Pamidronic acid (Pamidronate)

Pamidronic acid (Pamidronate) is used to treat high levels of a mineral called calcium in people who have cancer. It is also used to treat or prevent weakening of the bones. Using this medicine can reduce your risk of breaking bones. Pamidronic acid (Pamidronate) is given by a doctor or nurse. You will not need to do this yourself. How much you are given, and how often, will be decided by your doctor. It may just be a single injection but if you are being treated for bone problems caused by the spread of cancer you may need regular injections. Your doctor will ask you to drink plenty of water before the injection, to avoid getting dehydrated. It may take several days to get the full benefit of this drug. Pamidronic acid (Pamidronate) is only part of a programme of treatment that may also include changes to your diet and taking calcium and vitamin supplements. The most common side effects include headache, back pain, muscle pain, indigestion, diarrhea and heartburn. These are usually mild and will disappear after a short time. If they do not go away, tell your doctor. Pamidronic acid (Pamidronate) can cause serious kidney problems, especially if you are dehydrated, if you take diuretic medicine (water pills), or if you already have kidney disease. It can also cause low levels of calcium in the blood and pain in the mouth or jaw. These are serious side effects and need urgent medical attention. Tell your doctor straight away. You should not be given this medicine if you are breastfeeding. Before taking it, tell your doctor if you have kidney problems or low calcium levels. Also let your doctor know what other drugs you are taking. Some of them may affect, or be affected by, this injection, especially medicines used to treat severe infections and medicines used to treat cancer and osteoporosis. You may need frequent medical tests to check your kidney function and mineral levels. Avoid smoking or try to quit as smoking can reduce your bone mineral density, making fractures more likely. Drinking large amounts of alcohol can also cause bone loss and should be avoided. Pamidronic acid (Pamidronate) is a bisphosphonate. It acts by suppressing the activity of osteoclasts, cells that cause the destruction of bone, thereby strengthening the bones and minimizing the risk of fractures.

• High calcium levels in the blood

The mechanism of action of pamidronate is inhibition of bone resorption. Pamidronate adsorbs to calcium phosphate (hydroxyapatite) crystals in bone and may directly block dissolution of this mineral component of bone. In vitro studies also suggest that inhibition of osteoclast activity contributes to inhibition of bone resorption. Pamidronate also targets farnesyl pyrophosphate (FPP) synthase. Nitrogen-containing bisphosphonates (such as pamidronate, alendronate, risedronate, ibandronate and zoledronate) appear to act as analogues of isoprenoid diphosphate lipids, thereby inhibiting FPP synthase, an enzyme in the mevalonate pathway. Inhibition of this enzyme in osteoclasts prevents the biosynthesis of isoprenoid lipids (FPP and GGPP) that are essential for the post-translational farnesylation and geranylgeranylation of small GTPase signalling proteins. This activity inhibits osteoclast activity and reduces bone resorption and turnover. In postmenopausal women, it reduces the elevated rate of bone turnover, leading to, on average, a net gain in bone mass.

Adult Dose: Intravenous Osteolytic bone metastases; Osteolytic lesions associated with multiple myeloma Adult: 90 mg as a single infusion 3-4 wkly. Max infusion rate: 60 mg/hr. Hypercalcaemia of malignancy Adult: 15-90 mg (based on initial plasma Ca concentration) as a single infusion or in divided doses over 2-4 consecutive days. Plasma Ca levels generally start declining 24-48 hr after a dose w/ normalisation w/in 3-7 days; may repeat treatment if normocalcaemia is not achieved w/in this time or if hypercalcaemia recurs. Max infusion rate: 60 mg/hr. Paget's disease of bone Adult: 30 mg once wkly by infusion for 6 wk (total dose: 180 mg), alternatively, 30 mg in the 1st wk, then 3 doses of 60 mg every other wk (total dose: 210 mg); may repeat course 6 mthly (total dose may be increased up to 360 mg) when clinically indicated. Max infusion rate: 60 mg/hr. Elderly: Initiate at lower end of adult dosing range. Renal Dose: Renal impairment: Max infusion rate: 20 mg/hr. CrCl (ml/min) Dosage Recommendation <30 Avoid, unless in life-threatening cases.

Your doctor or nurse will give you this medicine. Kindly do not self administer.

If you miss a dose of Pamidronic acid (Pamidronate), skip it and continue with your normal schedule. Do not double the dose.

Common: • Headache • Back pain • Musculoskeletal (bone, muscle or joint) pain • Heartburn • Diarrhea

[UNSAFE] Pamidronic acid (Pamidronate) may decrease alertness, affect your vision or make you feel sleepy and dizzy. Do not drive if these symptoms occur. It is given by injection into a vein, usually over at least 15 minutes or as directed by your doctor. Drink plenty of fluids to prevent dehydration and kidney damage. It can lower the level of calcium in the blood. Take calcium and vitamin D supplements as suggested by your doctor. You may develop fever or flu like symptoms, such as chills, tiredness and weakness. These are usually temporary and should go away after a few days. You may take a pain reliever/fever reducer to prevent or treat these symptoms. It may cause a rare condition called osteonecrosis of the jaw. Have regular dental check-ups and inform your doctor if you develop sudden pain in your jaw. Your doctor will monitor your response to Pamidronic acid (Pamidronate) by testing your bone mineral density (BMD). This is usually done every 1-3 years. Do not take it if you are pregnant or breastfeeding.

Hypersensitivity, Lactation.

Concomitant use w/ other bisphosphonates, other antihypercalcaemic agents and calcitonin may lead to hypocalcaemia w/ associated clinical symptoms (e.g. paraesthesia, tetany, hypotension). Enhanced hypocalcaemic effect w/ aminoglycosides. Increased nephrotoxic effect w/ thalidomide. Enhanced adverse effects w/ NSAIDs. Synergistic effect w/ calcitonin in patients w/ severe hypercalcaemia.

[SAFE] Consuming alcohol with Pamidronic acid (Pamidronate) does not cause any harmful side effects.

[CONSULT YOUR DOCTOR] Pamidronic acid (Pamidronate) is unsafe to use during pregnancy as there is definite evidence of risk to the developing baby. However, the doctor may rarely prescribe it in some life-threatening situations if the benefits are more than the potential risks. Please consult your doctor.

[SAFE IF PRESCRIBED] Pamidronic acid (Pamidronate) is probably safe to use during breastfeeding. Limited human data suggests that the drug does not represent any significant risk to the baby. If you are taking Pamidronic acid (Pamidronate) during breastfeeding, monitor baby's blood calcium levels during the first two months.

[CAUTION] Pamidronic acid (Pamidronate) should be used with caution in patients with severe kidney disease. Dose adjustment of Pamidronic acid (Pamidronate) may be needed. Please consult your doctor. [CAUTION] Pamidronic acid (Pamidronate) should be used with caution in patients with severe liver disease. Dose adjustment of Pamidronic acid (Pamidronate) may be needed. Please consult your doctor. Limited information is available on the use of Pamidronic acid (Pamidronate) in these patients. No dose adjustment is recommended in patients with mild to moderate liver disease.

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