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Pronunciation
(pa mi DROE nate)
Generic Available (U.S.)
Yes
Index Terms
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Use: Labeled Indications
Treatment of moderate or severe hypercalcemia associated with malignancy (in conjunction with adequate hydration) with or without bone metastases; treatment of osteolytic bone lesions associated with multiple myeloma or metastatic breast cancer; moderate-to-severe Paget's disease of bone
Use: Unlabeled/Investigational
Treatment of osteogenesis imperfecta; treatment of symptomatic bone metastases of thyroid cancer; prevention of bone loss associated with androgen deprivation treatment in prostate cancer
Pregnancy Risk Factor
D
Pregnancy Considerations
Pamidronate has been shown to cross the placenta and cause nonteratogenic embryo/fetal effects in animals. There are no adequate and well-controlled studies in pregnant women; manufacturer states pamidronate should not be used in pregnancy. Based on limited case reports, serum calcium levels in the newborn may be altered if pamidronate is administered during pregnancy. Bisphosphonates are incorporated into the bone matrix and gradually released over time. Theoretically, there may be a risk of fetal harm when pregnancy follows the completion of therapy. Women of childbearing potential should be advised to use effective contraception and avoid becoming pregnant during therapy.
Lactation
Excretion in breast milk unknown/use caution
Contraindications
Hypersensitivity to pamidronate, other bisphosphonates, or any component of the formulation
Warnings/Precautions
Concerns related to adverse effects:
• Musculoskeletal pain: Infrequently, severe (and occasionally debilitating) bone, joint, and/or muscle pain have been reported during bisphosphonate treatment. The onset of pain ranged from a single day to several months. Consider discontinuing therapy in patients who experience severe symptoms; symptoms usually resolve upon discontinuation. Some patients experienced recurrence when rechallenged with same drug or another bisphosphonate; avoid use in patients with a history of these symptoms in association with bisphosphonate therapy.
• Electrolyte abnormalities: Use has been associated with asymptomatic electrolyte abnormalities (including hypophosphatemia, hypokalemia, hypomagnesemia, and hypocalcemia). Rare cases of symptomatic hypocalcemia, including tetany have been reported.
• Myelosuppression: Patients with pre-existing anemia, leukopenia, or thrombocytopenia should be closely monitored during the first 2 weeks of treatment.
• Osteonecrosis of the jaw (ONJ): ONJ has been reported in patients receiving bisphosphonates. Risk factors include invasive dental procedures (eg, tooth extraction, dental implants, boney surgery); a diagnosis of cancer, with concomitant chemotherapy, radiotherapy, or corticosteroids; poor oral hygiene, ill-fitting dentures; and comorbid disorders (anemia, coagulopathy, infection, pre-existing dental disease). Most reported cases occurred after I.V. bisphosphonate therapy; however, cases have been reported following oral therapy. A dental exam and preventative dentistry should be performed prior to placing patients with risk factors on chronic bisphosphonate therapy. The manufacturer's labeling states that discontinuing bisphosphonates in patients requiring invasive dental procedures reduces the risk of ONJ. However, other experts suggest that there is no evidence that discontinuing therapy reduces the risk of developing ONJ (Assael, 2009). The benefit/risk must be assessed by the treating physician and/or dentist/surgeon prior to any invasive dental procedure. Patients developing ONJ while on bisphosphonates should receive care by an oral surgeon.
• Renal deterioration: Single pamidronate doses should not exceed 90 mg. Initial or single doses have been associated with renal deterioration, progressing to renal failure and dialysis. Glomerulosclerosis (focal segmental) with or without nephrotic syndrome has also been reported. Longer infusion times (>2 hours) may reduce the risk for renal toxicity, especially in patients with pre-existing renal insufficiency. Withhold pamidronate treatment (until renal function returns to baseline) in patients with evidence of renal deterioration.
Disease-related concerns:
• Hypercalcemia of malignancy: Adequate hydration is required during treatment (urine output ~2 L/day); avoid overhydration, especially in patients with heart failure.
