- 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)
- 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 Intermittent Infusion||
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
- 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)
- 30 mg IV for 3 consecutive days
Multiple myeloma/Bone metastases:
- 90 mg IV every 3 - 4 weeks
- 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
- 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.