Pamidronate

Mechanism-of-action class: Bone Surface Interactions.

• Hypercalcemia of Malignancy Pamidronate disodium, in conjunction with adequate hydration, is indicated for the treatment of moderate or severe hypercalcemia associated with malignancy, with or without bone metastases. Patients who have either epidermoid or non-epidermoid tumors respond to treatment with pamidronate disodium.ICD-10: E83.52

• Pamidronate disodium is contraindicated in patients with clinically significant hypersensitivity to pamidronate disodium or other bisphosphonates.contraindicated

Hypercalcemia of Malignancy Consideration should be given to the severity of as well as the symptoms of hypercalcemia. Vigorous saline hydration alone may be sufficient for treating mild, asymptomatic hypercalcemia. Overhydration should be avoided in patients who have potential for cardiac failure. In hypercalcemia associated with hematologic malignancies, the use of glucocorticoid therapy may be helpful. Moderate Hypercalcemia The recommended dose of pamidronate disodium in moderate hypercalcemia (corrected serum calcium* of approximately 12 to 13.5 mg/dL) is 60 to 90 mg given as a SINGLE DOSE, intravenous infusion over 2 to 24 hours. Longer infusions (i.e., >2 hours) may reduce the risk for renal toxicity, particularly in patients with preexisting renal insufficiency. Severe Hypercalcemia The recommended dose of pamidronate disodium in severe hypercalcemia (corrected serum calcium* >13.5 mg/dL) is 90 mg given as a SINGLE DOSE, intravenous infusion over 2 to 24 hours. Longer infusions (i.e., >2 hours) may reduce the risk for renal toxicity, particularly in patients with preexisting renal insufficiency. * Albumin-corrected serum calcium (CCa, mg/dL) = serum calcium, mg/dL + 0.8 (4.0-serum albumin, g/dL). Retreatment A limited number of patients have received more than one treatment with pamidronate disodium for hypercalcemia. Retreatment with pamidronate disodium, in patients who show complete or partial response initially, may be carried out if serum calcium does not return to normal or remain normal after initial treatment.

Deterioration in Renal Function Bisphosphonates, including pamidronate disodium, have been associated with renal toxicity manifested as deterioration of renal function and potential renal failure. DUE TO THE RISK OF CLINICALLY SIGNIFICANT DETERIORATION IN RENAL FUNCTION, WHICH MAY PROGRESS TO RENAL FAILURE, SINGLE DOSES OF PAMIDRONATE DISODIUM SHOULD NOT EXCEED 90 MG (see DOSAGE AND ADMINISTRATION for appropriate infusion durations). Renal deterioration, progression to renal failure, and dialysis have been reported in patients after the initial or a single dose of pamidronate disodium. Focal segmental glomerulosclerosis (including the collapsing variant) with or without nephrotic syndrome, which may lead to renal failure, has been reported in pamidronate disodium-treated patients, particularly in the setting of multiple myeloma and breast cancer. Some of these patients had gradual improvement in renal status after pamidronate disodium was discontinued. Patients who receive pamidronate disodium should have serum creatinine assessed prior to each treatment. Patients treated with pamidronate disodium for bone metastases should have the dose withheld if renal function has deteriorated (see DOSAGE AND ADMINISTRATION ). PREGNANCY: Bisphosphonates, such as pamidronate disodium, are incorporated into the bone matrix, from where they are gradually released over periods of weeks to years. Pamidronate disodium may cause fetal harm when administered to a pregnant woman.

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Clinical Studies Hypercalcemia of Malignancy Transient mild elevation of temperature by at least 1°C was noted 24 to 48 hours after administration of pamidronate disodium in 34% of patients in clinical trials. In the saline trial, 18% of patients had a temperature elevation of at least 1°C 24 to 48 hours after treatment. Drug-related local soft-tissue symptoms (redness, swelling or induration and pain on palpation) at the site of catheter insertion were most common in patients treated with 90 mg of pamidronate disodium. Symptomatic treatment resulted in rapid resolution in all patients. Rare cases of uveitis, iritis, scleritis, and episcleritis have been reported, including one case of scleritis, and one case of uveitis upon separate rechallenges. Five of 231 patients (2%) who received pamidronate disodium during the four U.S. controlled hypercalcemia clinical studies were reported to have had seizures, 2 of whom had preexisting seizure disorders. None of the seizures were considered to be drug-related by the investigators. However, a possible relationship between the drug and the occurrence of seizures cannot be ruled out. It should be noted that in the saline arm 1 patient (4%) had a seizure.