• Hypoparathyroidism: Use caution with a history of thyroid surgery; patients may have relative hypoparathyroidism, predisposing them to pamidronate-related hypocalcemia.
• Multiple myeloma: According to the American Society of Clinical Oncology (ASCO) guidelines for bisphosphonates in multiple myeloma, treatment with pamidronate is not recommended for asymptomatic (smoldering) or indolent myeloma or with solitary plasmacytoma (Kyle, 2007). The National Comprehensive Cancer Network® (NCCN) multiple myeloma guidelines (v.1.2011) also do not recommend pamidronate use in stage 1 or smoldering disease, unless part of a clinical trial.
• Renal impairment: Patients with serum creatinine >3 mg/dL were not studied in clinical trials; limited data are available in patients with Clcr <30 mL/minute. Evaluate serum creatinine prior to each treatment. For the treatment of bone metastases, use is not recommended in patients with severe renal impairment. With indications other than bone metastases, use clinical judgment to determine if benefits outweigh potential risks in patients with renal impairment.
Special populations:
• Women of childbearing potential: Women of childbearing potential should be advised to use effective contraception and avoid becoming pregnant during therapy.
Adverse Reactions
Note: Actual percentages may vary by indication; treatment for multiple myeloma is associated with higher percentage.
>10%:
Central nervous system: Fever (18% to 39%; transient), fatigue (≤37%), headache (≤26%), insomnia (≤22%)
Endocrine & metabolic: Hypophosphatemia (≤18%), hypokalemia (4% to 18%), hypomagnesemia (4% to 12%), hypocalcemia (≤12%)
Gastrointestinal: Nausea (≤54%), vomiting (≤36%), anorexia (≤26%), abdominal pain (≤23%), dyspepsia (≤23%)
Genitourinary: Urinary tract infection (≤19%)
Hematologic: Anemia (≤43%), granulocytopenia (≤20%)
Local: Infusion site reaction (≤18%; includes induration, pain, redness and swelling)
Neuromuscular & skeletal: Myalgia (≤26%), weakness (≤22%), arthralgia (≤14%), osteonecrosis of the jaw (cancer patients: 1% to 11%)
Renal: Serum creatinine increased (≤19%)
Respiratory: Dyspnea (≤30%), cough (≤26%), upper respiratory tract infection (≤24%), sinusitis (≤16%), pleural effusion (≤11%)
1% to 10%:
Cardiovascular: Atrial fibrillation (≤6%), hypertension (≤6%), syncope (≤6%), tachycardia (≤6%), atrial flutter (≤1%), cardiac failure (≤1%), edema (≤1%)
Central nervous system: Somnolence (≤6%), psychosis (≤4%), seizure (≤2%)
Endocrine & metabolic: Hypothyroidism (≤6%)
Gastrointestinal: Constipation (≤6%), gastrointestinal hemorrhage (≤6%), diarrhea (≤1%), stomatitis (≤1%)
Hematologic: Leukopenia (≤4%), neutropenia (≤1%), thrombocytopenia (≤1%)
Neuromuscular & skeletal: Back pain, bone pain
Renal: Uremia (≤4%)
Respiratory: Rales (≤6%), rhinitis (≤6%)
Miscellaneous: Moniliasis (≤6%)
<1%, postmarketing, and/or case reports: Acute renal failure, adult respiratory distress syndrome, allergic reaction, anaphylactic shock, angioedema, bronchospasm, CHF, confusion, conjunctivitis, electrolyte/mineral abnormality, episcleritis, fluid overload, flu-like syndrome, focal segmental glomerulosclerosis (including collapsing variant), hallucinations (visual), hematuria, herpes virus reactivation, hyperkalemia, hypernatremia, hypotension, injection site phlebitis/thrombophlebitis, interstitial pneumonitis, iridocyclitis, iritis, joint and/or muscle pain (sometimes severe and/or incapacitating), left ventricular failure, lymphocytopenia, malaise, nephrotic syndrome, orbital inflammation, osteonecrosis (other than jaw), paresthesia, pruritus, rash, renal deterioration, renal failure, scleritis, tetany, uveitis, xanthopsia
Metabolism/Transport Effects
None known.
