pamidronate

Adult Dosing .

Dosage forms:  INJ

hypercalcemia, malignant

[60-90 mg IV x1]

Max: 90 mg/dose; Info: dose depends on severity of hypercalcemia; use w/ hydration; avoid invasive dental procedure; may repeat dose after >7 days

Paget bone dz, mod-severe

[30 mg IV qd x3 days]

Info: may repeat course x1; avoid invasive dental procedure; calcium and vitamin D supplementation recommended

osteolytic lesions, multiple myeloma-associated

[90 mg IV x1 qmo]

Max: 90 mg/dose; Info: hold dose if incr. Cr; avoid invasive dental procedure; calcium and vitamin D supplementation recommended

bone metastases, breast CA-associated

[90 mg IV x1 q3-4wk]

Max: 90 mg/dose; Info: hold dose if incr. Cr; avoid invasive dental procedure; calcium and vitamin D supplementation recommended

renal dosing

[osteolytic lesions or bone metastases]

severe impairment: avoid use

HD/PD: not defined

[all other indications]

mild-mod impairment: no adjustment; severe impairment: not defined, caution advised

HD/PD: not defined

hepatic dosing

[see below]

mild-moderate impairment: no adjustment; severe impairment: not defined

Peds Dosing .

Dosage forms:  INJ

osteogenesis imperfecta (off-label)

[14 days old-23 mo]

Dose: 0.5 mg/kg/dose IV qd x3 days q2mo; Start: 0.25 mg/kg/dose IV qd on day 1, then 0.5 mg/kg/dose IV qd on days 2-3 of 1st cycle; Max: 90 mg/dose, 9 mg/kg total annual dose; Info: avoid invasive dental procedure; calcium and vitamin D supplementation recommended if inadequate dietary intake; periodically reassess need for tx; give for 1-4y

[2-3 yo]

Dose: 0.75 mg/kg/dose IV qd x3 days q3mo; Start: 0.38 mg/kg/dose IV qd on day 1, then 0.75 mg/kg/dose IV qd on days 2-3 of 1st cycle; Max: 90 mg/dose, 9 mg/kg total annual dose; Info: avoid invasive dental procedure; calcium and vitamin D supplementation recommended if inadequate dietary intake; periodically reassess need for tx; give for 1-4y

[4 yo and older]

Dose: 1 mg/kg/dose IV qd x3 days q4mo; Start: 0.5 mg/kg/dose IV qd on day 1, then 1 mg/kg/dose IV qd on days 2-3 of 1st cycle; Max: 90 mg/dose, 9 mg/kg total annual dose; Info: avoid invasive dental procedure; calcium and vitamin D supplementation recommended if inadequate dietary intake; periodically reassess need for tx; give for 1-4y

osteopenia (off-label)

[3 yo and older]

Dose: 0.4-1 mg/kg/dose IV qd x3 days q3-6mo; Max: 90 mg/dose; Info: avoid invasive dental procedure; calcium and vitamin D supplementation recommended if inadequate dietary intake; periodically reassess need for tx; give for 1-4y

osteoporosis (off-label)

[3 yo and older]

Dose: 0.4-1 mg/kg/dose IV qd x3 days q3-6mo; Max: 90 mg/dose; Info: avoid invasive dental procedure; calcium and vitamin D supplementation recommended if inadequate dietary intake; periodically reassess need for tx; give for 1-4y

renal dosing

[not defined]

renal impairment: not defined, caution advised

HD/PD: not defined

hepatic dosing

[not defined]

hepatic impairment: consider adult hepatic dosing for guidance