Pamidronate Disodium

How it works

It binds to bone mineral and inhibits osteoclast-mediated bone resorption, reducing pathological bone breakdown and lowering serum calcium in hypercalcaemia.

Prescribing in practice

• It must be given by slow intravenous infusion with the rate not exceeded as specified in the SPC, because rapid administration risks serious renal impairment.
• Correct hypocalcaemia and ensure adequate hydration before infusion, and counsel on the risks of osteonecrosis of the jaw and atypical femoral fractures with bisphosphonate therapy.
• An acute phase reaction with flu-like symptoms can occur after early infusions, and renal function should be assessed before dosing.

Monitoring

Monitor renal function and serum calcium and electrolytes before and during treatment, and review dental health where prolonged therapy is planned.

Counselling the patient

• You may feel flu-like with fever or aching for a day or two after the first infusions.
• Tell your team about any jaw pain or dental problems, or new thigh, hip or groin pain.
• Maintain good dental hygiene and report reduced urine output or swelling.

Evidence & guidelines

Intravenous bisphosphonates such as pamidronate are established treatment for hypercalcaemia of malignancy and Paget's disease, with MHRA advice noting osteonecrosis of the jaw and atypical femoral fracture risks.