Drug Interactions
Aminoglycosides: May enhance the hypocalcemic effect of Bisphosphonate Derivatives. Risk C: Monitor therapy
Deferasirox: Bisphosphonate Derivatives may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern. Risk C: Monitor therapy
Phosphate Supplements: Bisphosphonate Derivatives may enhance the hypocalcemic effect of Phosphate Supplements. Risk C: Monitor therapy
Proton Pump Inhibitors: May diminish the therapeutic effect of Bisphosphonate Derivatives. Risk C: Monitor therapy
Thalidomide: May enhance the nephrotoxic effect of Pamidronate. Risk C: Monitor therapy
Storage
Powder for reconstitution: Store below 30°C (86°F). The reconstituted solution is stable for 24 hours stored under refrigeration at 2°C to 8°C (36°F to 46°F).
Solution for injection: Store at 20°C to 25°C (68°F to 77°F).
Pamidronate solution for infusion is stable at room temperature for up to 24 hours.
Reconstitution
Powder for injection: Reconstitute by adding 10 mL of SWFI to each vial of lyophilized pamidronate disodium powder, the resulting solution will be 30 mg/10 mL or 90 mg/10 mL.
Pamidronate may be further diluted in 250-1000 mL of 0.45% or 0.9% sodium chloride or 5% dextrose. (The manufacturer recommends dilution in 1000 mL for hypercalcemia of malignancy, 500 mL for Paget's disease and bone metastases of myeloma, and 250 mL for bone metastases of breast cancer.)
Compatibility
Stable in D5W, NS; incompatible with calcium-containing infusion solutions such as Ringer's injection.
Mechanism of Action
A bisphosphonate which inhibits bone resorption via actions on osteoclasts and/or on osteoclast precursors. Does not appear to produce any significant effects on renal tubular calcium handling and is poorly absorbed following oral administration (high oral doses have been reported effective); therefore, I.V. therapy is preferred.
Pharmacodynamics/Kinetics
Onset of action: 24-48 hours
Peak effect: Maximum: 5-7 days
Absorption: Poor; pharmacokinetic studies lacking
Metabolism: Not metabolized
Half-life elimination: 21-35 hours
Excretion: Biphasic; urine (30% to 62% as unchanged drug; lower in patients with renal dysfunction) within 120 hours
Dosage
Note: Single doses should not exceed 90 mg. I.V.: Adults:
Hypercalcemia of malignancy:
Moderate cancer-related hypercalcemia (corrected serum calcium: 12-13.5 mg/dL): 60-90 mg, as a single dose over 2-24 hours
Severe cancer-related hypercalcemia (corrected serum calcium: >13.5 mg/dL): 90 mg, as a single dose over 2-24 hours
Retreatment in patients who show an initial complete or partial response (allow at least 7 days to elapse prior to retreatment): May retreat at the same dose if serum calcium does not return to normal or does not remain normal after initial treatment.
Multiple myeloma, osteolytic bone lesions: 90 mg over 4 hours monthly
Lytic disease: American Society of Clinical Oncology (ASCO) guidelines: 90 mg over at least 2 hours every 3-4 weeks for 2 years; discontinue after 2 years in patients with responsive and/or stable disease; resume therapy with new-onset skeletal-related events (Kyle, 2007)
Newly-diagnosed, symptomatic (unlabeled dose): 30 mg over 2.5 hours monthly for at least 3 years (Gimsing, 2010)
Breast cancer, osteolytic bone metastases: 90 mg over 2 hours every 3-4 weeks
Paget's disease (moderate-to-severe): 30 mg over 4 hours daily for 3 consecutive days (total dose = 90 mg); may retreat at initial dose if clinically indicated
Prevention of androgen deprivation-induced osteoporosis (unlabeled use): 60 mg over 2 hours every 3 months (Smith, 2001) or 90 mg as a single dose over 3-4 hours (Diamond, 2001)
Elderly: Begin at lower end of adult dosing range.
Dosing adjustment in renal impairment: Patients with serum creatinine >3 mg/dL were excluded from clinical trials; there are only limited pharmacokinetic data in patients with Clcr <30 mL/minute.
