Pamidronate Disodium

In this article, we will discuss Pamidronate Disodium (Dosage Overview). So, let’s get started.

Indications

Hypercalcemia of Malignancy

Pamidronate disodium is indicated for the treatment of moderate or severe hypercalcemia associated with malignancy, with or without bone metastases.

Paget’s Disease

Pamidronate disodium is indicated for the treatment of patients with moderate to severe Paget’s disease of bone.

Osteolytic Bone Metastases of Breast Cancer and Osteolytic Lesions of Multiple Myeloma

Pamidronate disodium is indicated in conjunction with standard antineoplastic therapy, for the treatment of osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma.

Limitations of Use

The safety and efficacy of pamidronate disodium in the treatment of hypercalcemia
associated with hyperparathyroidism or with other non-tumor-related conditions has not been established.

Dosage

Hypercalcemia of Malignancy

Vigorous saline hydration, should be initiated promptly along with pamidronate therapy and if possible the urine output should be about 2 L/day throughout treatment.

Patients who receive pamidronate disodium should have serum creatinine assessed prior
to each treatment. Treatment should be withheld for renal deterioration.

Moderate Hypercalcemia

The recommended dose of pamidronate disodium in moderate hypercalcemia (corrected serum calcium* of approximately 12 mg/dL to 13.5 mg/dL) is 60 mg to 90 mg given as a single-dose, intravenous infusion over 2 hours to 24 hours. Longer infusions (i.e., greater than 2 hours) may reduce the risk for renal toxicity, particularly in patients with preexisting renal impairment.

Severe Hypercalcemia

The recommended dose of pamidronate disodium in severe hypercalcemia (corrected serum calcium* >13.5 mg/dL) is 90 mg given as a single-dose, intravenous infusion over 2 to 24 hours. Longer infusions (i.e., greater than 2 hours) may reduce the risk for renal toxicity, particularly in patients with preexisting renal insufficiency/impairment.
*Albumin-corrected serum calcium = serum calcium, mg/dL + 0.8 (4.0-serum albumin,
g/dL).

Retreatment

Retreatment with pamidronate disodium in patients who show complete or partial
response initially may be carried out if serum calcium does not return to normal or
remain normal after initial treatment. A minimum of 7 days between treatments is
recommended to allow for full response to the initial dose. The dose and manner of
retreatment is identical to that of the initial therapy.

Paget’s Disease

The recommended dose of pamidronate disodium in patients with moderate to severe Paget’s disease of bone is 30 mg daily, administered as a 4-hour infusion on 3
consecutive days for a total dose of 90 mg. When clinically indicated, patients should be retreated at the dose of initial therapy.

Osteolytic Bone Metastases of Breast Cancer and Osteolytic Lesions of Multiple Myeloma

Osteolytic Bone Metastases of Breast Cancer
The recommended dose of pamidronate disodium in patients with osteolytic bone
metastases is 90 mg administered over a 2-hour infusion given every 3 to 4 weeks.
In a clinical study, renal deterioration was defined as follows:
• With normal baseline creatinine, an increase of 0.5 mg/dL.
• With abnormal baseline creatinine, an increase of 1 mg/dL.
In this clinical study, pamidronate disodium treatment was resumed only when the
creatinine returned to within 10% of the baseline value.

The optimal duration of therapy is not known; however, in two breast cancer studies, final analyses performed after 24 months of therapy demonstrated overall benefits.

Osteolytic Bone Lesions of Multiple Myeloma

The recommended dose of pamidronate disodium in patients with osteolytic bone lesions of multiple myeloma is 90 mg administered as a 4-hour infusion administered every four weeks. Patients with marked Bence-Jones proteinuria and dehydration should receive adequate hydration prior to pamidronate disodium infusion.

Limited information is available on the use of pamidronate disodium in multiple
myeloma patients with a serum creatinine greater than or equal to 3 mg/dL.
Patients who receive pamidronate disodium should have serum creatinine assessed prior
to each treatment. Treatment should be withheld for renal deterioration.

In a clinical study, renal deterioration was defined as follows:
• With normal baseline creatinine, an increase of 0.5 mg/dL.
• With abnormal baseline creatinine, an increase of 1 mg/dL.

In this clinical study, pamidronate disodium treatment was resumed only when the
creatinine returned to within 10% of the baseline value. The optimal duration of therapy is not known. However, in a study of patients with myeloma, final analysis after 21 months demonstrated overall benefits.

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