Pamidronate

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Generic Name: Pamidronate Brand Name(s): Generics only. No brands available.

Uses

What is Pamidronate used for?

Pamidronate is used to treat high blood calcium levels and certain bone problems (bone metastases/lesions) that may occur with some types of cancer. It is also used to treat a certain type of bone disease (Paget’s disease) that causes abnormal and weak bones.

Pamidronate belongs to a class of drugs known as bisphosphonates. It works by slowing the release of calcium from bones to lower blood calcium levels, reducing the risk of broken bones (fractures) and reducing bone pain.

How should I take Pamidronate?

This medication is given by slow injection into a vein for at least 2 hours, but up to 24 hours, or as directed by your doctor.

The dosage is based on your medical condition, laboratory tests, and response to treatment. Your doctor will order blood tests to check your kidney function prior to each treatment with this medication. The usual maximum adult dose of this medication is 90 milligrams for a single dose.

If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.

If you are being treated for a high blood calcium level, you may receive only a single dose of pamidronate. If you are being treated for cancer-related bone problems, you may receive a dose every 3 to 4 weeks. If you are being treated for Paget’s disease, you may receive treatment daily for 3 days. Consult your doctor or pharmacist for more details.

During treatment with this medication, it is important that you take in plenty of fluids and pass urine frequently to help avoid kidney problems. Intravenous fluids are usually given with this medication. Ask your doctor how much fluid you should drink, and follow these instructions carefully.

It may take up to 7 days before the full benefit of this drug takes effect.

Tell your doctor if your condition does not improve or if it worsens.

How do I store Pamidronate?

Pamidronate is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Pamidronate in the bathroom or the freezer. There may be different brands of Pamidronate that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

Mixed medicine must be used within 24 hours.

Each single-use vial (bottle) of this medicine is for one use only. Throw it away after one use, even if there is still medicine left inside.

You should not flush Pamidronate down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Pamidronate?

Before using pamidronate, tell your doctor or pharmacist if you are allergic to it; or other bisphosphonates (such as alendronate); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: recent or planned dental procedures (such as tooth removal), parathyroid/thyroid surgery, kidney problems, severe loss of body water (dehydration), heart failure.

Some people using pamidronate may have serious jawbone problems. Your doctor should check your mouth before you start this medication. Tell your dentist that you are using this medication before you have any dental work done. To help prevent jawbone problems, have regular dental exams and learn how to keep your teeth and gums healthy. If you have jaw pain, tell your doctor and dentist right away.

Before having any surgery (especially dental procedures), tell your doctor and dentist about this medication and all other products you use (including prescription drugs, nonprescription drugs, and herbal products). Your doctor or dentist may tell you to stop taking pamidronate before your surgery. Ask for specific instructions about stopping or starting this medication.

This medication may cause severe kidney problems. Consult your doctor or pharmacist for more information. To help prevent harm to your kidneys, drink plenty of fluids unless otherwise directed by your doctor.

This drug may rarely make you dizzy or drowsy. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

Caution is advised if you are pregnant or planning to become pregnant in the future. This medication is not recommended for use during pregnancy. It may stay in your body for several years and may harm an unborn baby. Consult your doctor for information on reliable forms of birth control.

It is unknown if pamidronate passes into breast milk. Discuss the risks and benefits with your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Pamidronate during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Pamidronate. Pamidronate is pregnancy risk category D according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Pamidronate?

Flu-like symptoms (such as mild fever, chills, fatigue, muscle/joint aches) may occur after treatment. Most of these effects are mild and can last up to 48 hours. Bone pain, redness/swelling/pain at the infusion site, headache, dizziness, loss of appetite, nausea, vomiting, diarrhea, drowsiness or trouble sleeping may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you experience any symptoms of low calcium such as muscle spasms or numbness/tingling (especially around the lips/mouth). Your doctor may ask you to take calcium and vitamin D supplements to prevent low blood calcium levels after treatment.