There have been several cases of drug maladministration of intravenous pamidronate disodium in hypercalcemia patients with total doses of 225 mg to 300 mg given over 2½ to 4 days. All of these patients survived, but they experienced hypocalcemia that required intravenous and/or oral administration of calcium. Single doses of pamidronate disodium should not exceed 90 mg and the duration of the intravenous infusion should be no less than 2 hours (See WARNINGS ). In addition, one obese woman (95 kg) who was treated with 285 mg of pamidronate disodium/day for 3 days experienced high fever (39.5°C), hypotension (from 170/90 mmHg to 90/60 mmHg), and transient taste perversion, noted about 6 hours after the first infusion. The fever and hypotension were rapidly corrected with steroids. If overdosage occurs, symptomatic hypocalcemia could also result; such patients should be treated with short-term intravenous calcium.

• Jun 27, 2002ANDAANDA075841Hospira
• Oct 31, 2008ANDAANDA078520Mylan Labs Ltd

1. 1Osteonecrosis53316%
2. 2Osteonecrosis Of Jaw43313%
3. 3Pain42012%
4. 4Bone Disorder1705.0%
5. 5Nausea1685.0%
6. 6Tooth Extraction1685.0%
7. 7Fatigue1524.5%
8. 8Diarrhoea1484.4%
9. 9Malignant Neoplasm Progression1444.3%
10. 10Pyrexia1374.1%
11. 11Drug Ineffective1344.0%
12. 12Infection1334.0%
13. 13Pneumonia1243.7%
14. 14Vomiting1183.5%
15. 15Off Label Use1173.5%

Recent PubMed references pinned to Pamidronate as a MeSH major topic. Citations link to pubmed.ncbi.nlm.nih.gov.

• Injectable hydrogel induces tumor cell extracellular calcification and bone regeneration to disrupt the osteolytic vicious cycle in bone metastasis.
  Journal of controlled release : official journal of the Controlled Release Society · 2026 · Lin M, Deng S, Liang S, et al.
  PMID 41662888DOI 10.1016/j.jconrel.2026.114701
• Evaluation of the efficacy and tolerance of pamidronate in complex regional pain syndrom type 1.
  Scientific reports · 2025 · Doussiere M, Besnier C, Hamidou Y, et al.
  PMID 40670562DOI 10.1038/s41598-025-11356-5
• Pamidronate regulates the osteogenic differentiation of periosteal-derived mesenchymal stem cells in congenital tibial pseudarthrosis via OPG/RANKL.
  Biochemical and biophysical research communications · 2025 · Wang R, Nie Y, Yang X, et al.
  PMID 40318381DOI 10.1016/j.bbrc.2025.151897
• Effectiveness and safety of bisphosphonates in inflammatory bone disorders: a systematic review.
  Clinical and experimental rheumatology · 2025 · Al-Mayouf SM, Alenzi F, Khamaj Y, et al.
  PMID 40153323DOI 10.55563/clinexprheumatol/y0ve3b
• Deficiency of ATF2 retards senescence induced by replication stress and pamidronate in mouse jaw bone marrow stem cells.
  Cellular signalling · 2025 · Li Y, Lin Y, Chen Z, et al.
  PMID 39733927DOI 10.1016/j.cellsig.2024.111579
• A non-lethal presentation of osteogenesis imperfecta type VIII due to homozygous mutation in P3H1 gene.
  BMJ case reports · 2024 · Khadse S, Shankaramurthy P, Shah N, et al.
  PMID 39455078DOI 10.1136/bcr-2024-260133
• Effect of zoledronic acid and pamidronate on renal function.
  Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners · 2025 · Koss K, Kocek M, King T, et al.
  PMID 39285742DOI 10.1177/10781552241284635
• Pamidronate Response in a Novel Biallelic CREB3L1 Gene Mutation-Associated Osteogenesis Imperfecta: A Case Report.
  JBJS case connector · 2024 · Selina A, Kandagaddala M, Madhuri V, et al.
  PMID 39058796DOI 10.2106/JBJS.CC.24.00093

