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Bisphosphonate

Pamidronate disodium

Brand names: Aredia

Adult dose

Dose: Hypercalcaemia of malignancy: 30–90mg IV infusion (rate ≤60mg/h, max concentration 60mg/250mL). Bone metastases: 90mg IV every 4 weeks

Route: IV

Frequency: per indication

Dose adjustments

Renal

Avoid if eGFR <30; reduce infusion rate

Clinical pearls

Hypercalcaemia of malignancy, multiple myeloma bone disease, Paget's disease
Dental review before; correct vitamin D + calcium before

Contraindications

Severe renal impairment
Hypocalcaemia
Hypersensitivity

Side effects

Acute-phase reaction (flu-like, 24–48h post first dose)
Hypocalcaemia
Hypophosphataemia
Renal impairment
Osteonecrosis of jaw
Atypical femoral fracture
Uveitis

Interactions

Loop diuretics (additive hypocalcaemia)

Monitoring

Calcium
U&E
Phosphate

Reference: BNF; NICE; https://bnf.nice.org.uk/drugs/pamidronate-disodium/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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