Pamidronic acid

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[edit] BRAND NAMES

[edit] STRUCTURE

Pamidronic acid.jpg

[edit] MECHANISM OF ACTION

Osteoblasts make bone, while osteoclasts resorb or take away bone. Pamidronate is a bisphosphonate, it has no direct effect on bone formation, but it stops the action of the osteoclasts, the cells that are involved in breaking down the bone tissue.
Pamidronate is internalized by osteoclasts, causing disruption of osteoclast cytoskeleton, loss of the ruffled border, and the subsequent loss of ability to resorb bone.

By preventing fractures Pamidronate is useful in cancer patients with bone metastases. Patients with tumours can also have high levels of calcium in their blood, released from the bones, Pamidronate helps to reduce hypercalcemia as well.

[edit] INDICATIONS

  • Treatment of Paget’s disease of bone in men and women
  • pamidronate in conjunction with adequate hydrationis indicated for the treatment of moderate or severe hypercalcemia in tumor-induced bone disease
  • Patients with multiple myeloma and patients with documented bone metastases from solid tumors, in conjunction with standard antineoplastic therapy.

[edit] DOSAGE

  • Treatment of Paget’s disease of bone in men and women: 30 mg daily, administered as a 4-hour infusion on 3 consecutive days for a total dose of 90 mg
  • Hypercalcemia in tumor-induced bone disease:
    • Moderate Hypercalcemia: 60 to 90 mg given as a single dose by intravenous infusion over 2 to 24 hours. Longer infusions (i.e., >2 hours) may reduce the risk for renal toxicity, particularly in patients with preexisting renal insufficiency.
    • Severe Hypercalcemia : 90 mg given as a single dose by intravenous infusion over 2 to 24 hours. Longer infusions (i.e., >2 hours) may reduce the risk for renal toxicity, particularly in patients with preexisting renal insufficiency.
  • Osteolytic Bone Lesions of Multiple Myeloma: 90 mg administered as a 4-hour infusion given on a monthly basis. The optimal duration of therapy is not yet known, however, in a study of patients with myeloma, final analysis after 21 months demonstrated overall benefits
  • Osteolytic Bone Metastases of Breast Cancer: The recommended dose of Aredia in patients with osteolytic bone metastases is 90 mg administered over a 2-hour infusion given every 3-4 weeks. The optimal duration of therapy is not known, however, in two breast cancer studies, final analyses performed after 24 months of therapy demonstrated overall benefits

[edit] CONTRAINDICATIONS

  • Hypersensitivity to Pamidronate

[edit] PRECAUTIONS

  • Bisphosphonates, including Pamidronate, have been associated with renal toxicity manifested as deterioration of renal function and potential renal failure, therefore, single doses of Pamidronate should not exceed 90 mg.

[edit] INTERACTIONS

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category D (US). Pamidronate may cause fetal harm when administered to a pregnant woman. In reproductive studies in rats and rabbits, pamidronate doses equivalent to 0.6 to 8.3 times the highest human recommended dose resulted in maternal toxicity and embryo/fetal effects. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, apprise the patient of the potential hazard to the fetus

[edit] SIDE EFFECTS

Most common adverse reactions are flu-like symptoms, fever and local soft-tissue symptoms (redness, swelling or induration and pain on palpation) at the site of catheter insertion.

[edit] RELATED LINKS

How osteoporosis develops

[edit] BIBLIOGRAPHY

[edit] REFERENCES