Manufacturer recommends the following guidelines:
Treatment of bone metastases: Use is not recommended in patients with severe renal impairment.
Renal impairment in indications other than bone metastases: Use clinical judgment to determine if benefits outweigh potential risks.
Multiple myeloma: American Society of Clinical Oncology (ASCO) guidelines (Kyle, 2007):
Severe renal impairment (serum creatinine >3 mg/dL or Clcr <30 mL/minute) and extensive bone disease: 90 mg over 4-6 hours. However, a reduced initial dose should be considered if renal impairment was pre-existing.
Albuminuria >500 mg/24 hours (unexplained): Withhold dose until returns to baseline, then recheck every 3-4 weeks; consider reinitiating at a dose not to exceed 90 mg every 4 weeks and with a longer infusion time of at least 4 hours
Dosing adjustment in renal toxicity: In patients with bone metastases, treatment should be withheld for deterioration in renal function (increase of serum creatinine ≥0.5 mg/dL in patients with normal baseline or ≥1.0 mg/dL in patients with abnormal baseline). Resumption of therapy may be considered when serum creatinine returns to within 10% of baseline.
Dosage adjustment in hepatic impairment: No adjustment required in patients with mild-to-moderate hepatic impairment; not studied in patients with severe hepatic impairment.
Administration: I.V.
Infusion rate varies by indication. Longer infusion times (>2 hours) may reduce the risk for renal toxicity, especially in patients with pre-existing renal insufficiency. The manufacturer recommends infusing over 2-24 hours for hypercalcemia of malignancy; over 2 hours for osteolytic bone lesions with metastatic breast cancer; and over 4 hours for Paget's disease and for osteolytic bone lesions with multiple myeloma. The ASCO guidelines for bisphosphonate use in multiple myeloma recommend infusing pamidronate over at least 2 hours; if therapy is withheld due to renal toxicity, infuse over at least 4 hours upon reintroduction of treatment after renal recovery.
Administration: I.V. Detail
pH: 6-7.4
Monitoring Parameters
Serum creatinine (prior to each treatment); serum electrolytes, including calcium, phosphate, magnesium, and potassium; CBC with differential; monitor for hypocalcemia for at least 2 weeks after therapy; dental exam and preventative dentistry prior to therapy for patients at risk of osteonecrosis, including all cancer patients; patients with pre-existing anemia, leukopenia, or thrombocytopenia should be closely monitored during the first 2 weeks of treatment; in addition, monitor urine albumin every 3-6 months in multiple myeloma patients
Reference Range
Calcium (total): Adults: 9.0-11.0 mg/dL (SI: 2.05-2.54 mmol/L), may slightly decrease with aging; Phosphorus: 2.5-4.5 mg/dL (SI: 0.81-1.45 mmol/L)
Test Interactions
Bisphosphonates may interfere with diagnostic imaging agents such as technetium-99m-diphosphonate in bone scans.
Dietary Considerations
Multiple myeloma or metastatic bone lesions from solid tumors or Paget's disease: Take adequate daily calcium and vitamin D supplement (if patient is not hypercalcemic).
Patient Education
Patients should be aware that a dental exam and any needed dental work should be completed before starting this medication. Patients need to understand the importance of good oral hygiene throughout treatment, especially if they are receiving chemotherapy, radiation therapy, or both. Report persistent muscle or bone pain or pain in mouth, jaws, or teeth.
Geriatric Considerations
The elderly are frequently treated long-term for osteoporosis. Elderly patients should be advised to report any lower extremity, jaw (osteonecrosis), or muscle pain that cannot be explained or lasts longer than 2 weeks. Additionally, elderly often receive concomitant diuretic therapy and therefore their electrolyte status (eg, calcium, phosphate) should be periodically evaluated.
