From the Guidelines
For multiple myeloma, the recommended dose of pamidronate is 90 mg administered as an intravenous infusion over at least 2 hours every 3-4 weeks, as stated in the most recent guideline update 1.
Key Considerations
- The infusion should be diluted in 500 ml of normal saline or 5% dextrose solution.
- Prior to administration, patients should be adequately hydrated with 500 ml of normal saline.
- Renal function should be monitored before each dose, with dose adjustments needed for patients with renal impairment.
- Calcium and vitamin D supplementation should be given concurrently to prevent hypocalcemia.
- Pamidronate works by inhibiting osteoclast activity, thereby reducing bone resorption and skeletal-related events common in multiple myeloma.
Potential Side Effects
- Flu-like symptoms after initial doses
- Renal toxicity
- Rare but serious risk of osteonecrosis of the jaw, which requires preventive dental care before starting therapy
Duration of Therapy
- Treatment should continue for up to 2 years, with less frequent dosing considered in patients with responsive or stable disease, as suggested by the update panel 1.
- Retreatment should be initiated at the time of disease relapse.
Renal Impairment
- For patients with pre-existing mild-to-moderate renal impairment, reduced dosage of zoledronic acid is recommended, but no similar guidelines are available for pamidronate, and the Update Committee recommends considering reducing the initial pamidronate dose in that setting 1.
- Pamidronate 90 mg administered over 4 to 6 hours is recommended for patients with extensive bone disease and existing severe renal impairment.
From the FDA Drug Label
Osteolytic Bone Lesions of Multiple Myeloma The recommended dose of pamidronate disodium in patients with osteolytic bone lesions of multiple myeloma is 90 mg administered as a 4 hour infusion given on a monthly basis
The recommended dose of Pamidronate in Multiple Myeloma is 90 mg administered as a 4 hour infusion given on a monthly basis 2.
From the Research
Pamidronate Dose in Multiple Myeloma
- The recommended dose of pamidronate for multiple myeloma patients is 90 mg via 2-hour intravenous infusion every 3 to 4 weeks for 12 months, as shown in studies 3, 4.
- However, a study found that a 1-hour infusion of pamidronate 90 mg was safe and tolerable for multiple myeloma patients with no pre-existing renal impairment 5.
- Another study compared the effect of two doses of pamidronate (30 mg and 90 mg) on physical function in patients with newly diagnosed multiple myeloma, and found that the lower dose (30 mg) was sufficient to prevent bone disease 6.
- The choice of pamidronate dose may depend on individual patient factors, such as renal function and risk of skeletal-related events.
- It is essential to monitor patients for adverse events, including hypocalcemia, renal impairment, and osteonecrosis of the jaw, when administering pamidronate 7.
Comparison with Zoledronic Acid
- Studies have compared the efficacy and safety of pamidronate with zoledronic acid in multiple myeloma patients, and found that both treatments were effective in reducing skeletal-related events 3, 4.
- Zoledronic acid was found to be more potent than pamidronate, with a recommended dose of 4 mg via 15-minute intravenous infusion every 3 to 4 weeks 3, 4.