Names and pronunciation
(pam-i-drone′ate) P
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Drug reference
(pam-i-drone′ate) P
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Func. class.: Bone-resorption inhibi- tor, electrolyte modifier
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Chem. class.: Bisphosphonate
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ACTION: Inhibits bone resorption, apparently without inhibiting bone for- mation and mineralization; adsorbs cal- cium phosphate crystals in bone and may directly block the dissolution of hydroxy- apatite crystals of bone
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USES: Moderate to severe Paget’s disease, hypercalcemia, osteolytic bone metastases in breast cancer, patients with multiple myeloma
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Unlabeled uses: Osteogenesis imper- fecta, hyperparathyroidism
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CONTRAINDICATIONS: Preg nancy, hypersensitivity to bisphosphonates Precautions: Children, nursing moth- ers, renal dysfunction, poor dentition
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SIDE EFFECTS CNS: Fever, fatigue CV: Hypertension, atrial fibrillation EENT: Ocular pain, inflammation, vision impairment GI: Abdominal pain, anorexia, constipa- tion, nausea, vomiting, dyspepsia GU: Renal failure HEMA: Thrombocytopenia, anemia, leukopenia INTEG: Redness, swelling, induration, pain on palpation at site of catheter insertion META: Hypokalemia, hypomagnese mia, hypophosphatemia, hypocalce mia, hypothyroidism MS: Severe bone pain, myalgia, osteone- crosis of the jaw RESP: Coughing, dyspnea, upper respi- ratory tract infection SYST: Angioedema, anaphylaxis
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INTERACTIONS None known Drug/Lab Test Increase: creatinine Decrease: potassium, magnesium, phos- phate, calcium, WBC, platelets
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DOSAGE AND ROUTES Hypercalcemia of malignancy • Adult: IV INFUSION 60-90 mg as single dose for moderate hypercalce mia; 90 mg for severe hypercalcemia over 2-24 hr; dose should be diluted in 1000 mL 0.45% NaCl, 0.9% NaCl, or D5W; wait 7 days before 2nd course Osteolytic lesions • Adult: IV 90 mg/500 mL of D5W, 0.45% NaCl, or 0.9% NaCl given over 4 hr each mo (multiple myeloma) or over 2 hr q3-4wk (breast carcinoma) Paget’s disease • Adult: IV INFUSION 30 mg/day given over 4 hr × 3 days
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Available forms: Powder for inj 30, 90 mg/vial; inj 3, 6, 9 mg/mL
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Administer: IV route • Use saline hydration to produce 2000 mL/24 hr of urine output • Avoid diuretics before treatment • After reconstituting by adding 10 mL sterile water for inj to each vial (30 mg/10 mL or 90 mg/10 mL, depending on vial used); add to 1000 mL of sterile 0.45%, 0.9% NaCl, D5W, run over 2-24 hr (hy percalcemia); dilute reconstituted sol in 500 mL of 0.9% NaCl, 0.45% NaCl, or D5W, give over 4 hr (multiple myeloma, Paget’s disease); dilute reconstituted sol in 250 mL of 0.9% NaCl, 0.45% NaCl, or D5W; give over 2 hr (osteolytic bone metastases of breast cancer) • Do not mix with calcium-containing infusion sol such as Ringer’s sol • Monitor IV site for pain, redness • Store infusion sol up to 24 hr at room temperature • Reconstituted sol with sterile water may be refrigerated for ≤24 hr Y-site compatibilities: Acyclovir, alfentanil, allopurinol, amifostine, amikacin, amino- caproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, ampicillin, anidulafungin, atenolol, atracu- rium, azithromycin, aztreonam, bivaliru- din, bleomycin, bumetanide, buprenor- phine, butorphanol, CARBOplatin, carmustine, ceFAZolin, cefepime, cefoper- azone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproM- AZINE, cimetidine, ciprofloxacin, cisatra- curium, CISplatin, clindamycin, cyclophos- phamide, cycloSPORINE, cytarabine, dacarbazine, DAPTOmycin, dexametha- sone, dexmedetomidine, dexrazoxane, digoxin, diltiaZEM, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, DOXOrubicin, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etopo- side, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, fos- carnet, fosphenytoin, furosemide, gallium, ganciclovir, gatifloxacin, gemcitabine, gen- tamicin, glycopyrrolate, granisetron, halo- peridol, heparin, hetastarch 