosis
- renal failure (unspecified)
- rhinitis
- seizures
- sinus tachycardia
- sinusitis
- stomatitis
- syncope
- thrombocytopenia
- uveitis
- visual impairment
- vomiting
Monitoring Parameters
- serum 25(OH)hydroxyvitamin D concentrations
- serum alkaline phosphatase
- serum calcium
- serum creatinine/BUN
- serum electrolytes
- serum magnesium
- serum phosphate
Contraindications
- acute bronchospasm
- anemia
- asthma
- breast-feeding
- chemotherapy
- children
- coagulopathy
- corticosteroid therapy
- dehydration
- dental disease
- dental work
- diabetes mellitus
- electrolyte imbalance
- geriatric
- hypertension
- hypocalcemia
- hypomagnesemia
- hypoparathyroidism
- hypophosphatemia
- hypovolemia
- infection
- multiple myeloma
- phosphonate hypersensitivity
- pregnancy
- renal failure
- renal impairment
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Amikacin
- Aminoglycosides
- Amlodipine; Celecoxib
- Aprotinin
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Calcium
- Calcium Acetate
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Calcium Chloride
- Calcium Gluconate
- Calcium; Vitamin D
- Capreomycin
- Celecoxib
- Chromium
- Cidofovir
- Colistimethate, Colistin, Polymyxin E
- Cyclosporine
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Doravirine; Lamivudine; Tenofovir disoproxil fumarate
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Emtricitabine; Tenofovir disoproxil fumarate
- Entecavir
- Esomeprazole; Naproxen
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Etodolac
- Famotidine; Ibuprofen
- Fenoprofen
- Flurbiprofen
- Gallium Ga 68 Dotatate
- Gentamicin
- Hetastarch; Dextrose; Electrolytes
- Hyaluronidase, Recombinant; Immune Globulin
- Hydrocodone; Ibuprofen
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Immune Globulin IV, IVIG, IGIV
- Indomethacin
- Inotersen
- Iron
- Iron Salts
- Kanamycin
- Ketoprofen
- Ketorolac
- Lamivudine; Tenofovir Disoproxil Fumarate
- Lansoprazole; Naproxen
- Lanthanum Carbonate
- Loop diuretics
- Mannitol
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Non-Ionic Contrast Media
- Nonsteroidal antiinflammatory drugs
- Omeprazole; Sodium Bicarbonate
- Oxaprozin
- Paromomycin
- Piroxicam
- Plazomicin
- Polymyxins
- Polysaccharide-Iron Complex
- Rofecoxib
- Sodium Bicarbonate
- Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
- Streptomycin
- Sulindac
- Tacrolimus
- Telavancin
- Telbivudine
- Tenofovir Alafenamide
- Tenofovir, PMPA
- Thalidomide
- Tobramycin
- Tolmetin
- Valdecoxib
- Vancomycin