Additional Information
Oncology Comment:
Metastatic breast cancer: The American Society of Clinical Oncology (ASCO) updated guidelines on the role of bone-modifying agents (BMAs) in the prevention and treatment of skeletal-related events for metastatic breast cancer patients (Van Poznak, 2011). The guidelines recommend initiating a BMA (denosumab, pamidronate, zoledronic acid) in patients with metastatic breast cancer to the bone. There is currently no literature indicating the superiority of one particular BMA. Optimal duration is not defined; however, the guidelines recommend continuing therapy until substantial decline in patient's performance status. In patients with normal Clcr (>60 mL/minute), no dosage/interval/infusion rate changes for pamidronate or zoledronic acid are necessary. For patients with Clcr <30 mL/minute, pamidronate and zoledronic acid are not recommended. While no renal dose adjustments are recommended for denosumab, close monitoring is advised for risk of hypocalcemia in patients with Clcr <30 mL/minute or on dialysis. The ASCO guidelines are in alignment with package insert guidelines for dosing, renal dose adjustments, infusion times, prevention and management of osteonecrosis of the jaw, and monitoring of laboratory parameter recommendations. BMAs are not the first-line therapy for pain. BMAs are to be used as adjunctive therapy for cancer-related bone pain associated with bone metastasis, demonstrating a modest pain control benefit. BMAs should be used in conjunction with agents such as NSAIDs, opioid and nonopioid analgesics, corticosteroids, radiation/surgery, and interventional procedures.
Multiple myeloma: The American Society of Clinical Oncology (ASCO) has also published guidelines on the use of bisphosphonates for prevention and treatment of bone disease in multiple myeloma (Kyle, 2007). Pamidronate or zoledronic acid use is recommended in multiple myeloma patients with lytic bone destruction or compression spine fracture from osteopenia. Clodronate (not available in the U.S.; available in Canada), administered orally or I.V., is an alternative treatment. The use of the bisphosphonates pamidronate and zoledronic acid may be considered in patients with pain secondary to osteolytic disease, adjunct therapy to stabilize fractures or impending fractures, and I.V. bisphosphonates for multiple myeloma patients with osteopenia but no radiographic evidence of lytic bone disease. Bisphosphonates are not recommended in patients with solitary plasmacytoma, smoldering (asymptomatic) or indolent myeloma, or monoclonal gammopathy of undetermined significance. The guidelines recommend monthly treatment for a period of 2 years. At that time, physicians need to consider discontinuing in responsive and stable patients, and reinitiate if a new-onset skeletal-related event occurs. The ASCO guidelines are in alignment with package insert guidelines for dosing, renal dose adjustments, infusion times, prevention and management of osteonecrosis of the jaw, and monitoring of laboratory parameter recommendations. The guidelines also recommend in patients with extensive bone disease with existing severe renal disease (a serum creatinine >3 mg/dL or Clcr <30 mL/minute) pamidronate at a dose of 90 mg over 4-6 hours (unless pre-existing renal disease in which a reduced initial dose should be considered). ASCO also recommends monitoring for albuminuria every 3-6 months. In patients with unexplained albuminuria >500 mg/24 hours, withhold the dose until level returns to baseline, then recheck every 3-4 weeks. Pamidronate may be reinitiated at a dose not to exceed 90 mg every 4 weeks with a longer infusion time of at least 4 hours.
Dental Health: Effects on Dental Treatment
Osteonecrosis of the jaw (ONJ), generally associated with local infection and/or tooth extraction and often with delayed healing, has been reported in patients taking bisphosphonates. Symptoms included nonhealing extraction socket or an exposed jawbone. Most reported cases of bisphosphonate-associated osteonecrosis have been in cancer patients treated with intravenous bisphosphonates. However, some have occurred in patients with postmenopausal osteoporosis taking oral bisphosphonates. Dental surgery, particularly tooth extraction, may increase the risk for ONJ. Patients who develop ONJ while on bisphosphonate therapy should receive care by an oral surgeon. See Dental Health Professional Considerations.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Dental Comment
The American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws, 2009 update, stated that I.V. bisphosphonate exposure in the setting of managing malignancy remains the major risk factor for the development of ONJ. After reviewing case series, case-controlled studies, and cohort studies, the estimates of the cumulative incidence of I.V. bisphosphonate-associated ONJ ranges from 0.8% to 12%.
