Pamidronate Disease Interactions

Standard hypercalcemia- related metabolic parameters, such as serum levels of calcium, phosphate, magnesium, and potassium, should be carefully monitored following initiation of therapy with pamidronate. Cases of asymptomatic hypophosphatemia, hypokalemia, hypomagnesemia, and hypocalcemia have been reported. Additionally, some rare cases of symptomatic hypocalcemia (including tetany), have been observed. Patients with a history of thyroid surgery may have relative hypoparathyroidism that may predispose to hypocalcemia with pamidronate.

Pamidronate has been associated with renal toxicity manifested as deterioration of renal function, and potential renal failure. Due to this risk, single doses of pamidronate disodium should not exceed 90 mg (see manufacturers instructions for appropriate infusion durations). Patients who receive pamidronate should have serum creatinine assessed prior to each treatment. Pamidronate is primarily eliminated intact by the kidney, and the risk of renal adverse reactions may be greater in patients with renal impairment. Caution and regular monitoring (prior to each treatment) is recommended.