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pamidronate (Aredia)
Tradename: Aredia.
Indications:
- Paget's disease of the bone
- hypercalcemia secondary to
- multiple myeloma
- breast cancer
- bone metastases
- ossification due to spinal cord injury
- after total hip replacement
- for other causes of hypercalcemia use
- hydration with normal saline
- loop diuretic
- calcitonin
- does NOT provide prophylaxis in osteolytic malignancies other than breast cancer & multiple myeloma
Contraindications:
- CKD4 [8]
Dosage:
1) hypercalcemia of multiple myeloma or breast cancer
a) 60-90 mg IV over 24 hours once weekly, or
b) 30 mg IV with 200 IU of calcitonin weekly
c) 90 mg IV over 90 minutes monthly for prophylaxis of osteolytic lesions
2) Paget's disease of the bone
- 30 mg IV daily infused over 4 hours for 3 days
Powder for injection: lyophilized, 30 mg.
Pharmacokinetics:
1) onset of action: 2-4 days
2) not metabolized
3) excreted in urine
4) prolonged effect on serum Ca+2 lasting weeks may be seen in some patients
Adverse effects:
1) not common (1-10%)
- transient low grade fever, fluid overload, nausea, diarrhea, constipation, dyspnea, convulsions, bone pain, hypocalcemia, hypophosphatemia, hypomagnesemia, hepatic dysfunction 2 uncommon (< 1%)
- fecal occult blood, pain, increased risk of bone fracture, nephrotoxicity, hypersensitivity, altered taste, angioedema, rash
3) other [3,5,6]
- hypokalemia
- irritation at the site of infusion
- musculoskeletal pain
- hypertension
- anorexia
- perioral paresthesia
- leukopenia [5]
- ocular inflammation: [6]
- conjunctivitis, blurred vision, eye pain (uncommon)
- osteonecrosis of the jaw [7]
- nephrotoxicity
- most commonly focal segmental glomerulosclerosis
- proteinuria
Mechanism of action:
1) bisphosphonate that inhibits bone resorption
2) inhibits osteoclastic activity
Interactions
drug interactions
drug adverse effects of bisphosphonates
Related
hypercalcemia
General
bisphosphonate
Properties
MISC-INFO: elimination route KIDNEY
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996.
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995,
pg 492
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16.
American College of Physicians, Philadelphia 1998, 2012
- Prescriber's Letter 10(5):26 2003
- FDA Safteywatch
http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#zometa2
- NEJM Knowledge+ Hematology