Two reports have attempted to assess more accurately the percent of cancer patients developing ONJ after bisphosphonate treatment. Maerevoet et al, reported that among 194 patients treated with Zometa® every 3-4 weeks, nine developed ONJ. Before receiving Zometa®, six had received Aredia® 90 mg every 3-4 weeks. The median duration of treatment with Aredia® was 39 months and for Zometa® 18 months. The incidence of ONJ in these patients was calculated to be 4.6%. Durie et al, described the results of a survey by the International Myeloma Foundation in 2004 to assess the risk factors of ONJ. Out of 1203 respondents, 904 had myeloma and 299 had breast cancer. Of the myeloma patients, 62 developed ONJ and 54 had suspicious findings. Of the breast cancer patients, 13 had ONJ and 23 had suspicious findings. The total number of cases of either ONJ or suspicious findings was 152. ONJ developed in 10% of 211 patients receiving Zometa® compared to 4% of 413 receiving Aredia®. The mean time to onset of ONJ among patients taking Zometa® was 18 months; the mean time to onset after Aredia® was 6 years. It should be noted that an early report by authors from Novartis Pharmaceuticals Corporation stressed that Aredia® and Zometa® had been used in 2.5 million patients world wide and reports of ONJ during their extensive use had been rare (Tarassoff, 2003). In addition, these authors stated that review of the reported cases revealed multiple risk factors for avascular necrosis. McMahon et al, followed up with a report that, along with other factors, bisphosphonates are additional stressors of bone health that can tip the balance to osteonecrosis. They suggested that the prevention of ONJ should be stressed such as the elimination of chronic dental infections prior to chemotherapy and bisphosphonate use in cancer patients.
Mental Health: Effects on Mental Status
May cause drowsiness
Mental Health: Effects on Psychiatric Treatment
May rarely cause leukopenia; use caution with clozapine and carbamazepine. Bisphosphonates, including pamidronate, have been associated with renal toxicity manifested as deterioration of renal function and potential renal failure. Use caution in patients receiving lithium.
Nursing: Physical Assessment/Monitoring
A thorough oral exam should be done prior to initiating any therapy. Patients need to be instructed on maintaining good oral hygiene throughout treatment. It is important to know that if a patient is undergoing chemotherapy, radiation therapy, or a combination of both, they are at a higher risk for osteonecrosis of the jaw.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Injection, powder for reconstitution, as disodium: 30 mg, 90 mg
Aredia®: 30 mg, 90 mg [DSC]
Injection, solution, as disodium: 3 mg/mL (10 mL); 6 mg/mL (10 mL); 9 mg/mL (10 mL)
Injection, solution, as disodium [preservative free]: 3 mg/mL (10 mL); 9 mg/mL (10 mL)
References
American Dental Association Council on Scientific Affairs, “Dental Management of Patients Receiving Oral Bisphosphonate Therapy,” JADA, 2006, 137(8):1144-50. Available at http://jada.ada.org/cgi/content/full/137/8/1144
Assael LA, “Oral Bisphosphonates as a Cause of Bisphosphonate-Related Osteonecrosis of the Jaws: Clinical Findings, Assessment of Risks, and Preventive Strategies,” J Oral Maxillofac Surg, 2009, 67(5 Suppl):35-43.
Bamias A, Kastritis E, Bamia C, et al, “Osteonecrosis of the Jaw in Cancer After Treatment With Bisphosphonates: Incidence and Risk Factors,” J Clin Oncol, 2005, 23(34):8580-7.
Diamond TH, Winters J, Smith A, et al, “The Antiosteoporotic Efficacy of Intravenous Pamidronate in Men With Prostate Carcinoma Receiving Combined Androgen Blockade: A Double Blind, Randomized, Placebo-Controlled Crossover Study,” Cancer, 2001, 92(6):1444-50.
Durie BG, Katz M, and Crowley J, “Osteonecrosis of the Jaw and Bisphosphonate,” N Engl J Med, 2005, 353(1):99-102.