Tell your doctor right away if you have any serious side effects, including: trouble breathing, sores in jaw/mouth, jaw pain, increased or severe bone/joint/muscle pain, new or unusual hip/thigh/groin pain, eye problems (such as redness/itching/swelling or sensitivity to light), signs of kidney problems (such as change in the amount of urine), unusual tiredness/weakness, mental/mood changes (such as irritability or confusion), fast/pounding/irregular heartbeat.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Pamidronate?

Some products that may interact with this drug include: other bisphosphonates (such as alendronate), other medications which may affect the kidneys (including NSAIDs such as ibuprofen or naproxen).

Pamidronate may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Pamidronate?

Pamidronate may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Pamidronate?

Pamidronate may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Pamidronate.

What is the dose of Pamidronate for an adult?

Usual Adult Dose for Hypercalcemia of Malignancy

Moderate Hypercalcemia (corrected serum calcium of approximately 12 mg/dL to 13.5 mg/dL):

-60 to 90 mg single intravenous infusion over 2 to 24 hours

Severe Hypercalcemia (corrected serum calcium greater than 13.5 mg/dL):

-90 mg single intravenous infusion over 2 to 24 hours

Retreatment:

-Patients who show complete or partial response initially may be retreated 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.

Use: Treatment of moderate or severe hypercalcemia associated with malignancy, with or without bone metastases

Usual Adult Dose for Paget’s Disease

Moderate to severe Paget’s Disease of the Bone:

-30 mg intravenous infusion every day, administered over 4 hours for 3 consecutive days, for a total dose of 90 mg

Comments: When clinically indicated, retreat patients at the dose of initial therapy.

Usual Adult Dose for Osteolytic Bone Lesions of Multiple Myeloma

-90 mg intravenous infusion administered over 2 hours every 4 weeks

Duration of therapy: 24 months of therapy demonstrated overall benefits

Comments:

-Patients with marked Bence-Jones proteinuria and dehydration should receive adequate hydration prior to infusion of this drug.

-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.

Usual Adult Dose for Osteolytic Bone Metastases of Breast Cancer

-90 mg intravenous infusion administered over 2 hours every 3 to 4 weeks

Duration of therapy: 24 months of therapy demonstrated overall benefits

Renal Dose Adjustments

Mild to moderate renal dysfunction (CrCl 30 to 90 mL/min): No adjustment recommended.

Severe renal dysfunction (CrCl less than 30 mL/min): Limited existing data.

Renal Deterioration in Osteolytic Bone Metastases of Breast Cancer and Osteolytic Lesions of Multiple Myeloma:

-Patients with normal baseline creatinine experienced an increase of 0.5 mg/dL.

-Patients with abnormal baseline creatinine experienced an increase of 1 mg/dL.

-Treatment with this drug was resumed only when the creatinine returned to within 10% of the baseline value.

Comments:

-Promptly initiate vigorous saline hydration along with this drug therapy; if possible, the urine output should be about 2 L/day throughout treatment.

-Longer infusions (i.e., greater than 2 hours) may reduce the risk for renal toxicity, particularly in patients with preexisting renal insufficiency/impairment.

-Asses serum creatinine prior to each treatment; withhold treatment for renal deterioration.

Liver Dose Adjustments

No adjustment recommended.

Other Comments

Administration advice:

-For IV infusion administration only.

-Should not be mixed with calcium-containing infusion solutions.

-Administer as a single intravenous solution and infuse using an intravenous line for this drug alone.

-Visual inspection for particulate matter and discoloration prior to administration is recommended.

Storage requirements: The manufacturer product information should be consulted.

Reconstitution/preparation techniques: The manufacturer product information should be consulted.

Limitations of Use:

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

Monitoring: Serum levels of calcium, phosphate, magnesium, and potassium, following initiation of therapy

Patient advice:

-Report any thigh, hip, or groin pain; these symptoms should be evaluated for an incomplete femur fracture.

-Avoid invasive dental procedures, if possible; maintain good dental hygiene and routine dental care.

What is the dose of Pamidronate for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Pamidronate available?

Pamidronate is available in the following dosage forms and strengths:

  • Intravenous solution,
  • Intravenous powder for injection.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Pamidronate, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: April 11, 2018 | Last Modified: April 11, 2018

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