Formulary
Pamidronate disodium: Indications, Dosing, Side Effects and Interactions
Bisphosphonates are adsorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution, and therefore reducing the rate of bone...
MedNext Academy | 3 min read
Pamidronate disodium: Indications, Dosing, Side Effects and Interactions
Bisphosphonates are adsorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution, and therefore reducing the rate of bone...
Drug action
Bisphosphonates are adsorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution, and therefore reducing the rate of bone turnover.
Indications and dose
**Hypercalcaemia of malignancy**
- **Adult** (By Intravenous Infusion): 15-60 mg, to be given (via cannula in a relatively large vein) as a single infusion or in divided doses over 2-4 days, dose adjusted according to serum calcium concentration; maximum 90 mg per course.
**Osteolytic lesions and bone pain in bone metastases associated with breast cancer or multiple myeloma**
- **Adult** (By Intravenous Infusion): 90 mg every 4 weeks, to be administered via cannula in a relatively large vein, dose may alternatively be administered every 3 weeks, to coincide with chemotherapy in breast cancer.
**Paget's disease of bone**
- **Adult** (By Intravenous Infusion): 30 mg every week for a 6 week course (total dose 180 mg), alternatively initially 30 mg once weekly for 1 week, then increased to 60 mg every 2 weeks (max. per dose 60 mg) for a 6 week course (total dose 210 mg), to be administered via cannula in a relatively large vein, course may be repeated every 6 months; maximum 360 mg per course.
**Osteoporosis (due to osteogenesis imperfecta and other causes) (specialist use only), Hypercalcaemia (specialist use only) for pamidronate disodium**
- **Child** (By intravenous infusion): (consult local protocols or specialist resources).
Cautions
Cautions, further information Elderly With oral use: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate in patients with a current or recent history of upper gastro-intestinal disease or bleeding (risk of relapse/exacerbation of oesophagitis, oesophageal ulcer, or oesophageal stricture). Cautions For pamidronate disodium Atypical femoral fractures; cardiac disease (especially in elderly); ensure adequate hydration; previous thyroid surgery (risk of hypocalcaemia)
Side effects
Common or very common Alopecia; anaemia; appetite decreased; arthralgia; asthenia; chills; constipation; diarrhoea; dizziness; dysphagia; electrolyte imbalance; eye inflammation; fever; gastritis; gastrointestinal discomfort; headache; influenza like illness; malaise; myalgia; nausea; oesophageal ulcer (discontinue); oesophagitis (discontinue); pain; peripheral oedema; renal impairment; skin reactions; taste altered; vomiting Uncommon Anaphylactic reaction; angioedema; bronchospasm; oesophageal stenosis (discontinue); osteonecrosis Rare or very rare Atypical femur fracture; Stevens-Johnson syndrome Side-effects For pamidronate disodium Common or very common Decreased leucocytes; drowsiness; flushing; hypertension; insomnia; paraesthesia; tetany; thrombocytopenia Uncommon Agitation; dyspnoea; hypotension; muscle cramps; seizure Rare or very rare Acute respiratory distress syndrome (ARDS); confusion; glomerulonephritis; haematuria; heart failure; interstitial lung disease; nephritis tubulointerstitial; nephrotic syndrome; oedema; pulmonary oedema; reactivation of infections; renal disorder exacerbated; renal tubular disorder; visual hallucinations; xanthopsia Frequency not known Atrial fibrillation Side-effects, further information Oral supplements are advised to minimise potential risk of hypocalcaemia for those with mainly lytic bone metastases or multiple myeloma at risk of calcium or vitamin D deficiency (e.g. through malabsorption or lack of exposure to sunlight) and in those with Paget's disease.
Interactions
**Severe interactions:**
- Pamidronate disodium has been administered concomitantly with commonly used anti-tumour drugs (including aminoglutethimide, cisplatin, corticosteroids, cyclophosphamide, cytarabine, doxorubicin,...
Pregnancy
Avoid-toxicity in animal studies.
Breast feeding
Avoid.
Hepatic impairment
Manufacturer advises caution in severe hepatic impairment (no information available).
Renal impairment
Dose adjustments Max. infusion rate 20 mg/hour. Avoid if creatinine clearance less than 30 mL/minute, except in life-threatening hypercalcaemia if benefit outweighs risk. M See Prescribing in renal impairment . If renal function deteriorates in patients with bone metastases, withhold dose until serum creatinine returns to within 10% of baseline value. M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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