Pamidronate disodium

How it works

It binds avidly to bone mineral and inhibits osteoclast-mediated bone resorption, thereby lowering serum calcium and reducing skeletal complications.

Prescribing in practice

• It must be given as a slow intravenous infusion and never as a bolus, because rapid administration risks serious renal impairment, and the patient should be adequately hydrated beforehand.
• Correct hypocalcaemia and ensure adequate vitamin D before treatment, and counsel on the small risk of osteonecrosis of the jaw, encouraging dental review beforehand.
• An acute-phase reaction with transient flu-like symptoms is common after the first infusion.

Monitoring

Monitor serum calcium and other electrolytes, renal function before and after infusions, and assess oral health for signs of jaw osteonecrosis.

Counselling the patient

• Flu-like symptoms with fever and aches may occur for a day or two after the first infusion and then settle.
• Maintain good dental hygiene and report any jaw pain, swelling or non-healing dental problems.
• Report numbness, tingling or muscle cramps, which may signal low calcium.

Evidence & guidelines

Intravenous bisphosphonates are established first-line treatment for hypercalcaemia of malignancy and for reducing skeletal events in metastatic bone disease, supported by oncology and endocrine guidance.