Fitton A and McTavish D, “Pamidronate: A Review of Its Pharmacological Properties and Therapeutic Efficacy in Resorptive Bone Disease,” Drugs, 1991, 41(2):289-318.
French AE, Kaplan N, Lishner M, et al, “Taking Bisphosphonates During Pregnancy,” Can Fam Physician, 2003, 49:1281-2.
Gimsing P, Carlson K, Turesson I, et al, “Effect of Pamidronate 30 mg Versus 90 mg on Physical Function in Patients With Newly Diagnosed Multiple Myeloma (Nordic Myeloma Study Group): A Double-Blind, Randomised Controlled Trial,” Lancet Oncol, 2010, 11(10):973-82.
Glorieux FH, Bishop NH, Plotkin H, et al, “Cyclic Administration of Pamidronate in Children With Severe Osteogenesis Imperfecta,” N Engl J Med, 1998, 339(14):947-52.
Hillner BE, Ingel JN, Chlebowski RT, et al, “American Society of Clinical Oncology 2003 Update on the Role of Bisphosphonates and Bone Health Issues in Women With Breast Cancer,” J Clin Oncol, 2003, 21(21):4042-57.
Kellihan MJ and Mangino PD, “Pamidronate,” Ann Pharmacother, 1992, 26(10):1262-9.
Kyle RA, Yee GC, Somerfield MR, et al, “American Society of Clinical Oncology 2007 Clinical Practice Guideline Update on the Role of Bisphosphonates in Multiple Myeloma,” J Clin Oncol, 2007, 25(17):2464-72.
Lteif AN and Zimmerman D, “Bisphosphonates for Treatment of Childhood Hypercalcemia,” Pediatrics, 1998, 102(4 Pt 1):990-3.
Maerevoet M, Martin C, and Duck L, “Osteonecrosis of the Jaw and Bisphosphonates,” N Engl J Med, 2005, 353(1):99-102.
McMahon RE, Bouquot JE, Glueck CJ, et al, “Osteonecrosis: A Multifactorial Etiology,” J Oral Maxillofac Surg, 2004, 62(7):904-5.
National Comprehensive Cancer Network® (NCCN), “Clinical Practice Guidelines in Oncology™: Multiple Myeloma,” Version 1.2011. Available at http://www.nccn.org/professionals/physician_gls/PDF/myeloma.pdf
Ralston SH, Gallacher SJ, Patel U, et al, “Cancer-Associated Hypercalcemia: Morbidity and Mortality, Clinical Experience in 126 Treated Patients,” Ann Intern Med, 1990, 112(7):499-504.
Rauch F and Glorieux FH, “Osteogenesis Imperfecta,” Lancet, 2004, 363(9418):1377-85.
Ruggiero SL, Dodson TB, Assael LA, et al, “American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws-2009 Update,” J Oral Maxillofac Surg, 2009, 67(5 Suppl):2-12.
Smith MR, McGovern FJ, Zietman AL, et al, “Pamidronate to Prevent Bone Loss During Androgen-Deprivation Therapy For Prostate Cancer,” N Engl J Med, 2001, 345(13):948-55.
Steelman J and Zeitler P, “Treatment of Symptomatic Pediatric Osteoporosis With Cyclic Single-Day Intravenous Pamidronate Infusions,,” J Pediatr, 2003, 142(4):417-23.
Tarassoff P and Csermak K, “Avascular Necrosis of the Jaws: Risk Factors in Metastatic Cancer Patients,” J Oral Maxillofac Surg, 2003, 61(10):1238-9.
Vitale G, Fonderico F, Martignetti A, et al, “Pamidronate Improves the Quality of Life and Induces Clinical Remission of Bone Metastases in Patients With Thyroid Cancer,” Br J Cancer, 2001, 84(12):1586-90.
Van Poznak CH, Temin S, Yee GC, et al, “American Society of Clinical Oncology Executive Summary of the Clinical Practice Guideline Update on the Role of Bone-Modifying Agents in Metastatic Breast Cancer,” J Clin Oncol, 2011, 29(9):1221-7.
International Brand Names
Lexi-Comp.com
Last full review/revision November 2011
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