Alternate Name(s):
AREDIA
Classification:
Bone metabolism regulator
Original Date:
August 2005
Revised Date:
March 2017
Indications:
- Moderate to severe Pagets disease
- Hypercalcemia associated with malignancy
- Osteolytic bone lesions associated with multiple myeloma
- Inhibit bone resorption in severe osteogenesis imperfecta (investigational use)
Reconstitution and Stability:
- Available as a 6 mg/mL injection
- Reconstituted solution is stable 24 hours at room temperature.
- Stable for 24 hours refrigerated in D5W
- Stable for 28 days at room temperature and in the fridge when diluted with 0.9% NaCl to a concentration of 0.36 mg/mL and stored in PVC bags.
- Protect from light
Compatibility:
- Solutions Compatible: D5W, 0.9% NaCl
- Additive/Above Cassette Compatible: no information
- Y-site Compatible: no information
- Incompatible: calcium-containing infusion solutions (eg. Ringers solution)
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Push |
NO |
| IV Intermittent Infusion |
YES Infusion time: 4 hours |
| IV Continuous Infusion | YES, has been used in adults for severe hypercalcemia Usual dilution: 90 mg to be diluted in 250-500 mL IV fluid |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric
- Treatment must be given slowly over 4 hours.
- Maximum dose 60 mg over 4 hours in 600 mL NS.
Hypercalcemia:
- 0.5-1 mg/kg IV
- Maximum: 90 mg, due to increased risk of nephrotoxicity
Osteogenesis imperfecta:
- 0.5-3 mg/kg/day IV for 3 days, may repeat in 4 to 6 month intervals
Adult
Hypercalcemia:
- Dose based on serum calcium measurement:
|
Serum Calcium (mmol/L) |
<3 |
3.0-3.5 |
3.5-4.0 |
>4 |
|
Pamidronate Dose (mg) |
30 |
30-60 |
60-90 |
90 |
Paget's Disease:
- 30 mg IV for 3 consecutive days
Multiple myeloma/Bone metastases:
- 90 mg IV every 3 - 4 weeks
Potential hazards of parenteral administration:
- Vein irritation, thrombophlebitis
- A transient low-grade fever 24-48 hours after initial infusion; may be accompanied by flu-like symptoms (malaise, rigors, fatigue, flushing)
- Hypocalcemia, hypophosphatemia, hypokalemia, hypomagnesemia
- Transient bone pain, myalgia, arthralgia
- Nephrotoxicity
Notes:
- Monitor serum creatinine prior to each dose; serum calcium, phosphate, potassium, magnesium, hemoglobin, hematocrit, CBC with differential.
- In addition, in Paget's disease, monitor serum alkaline phosphatase, urinary hydroxyproline excretion.
- Use with caution in patients with renal impairment; maintain adequate hydration and urinary output during treatment.