pamidronate (Aredia)

Introduction

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

pregnancy category = c

safety in lactation = ?

Dosage

• hypercalcemia of multiple myeloma or breast cancer
  • 60-90 mg IV over 24 hours once weekly, or
  • 30 mg IV with 200 IU of calcitonin weekly
  • 90 mg IV over 90 minutes monthly for prophylaxis of osteolytic lesions
• Paget's disease of the bone
  • 30 mg IV daily infused over 4 hours for 3 days

Powder for injection: lyophilized, 30 mg.

Pharmacokinetics

• onset of action: 2-4 days
• not metabolized
• excreted in urine
• prolonged effect on serum Ca+2 lasting weeks may be seen in some patients

elimination via kidney

Adverse effects

• 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
• other
  • hypokalemia
  • irritation at the site of infusion
  • musculoskeletal pain
  • hypertension
  • anorexia
  • perioral paresthesia
  • leukopenia
  • ocular inflammation:
    • conjunctivitis, blurred vision, eye pain (uncommon)
  • osteonecrosis of the jaw
  • nephrotoxicity
    • most commonly focal segmental glomerulosclerosis
      • proteinuria

• drug adverse effects of bisphosphonates

Mechanism of action

• bisphosphonate that inhibits bone resorption
• inhibits osteoclastic activity

More general terms

• bisphosphonate

Additional terms

• hypercalcemia

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=73351
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=4674
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=4673
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=60342
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=404467