Pamidronate

Pamidronate refers to biophosphonate preparations for the correction of bone tissue metabolism, which affects the process of its mineralization and counteracts osteolysis. The international non-proprietary name is Disodium Pamidronate. Other trade names: Pamiredin, Pamidria, Pamirid, Pamifos, Pomigara, Armedia, etc.

[1], [2], [3], [4], [5], [6], [7]

Indications Pamidronate

Pamidronate is used to treat diseases associated with the pathological activation of osteoclasts that destroy bone tissue:

• bone metastases of cancer;
• hypercalcemia (increase in calcium in the blood plasma) oncological etiology;
• lesions of bones and hypercalcemia in myeloma;
• deforming osteitis (Paget's disease).

[8], [9]

Release form

The drug is available as a lyophilized dry substance or concentrate (in bottles of 15, 30, 60 and 90 mg) for the preparation of an injection solution.

[10], [11], [12], [13], [14]

Pharmacodynamics

Therapeutic effect Pamidronate provides its active substance - disodium pamidronate (a derivative of pamidronic acid). By the adsorption of calcium phosphate from the mineral and intercellular matrix of bone tissue containing calcium in the form of hydroxyapatite crystals, disodium pamidronate significantly slows the formation and dissolution of these crystals.

As a result, changes occur in the osteoid tissue: the formation of osteoclasts in the periosteum, the cells that destroy the bone tissue, is delayed. That is, the action of Pamidronate inhibits the bone resorption inherent in diseases with pathological destruction of the bones of the skeleton.

This helps to increase the number of osteoblasts and bone density, preventing pathological bone remodeling.

[15], [16], [17]

Pharmacokinetics

No more than 54% of Pamidronate after its introduction into the blood binds to plasma proteins; the half-life of blood is 27 hours. The rest of the active substance binds to hydroxyapatite crystals and is cumulated in the mineral matrix of bone tissue.

The drug is not subjected to biochemical transformation in the body and has no metabolites. Excretion of about a third of the drug occurs with urine within three days after infusion; the duration of excretion of disodium pamidronate from the liver and spleen is six months, and from the bone tissue - about 10 months (through the kidneys).

[18], [19], [20], [21], [22], [23], [24]

Dosing and administration

Pamidronate is used only with intravenous slow infusions. The maximum course dose of the drug is 90 mg, which can be administered single-time or for 2-4 consecutive days. The individual dosage, the schedule of administration and the duration of administration of the drug are determined by the attending physician, based on a specific diagnosis.

[29], [30], [31], [32], [33], [34], [35]

Use Pamidronate during pregnancy

Use during pregnancy and during lactation is contraindicated. The medicine is not prescribed for children under 16 years of age

Contraindications

The use of pamidronate is contraindicated with increased individual sensitivity to its active ingredient or other derivatives of bisphosphonic acids.

In addition, given the high likelihood of adverse effects, Pamidronate is not recommended for patients with severe forms of renal dysfunction (creatinine clearance below 30 ml / min.) And hypercalcemia.

[25]

Side effects Pamidronate

The use of this medication may cause side effects similar to those of influenza, as well as nausea, vomiting, abdominal pain and intestinal disturbances; skin rashes with itching, flushing; changes in blood composition; sleep disturbances, increased blood pressure; muscle and joint pain, etc.

Particular attention should be paid to controlling the calcium content of the blood in order to avoid hypo- or hypercalcemia.

[26], [27], [28]

Overdose

Overdosing of the drug leads to the development of hypocalcemia and the appearance of numbness of the skin, convulsive attacks and lowering blood pressure. The way to eliminate the symptoms of an overdose is by injecting calcium preparations.

[36], [37], [38], [39], [40], [41], [42], [43]

Interactions with other drugs

It is necessary to avoid the simultaneous use of Pamidronate and the hormonal drug calcitonin, as this leads to synergism of their action and increases the degree of decrease in the level of calcium in the blood.

The use of other biofosfonate preparations simultaneously with Pamidronate, as well as those that have toxic effects on the kidneys, is not recommended.

At the same time, there were no negative consequences of concurrent use of Pamidronate with antitumor drugs.

[44], [45], [46], [47]

Storage conditions

Pamidronate in an unopened vial should be stored at room temperature not exceeding + 28 ° C. The prepared solution should be stored at a temperature of + 2-8 ° C.

[48], [49]

Shelf life

Shelf life is 24 months (in the package), ready-made injection solution is suitable for use within 24 hours.

[50], [51], [52]