Pamidronic acid

When ATH:
M05BA03

Characteristic.

White or almost white powder. Soluble in water and 2 n. sodium hydroxide, sparingly soluble in dilute (0,1 n.) hydrochloric and acetic acids, practically insoluble in organic solvents. pH 1% aqueous 8,3.

Pharmacological action.
Inhibiting bone resorption.

Application.

Hypercalcemia, caused by malignant tumors (epidermoid origin and neepidermoidnogo, with or without bone metastases, immobilizaciej, primary hyperparathyroidism), osteitis deformans (Paget's disease), metastases of malignant tumors in the bone and multiple myeloma with osteolytic bone lesions, osteoporosis, incl. for the treatment of glucocorticoid, fibrous osteodysplasia (simptomaticheskaya therapy).

Contraindications.

Hypersensitivity, expressed by the human kidney, pregnancy, lactation (at the end of treatment), childhood.

Side effects.

Fervescence (at 1-2° c for 24-48 h after infusion), nausea, vomiting, anorexia, stomach ache, constipation / diarrhea, dyspepsia, symptoms of gastritis, generalized pain, ostealgias, back, arthralgia and myalgia (often metastases, multiple myeloma), convulsive status, dizziness, headache, paresthesia, excitation, disorientation, insomnia or drowsiness, lethargy, heteroptics, conjunctivitis, uveitis (Irit, iridocyclitis), scleritis, episcleritis, Xanthopsia, Hypertension / hypotension, signs of left ventricular or congestive heart failure, anemia, Lymphocytopenia, thrombocytopenia and leykopeniya (mainly on chemotherapy of metastases), hematuria, acute renal failure, worsening of existing kidney disease, hypocalcemia, gipofosfatemiя, gipomagniemiya, hypokalemia / hyperkalemia, gipernatriemiya, change in the functional liver samples, increasing the concentration of creatinine and urea in the serum, Allergic (rash, itch) and anaphylactoid (bronchospasm, breathlessness, angioedema, anaphylactic shock) reaction, flu-like symptoms (malaise, chills, feeling tired, tides, Sweating), herpes, urinary tract infections and respiratory, Local reactions: soreness, redness, puffiness, packing, phlebitis, thrombophlebitis at the injection site.

Cooperation.

Compatible with anticancer drugs. Calcitonin accelerates reduction of calcium in the blood.

Pharmaceutical incompatible with infusion solutions, containing calcium (incl. Ringer).

Overdose.

Symptoms: hypocalcemia (paraesthesia, tetany, hypotension).

Treatment: / in the administration of calcium gluconate.

Dosing and Administration.

B /, drop, slowly (at no more than 60 mg / h) as an infusion. For the preparation of an infusion solution for infusion dry substance is dissolved beforehand in water for injection (15 mg — in 5 ml, 30 mg — in 10 ml), and in concentrate for the infusions add 10 ml water and then diluted with 0,45% or 0,9% solution of sodium chloride or 5% glucose solution — in 1000 ml for therapy gipercalziemii, in 500 ml-in other cases; concentration in infuzionnom solution may not exceed 90 mg/250 ml.

If hypercalcemia, induced malignancy, -dose set individually on the basis of a reference concentration of calcium in the blood. For adults and older — with less concentration of calcium in the blood 3 mmol/l total dose rate is 15-30 mg, at 3-3, 5 mmol/l is 30-60 mg, at 3.5-4 mmol/l — 90 mg; dose introducing/in infuzionno for 2 h one or more receptions for 2-4 consecutive days; When the reception level of calcium in the blood is reduced through 24-48 h, normal within 3-7 days; in the absence of effect within this time, repeat the course. An alternative embodiment: at moderate hypercalcaemia (level of serum calcium 12-13, 5 mg/ml) the initial single dose in/in infuzionno- 60 mg for 4 or h 90 mg for 24 no; in severe hypercalcemia (calcium levels more 13,5 mg / ml) - 90 mg, odnokratnaya in / 24 chasovaya infusion; if necessary (If calcium indicators do not return to normal) course repeat, but not earlier, than 7 days. Maximum course dose (initial, refresher courses) - 90 mg.

When Paget's disease - 30 mg per day in the form of a 4-hour infusions for 3 consecutive days (total dose 90 mg); possible repetition rate.

In the case of metastases of malignant tumors in the bone, multiple myeloma is 90 mg, once in the form of 2-4-hour in / infusion every 4 Sun; provided through the use of antineoplastic therapy 3 It is possible to use every week 3 Sun.

Precautions.

During treatment, especially with frequent infusions over time, needs periodic monitoring (standard clinical and laboratory parameters) renal function. If hypercalcemia, mainly in the beginning of the course, It recommends monitoring serum levels of calcium, Phosphates, Magnesium, sodium, creatinine; If signs of hypocalcemia, including tetany, therapy is stopped. Before or during treatment to conduct adequate rehydration saline (including cases of mild asymptomatic hypercalcemia); hypercalcemia, induced hematological malignancies, additionally used glucocorticoids. When expressed renal dysfunction solution infused at a rate of, not exceeding 20 mg / h. Patients with heart failure potential to avoid excessive rehydration. During the period of treatment should refrain from activities potentially hazardous activities, require attention and speed of mental reactions. Not to be combined with other acid Pamidronic bisphosphonates; introduce / bolus.