Usual Adult Dose for Hypercalcemia of Malignancy

Moderate Hypercalcemia (corrected serum calcium of approximately 12 mg/dL to 13.5 mg/dL):

• 60 to 90 mg single intravenous infusion over 2 to 24 hours

Severe Hypercalcemia (corrected serum calcium greater than 13.5 mg/dL):

• 90 mg single intravenous infusion over 2 to 24 hours

Retreatment:

• Patients who show complete or partial response initially may be retreated if serum calcium does not return to normal or remain normal after initial treatment.
• A minimum of 7 days between treatments is recommended to allow for full response to the initial dose.
• The dose and manner of retreatment is identical to that of the initial therapy.

Use: Treatment of moderate or severe hypercalcemia associated with malignancy, with or without bone metastases

Usual Adult Dose for Paget's Disease

Moderate to severe Paget's Disease of the Bone:

• 30 mg intravenous infusion every day, administered over 4 hours for 3 consecutive days, for a total dose of 90 mg

Comments: When clinically indicated, retreat patients at the dose of initial therapy.

Usual Adult Dose for Osteolytic Bone Lesions of Multiple Myeloma

• 90 mg intravenous infusion administered over 2 hours every 4 weeks

Duration of therapy: 24 months of therapy demonstrated overall benefits

Comments:

• Patients with marked Bence-Jones proteinuria and dehydration should receive adequate hydration prior to infusion of this drug.
• Limited information is available on the use of pamidronate disodium in multiple myeloma patients with a serum creatinine greater than or equal to 3 mg/dL.

Usual Adult Dose for Osteolytic Bone Metastases of Breast Cancer

• 90 mg intravenous infusion administered over 2 hours every 3 to 4 weeks

Duration of therapy: 24 months of therapy demonstrated overall benefits

Renal Dose Adjustments

Mild to moderate renal dysfunction (CrCl 30 to 90 mL/min): No adjustment recommended.
Severe renal dysfunction (CrCl less than 30 mL/min): Limited existing data.

Renal Deterioration in Osteolytic Bone Metastases of Breast Cancer and Osteolytic Lesions of Multiple Myeloma:

• Patients with normal baseline creatinine experienced an increase of 0.5 mg/dL.
• Patients with abnormal baseline creatinine experienced an increase of 1 mg/dL.
• Treatment with this drug was resumed only when the creatinine returned to within 10% of the baseline value.

Comments:

• Promptly initiate vigorous saline hydration along with this drug therapy; if possible, the urine output should be about 2 L/day throughout treatment.
• Longer infusions (i.e., greater than 2 hours) may reduce the risk for renal toxicity, particularly in patients with preexisting renal insufficiency/impairment.
• Asses serum creatinine prior to each treatment; withhold treatment for renal deterioration.

Liver Dose Adjustments

No adjustment recommended.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• For IV infusion administration only.
• Should not be mixed with calcium-containing infusion solutions.
• Administer as a single intravenous solution and infuse using an intravenous line for this drug alone.
• Visual inspection for particulate matter and discoloration prior to administration is recommended.

Storage requirements: The manufacturer product information should be consulted.

Reconstitution/preparation techniques: The manufacturer product information should be consulted.

Limitations of Use:
The safety and efficacy of this drug in the treatment of hypercalcemia associated with hyperparathyroidism or with other non-tumor-related conditions has not been established.

Monitoring: Serum levels of calcium, phosphate, magnesium, and potassium, following initiation of therapy

Patient advice:

• Report any thigh, hip, or groin pain; these symptoms should be evaluated for an incomplete femur fracture.
• Avoid invasive dental procedures, if possible; maintain good dental hygiene and routine dental care.