Drug Interaction:
Bisphonates include- Alendronate, Etidronate, Pamidronate Refer Alendronate
In patients with hypercalcamia, pamidronate has been successfully combined with both calcitron and mitramycin to acceletate and potentiate the calciun lowering effect.
Indication:
Pagets disorder of the bone
Approved by (DCI) Drug Controller GENERAL - India For Marketing
(Ref- IDMA Publication)
Name of Drug Indications Date of Approval
Palmidronate Anti-cancer February 1995
Sodium
Patent Expiry Date of drugs (Ref - IDMA Publication)
Chemical Category Manufacturer/ US Patent
Ingredient- Marketer Expiration Date
Pamidronate Cancer/Oncolgy Novartis 29-07-2005
Sodium
Adverse Reaction:
Acute overdosage hypocalcaemia can occur and should be reversed by an infusion of calciun gluconate Severe or irreversible asymptotomatic pyrexia and acute-phase response may occur Thrombophlebitis in patients receiving repeated infusions Hypocalcaemia, hypophosphatemia and defective mineralisation
Contra-Indications:
History of allergy to phosphonates Special precautions Mothers receiving the drug should refrain from breast feeding. Avoid during pregnancy unless there are compelling reasons Can be used in elderly persons, provided the renal function is not severely impaired
Dosages/ Overdosage Etc:
Pagets disorder of the bone
Dosage-
Recommended dose is - 30mg daily 9over4 hr ) for 3 consecutive days .
Max toal dose - 360mg/course May repeat course when clinically indicated Max infusion rate- 60mg/hr Elderly- initiate with lower dosages
Patient Information:
Ref - USP PDI Vol II 17th Edition (1997)
PAMIDRONATE- Systemic
1.Allergies-
Tell your doctor if you have ever had any unusual or allergic reaction to
Pamidronate or etiodronate. Also tell your healthcare care professional
if you are allergic to any other substances such as foods. preservatives
or dyes.
2.Pregnancy-
Studies have not been done in humans. However, studies in rats
given higher doses of oral pamidronate have shown that the medicine
can decrease fertility, increase in length of pregnancy and cause
defects to baby rats.
3. Breast-feeding-
It is not known if pamidronate passes into breast milk.
4.Children-
Studies of this medicine has been done only in adult patients and
there is no specific information comparing use of pamidronate
in children with use in other age groups.
5.Older adults-
When pamidronate is given along with large amounts of fluids, older
people tend to retain the excess fluid.
6. Other medicines-
Tell your doctor if you are using any of the following -
Calcium containing prepartions or
Vitamin D - containing preparation- use with pamidronate
may keep pamidronate from working properly
7. Other medical problems-
Make sure you tell your doctor if you have any other medical problems
especially-
Heart problems - the increased amounnt of fluid may make this medicine
worse
kidney problems- pamidronate may build up in the blood stream
which may increase the chance of side effects
Pharmacology/ Pharmacokinetics:
Pharmacology
Bisphosphonates such as pamidronate inhibit the precipitation of calcium phosphate from clear solutions and block the transformation of amorphous calcium phosphate into hydroxyapitite. Pamidronate inhibit bone resorption. Although the main effect is on the osteoclast, there is evidence to suggest that osteoblastic cells mediate the inhibitory effects of bisphophonates on osteoclasts.
Pharmacokinetics:
The initial plasma half-life of intervenously administered opamidronate is short(< 1 hour) and the apparent plasma clearance is high. Substantial renal elimination occurs in the first 24 hours, with little detectable in urine thereafter. The terminal half-life of the drug is very long(many months). Metabolic elimination of pamidronate is not known to occur
Pregnancy and lactation:
Pregnancy:
Avoid during pregnancy unless there are compelling reasons
Lactation:
Mothers receiving the drug should refrain from breast feeding.
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