Pamidronate (as disodium) Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Unlicensed preparation
See under 'Dose' for adjustments required in renal impairment
Patients must be adequately hydrated^{(ref 1)}
Osteonecrosis of the jaw has been reported predominantly in patients with cancer receiving treatment regimens including bisphosphonates

Disodium pamidronate

Already in solution

Dilute further prior to administration

Sodium chloride 0.9% or Glucose 5%

Intermittent intravenous infusion (administer using an electronically controlled infusion device)

The concentration in the infusion solution should not exceed 90mg/250mL - this is usually given over two hours ^{(ref 1)}
Maximum rate is 60mg per hour (20mg per hour if eGFR less than 50mL/minute/1.73m²) ^{(ref 2)}
Multiple myeloma and Tumour-induced hypercalcaemia: should not exceed 90mg in 500mL over four hours^{(ref 1)}

Osteolytic lesions and bone pain in bone metastases associated with breast cancer or multiple myeloma

Give 90mg as a single dose, every four weeks
The dose may be administered at three-weekly intervals to coincide with chemotherapy if desired in the treatment of breast cancer

Tumour-induced hypercalcaemia

Patients with tumour-induced hypercalcaemia should be rehydrated with sodium chloride 0.9% PRIOR to treatment
The total dose per treatment course depends on the patient's initial serum calcium level
The ranges given apply to both corrected and uncorrected calcium values

Initial serum calcium (millimol/L)	Recommended total dose
up to 3	15 to 30mg
3 to 3.5	30 to 60mg
3.5 to 4	60 to 90mg
Greater than 4	90mg

The total dose may be administered either as a single infusion or in divided doses over two to four consecutive days
The maximum dose per treatment course is 90mg for both initial and repeat courses
Titrate to response - a significant decrease in serum calcium is generally observed 24 to 48 hours after administration, and normalisation is usually achieved within 3 to 7 days
If normocalcaemia is not achieved within this time, a further dose may be considered
The duration of the response may vary from patient to patient, and treatment can be repeated whenever hypercalcaemia recurs
Clinical experience to date suggests that pamidronate may be less effective as the number of treatments increases

Pagets disease of bone ^{(ref 3)}

Usual dose: 60mg every two weeks for three doses, or 30mg weekly for six weeks to total dose of 180mg
If unit doses of 60mg are being used, it is recommended that treatment be started with an initial dose of 30mg to minimise side effects.i.e. 30mg, 60mg, 60mg, 60mg (total dose 210mg)
Repeated doses up to a total of 360mg (in divided doses, each of 60mg) may be required within any 6-month period

Renal impairment

Pamidronate should not be administered to patients with severe renal impairment (eGFR less than 30ml/min/1.73m²), unless in life-threatening tumour-induced hypercalcaemia where the benefit outweighs the potential risks.
The Renal drug database provides some guidance on doses for patients with renal impairment - no dosage adjustment required if creatinine clearance is greater than 30ml per minute. Where creatinine clearance is less than 30ml per minute- the dose should be 60mg if serum calcium is greater than 4mmol/L, and 30mg if serum calcium is less than 4mmol/L ^{(ref 2)}
A maximum rate of 20mg/hour should not be exceeded in patients with renal impairment ^{(ref 2)}
As pamidronate has been associated with renal toxicity, serum creatinine should be checked prior to each dose of the drug

Hepatic impairment

Pamidronate should be used with caution in patients with severe hepatic impairment

Renal function, serum electrolytes, calcium, magnesium and phosphate should be monitored following initiation of therapy with pamidronate
Monitor serum creatinine prior to each dose of pamidronate

SPC (Mylan) December 2015

SPC (Hospira UK) February 2024

1: Injectable Medicines Administration Guide Medusa downloaded 18/06/2025

2: Renal drug database accessed online 18/06/2025

3. BNF accessed online via medicinescomplete 18/06/2025

Bisphosphonate