The 10 most recently updated of 49 ClinicalTrials.gov registrations naming Pamidronate as an intervention. Registration is not evidence of efficacy or safety — reference crosswalk only.

• Complex Regional Pain Syndrome: Analgesic Outcome
  Active not recruiting · Observational · 200 enrolled · Ciusss de L'Est de l'Île de Montréal
  NCT07228949updated 2026-05-18
• Comparing Continuation or De-escalation of Bone Modifying Agents (BMA) in Patients Treated for Over 2 Years for Bone Metastases From Either Breast or Castration-resistant Prostate Cancer
  Active not recruiting · Phase 4 · Interventional · 240 enrolled · Ottawa Hospital Research Institute
  NCT04549207updated 2026-04-07
• CHronic Nonbacterial Osteomyelitis International Registry
  Recruiting · Observational · 2,000 enrolled · Seattle Children's Hospital
  NCT04725422updated 2024-07-30
• Effect of Local Pamidronate in Preventing Bone Loss After Total Hip Arthroplasty
  Unknown · Phase 1 · Interventional · 40 enrolled · General and Teaching Hospital Celje
  NCT00548288updated 2024-04-15
• Prevention of Bone Loss After Pediatric Hematopoietic Cell Transplantation
  Completed · Phase 2 · Interventional · 63 enrolled · Masonic Cancer Center, University of Minnesota
  NCT02074631updated 2024-02-20
• Prevention of Post Operative Bone Loss in Children
  Completed · Interventional · 24 enrolled · University of New Mexico
  NCT00655681updated 2023-08-22
• Pamidronate Administration in Breast Cancer Patients With Bone Metastases
  Completed · Phase 4 · Interventional · 152 enrolled · Spanish Breast Cancer Research Group
  NCT00128297updated 2023-03-28
• Biomarker Identification in Orthopaedic & Oral Maxillofacial Surgery Subjects to Identify Risks of Bisphosphonate Use
  Completed · Observational · 314 enrolled · University of Pennsylvania
  NCT01875458updated 2023-01-13
• 4-weekly Versus 12-weekly Administration of Bone-targeted Agents in Patients With Bone Metastases
  Completed · Phase 4 · Interventional · 263 enrolled · Ottawa Hospital Research Institute
  NCT02721433updated 2020-12-02
• Zoledronate in Treating Bone Marrow Micrometastases in Women With Stage I, Stage II, or Stage III Breast Cancer
  Completed · Phase 2 · Interventional · 45 enrolled · University of California, San Francisco
  NCT00295867updated 2020-05-12

Frequently asked questions

How does Pamidronate work?

Mechanism-of-action class: Bone Surface Interactions.

What is Pamidronate used for?

According to FDA labeling, Pamidronate carries indications including: Hypercalcemia of Malignancy Pamidronate disodium, in conjunction with adequate hydration, is indicated for the treatment of moderate or severe hypercalcemia associated with malignancy, with or without bone metastases. Patients who have either epidermoid or non-epidermoid tumors respond to treatment with pamidronate disodium.. This is a reference summary of labeled uses, not medical advice or a treatment recommendation.

What class of drug is Pamidronate?

Pamidronate is classified as Bone Surface Interactions, Bone Resorption Inhibition.

What are the contraindications for Pamidronate?

Pamidronate labeling lists contraindications including: Pamidronate disodium is contraindicated in patients with clinically significant hypersensitivity to pamidronate disodium or other bisphosphonates.. Always consult the full prescribing information and a clinician.