Parenteral Manual


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Alternate Name(s): 
Bone metabolism regulator
Original Date: 
August 2005
Revised Date: 
March 2017
  • 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

- 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)


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Push


IV Intermittent Infusion

Usual dilution: 0.06-0.36 mg/mL

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

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • Treatment must be given slowly over 4 hours.
  • Maximum dose 60 mg over 4 hours in 600 mL NS.


  • 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


  • Dose based on serum calcium measurement:

Serum Calcium (mmol/L)





Pamidronate Dose (mg)





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
  • 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.

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