6%, hydrALA- ZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem-cilas- tatin, inamrinone, insulin (regular), iso- proterenol, ketorolac, labetalol, levoFLOX- acin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperi- dine, meropenem, mesna, metaraminol, methotrexate, methyldopate, methylPRED- NISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANTRONE, mivacu- rium, morphine, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, niCAR- dipine, nitroglycerin, nitroprusside, nor- epinephrine, octreotide, ondansetron, oxytocin, PACLitaxel, palonosetron, pan- curonium, PEMEtrexed, pentamidine, pen- tazocine, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, polymyxin B, potassium chloride/phosphates, procain- amide, prochlorperazine, promethazine, propranolol, quiNIDine, quinupristin-dal- fopristin, raNITIdine, remifentanil, rocuronium, sodium acetate/bicarbonate/ phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tenipo- side, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecy- cline, tirofiban, tobramycin, tolazoline, topotecan, trimethobenzamide, vancomy- cin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, vori- conazole, zidovudine
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Assess: • Hypocalcemia: nausea, vomiting, con- stipation, thirst, dysrhythmias, hypocal- cemia, paresthesia, twitching, laryngo- spasm, Chvostek’s sign, Trousseau’s sign; hypercalcemia: thirst, nausea, vomit- ing, dysrhythmias • Dehydration/hypovolemia: should be corrected during treatment of hypercal- cemia, before therapy, maintain adequate urine output • Labs: Monitor WBCs, platelets, electro- lytes, creatinine, BUN, HB/Hct before beginning treatment • Dental health: optimal dental health should be obtained before treatment with this product; cover with antiinfectives for dental extractions • Temperature may be elevated during the first 3 days after a dose; risk of fever increases as dose increases • Renal disease: max 90-mg single dose, longer infusions >2 hr may increase risk for renal toxicity • Bone pain: use analgesics • I&O, check for fluid overload, edema, crackles, increased B/P; BUN, creatinine, electrolytes (calcium, potassium, magne- sium) • Pregnancy/breastfeeding: do not use in pregnancy/breastfeeding; use contra- ception
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Evaluate: • Therapeutic response: decreased cal- cium levels P Teach patient/family • To notify prescriber if pregnancy is planned or suspected; to use contracep- tion while taking this product • To report hypercalcemic relapse: nau- sea, vomiting, bone pain, thirst; unusual muscle twitching, muscle spasms; severe diarrhea, constipation • To continue with dietary recommenda- tions, including calcium and vit D • To obtain analgesic from provider for bone pain • That small, frequent meals may help if nausea, vomiting occur • To report ocular symptoms to prescriber: blurred vision, edema, inflammation • To maintain good oral hygiene; to get regular dental checkups • To report dental or jaw pain to pre- scriber
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CLINICAL CONSIDERATIONS
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PHARMACOKINETICS Rapidly cleared from circulation and taken up mainly by bones, primarily in areas of high bone turnover; elimi- nated primarily by kidneys; half-life 21-35 hr, terminal half-life in bone is 300 days
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• Adult: IV INFUSION 60-90 mg as single dose for moderate hypercalce mia; 90 mg for severe hypercalcemia over 2-24 hr; dose should be diluted in 1000 mL 0.45% NaCl, 0.9% NaCl, or D5W; wait 7 days before 2nd course Osteolytic lesions
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• Adult: IV 90 mg/500 mL of D5W, 0.45% NaCl, or 0.9% NaCl given over 4 hr each mo (multiple myeloma) or over 2 hr q3-4wk (breast carcinoma) Paget’s disease
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• Adult: IV INFUSION 30 mg/day given over 4 hr × 3 days
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