The recommended total dose Pomegary during the course of treatment is 180 – 210 mg. The total dose was 180 mg, can be administered either in the form of six infusions (1 to 30 mg once a week) or in the form of three infusion (1 to 60 mg every 2 weeks). If the alleged total dose of 210 mg should make, for the first administration of recommended dose of 30 mg. This dosing regimen (but with the omission of the initial dose of 30 mg) can be repeated after 6 months until remission jelfa omnadren 250 of disease or in the case of aggravation.
Use in patients with impaired renal function
Pamidronic acid is not recommended for patients with severe renal impairment (creatinine clearance less than 30 ml / min), except in cases of life-threatening hypercalcaemia if the potential benefits of application exceeds the risk of possible complications.
In patients with mild (clearance creatinine 61-90 ml / min) or moderate (creatinine clearance 30-60 ml / min), severe renal impairment, adjustment of the drug dosage regimen is required. The infusion rate pamidronic acid in these patients should not exceed 90 mg / 4 hour. (Approximately 20 – 22 mg / h)
When signs of renal dysfunction, pamidronic acid therapy must be canceled prior to the recovery of renal function (excess creatinine concentration of not more than 10% from baseline). Use in patients with impaired hepatic function in patients with mild to moderate hepatic impairment the drug correction mode is not required.
Rules of drug infusion solution .
The contents of the vial prior to administration should be further diluted for infusion solution not containing calcium (such as 0.9% sodium chloride or 5% dextrose) at a concentration of no more than 90 mg / 250 ml.
Adverse reactions in the application pamidronic acid are usually mild and of a temporary nature. The most common adverse reactions are asymptomatic hypocalcaemia and fever (an increase in body temperature of 1-2 ° C), usually develops within the first 48 hours after the infusion. Fever usually resolves on its own and does not require treatment.
Immune system: sometimes – allergic reactions, including anaphylactoid reactions, bronchospasm / dyspnoea, angioedema; very rarely – anaphylactic shock. From the nervous system: often – paresthesia, tetany (as a manifestation of hypocalcemia), headache, insomnia or hypersomnia; sometimes – seizures, agitation, dizziness; very rare – confusion, visual hallucinations. From the senses: often – conjunctivitis; sometimes – uveitis (iritis, iridocyclitis); very rarely – scleritis, episcleritis, xanthopsia (seeing things in yellow). On the part of the cardiovascular system: often – pronounced rise in blood pressure (BP); sometimes – marked reduction of blood pressure; very rarely – shortness of breath, pulmonary edema (as signs of left ventricular failure), swelling (as a sign of congestive heart failure) due to overload of fluid injected. On jelfa omnadren 250 the part of the gastrointestinal tract: often – nausea, vomiting, anorexia, abdominal pain, diarrhea, constipation, gastritis; . sometimes – dyspepsia For the skin: often – a rash; sometimes – itching. On the part of the musculoskeletal system: often – transient bone pain, arthralgia, myalgia; . sometimes – muscle spasms From the urinary system: sometimes – acute renal failure; rarely – focal segmental glomerulosclerosis including kollaptoidnye variant, nephrotic syndrome; very rarely – the aggravation associated renal disease, haematuria. Exacerbation of infectious diseases: very rarely – reactivation of latent viral infections (Herpes simplex, Herpes Zoster). Local reactions: often – pain, redness, swelling, induration, phlebitis, thrombophlebitis at the injection site. Laboratory findings: very often – hypocalcemia, hypophosphatemia; often – hypokalemia, hypomagnesemia, increased creatinine concentration in blood serum; sometimes – changes in the functional liver samples, increasing concentrations of urea in blood serum; very rarely – hyperkalemia, hypernatremia Other: very often – fever and flu-like symptoms sometimes accompanied by malaise, fever, fatigue and hot flashes. Very rarely – the development of osteonecrosis (primarily of the jaw, usually after tooth extraction or other dental treatment). A clear causal relationship between the development of osteonecrosis has not been established.
If you exceed the recommended doses of the drug requires careful monitoring of the patient. The antidote is not known. With the development of clinical symptoms of hypocalcemia (paresthesia, tetany, marked reduction in blood pressure) should be performed infusion of calcium gluconate.
Interaction with other drugs
The combined use of pamidronic acid commonly used anti-cancer agents has not been accompanied by any significant interactions.
The combined use of calcitonin in patients with severe hypercalcemia observed synergistic effect, resulting in a more rapid decrease in the concentration of calcium in the blood serum.
While the appointment of a need for caution with other drugs possessing nephrotoxic effect.
In patients with multiple myeloma or combined with tolbutamide increases the risk of renal dysfunction.
Pharmaceutical incompatibility. Pamidronic jelfa omnadren 250 acid may form complexes with divalent cations, and therefore it should not be added to solutions for intravenous administration, containing calcium (such as Ringer’s solution).
Bisphosphonates, including Pamidronic acid may lead to renal dysfunction. Due to the risk of clinically significant renal impairment, single dose should not exceed 90 mg, it should also comply with the recommended rate of dilution and rate of administration. Typically pamidronic acid 90 mg in 250 ml of infusion solution is administered over 2 hours. In patients with multiple myeloma and hypercalcemia due to malignancy dose pamidronic acid component of 90 mg diluted in 500 ml infusion solution and is administered for more than 4 hours.
The course of treatment requires the monitoring of renal function (serum creatinine concentrations before each infusion pamidronic acid), the concentration of electrolytes, calcium and phosphorus in the blood serum.
The risk of developing hypocalcemia increased in patients who had undergone surgery on the thyroid gland, due to latent hypoparathyroidism.
patients with cardiac disease, especially in elderly patients, the introduction of additional quantities of physiological solution can lead to the emergence or strengthening of heart failure (left ventricular acute or chronic). Fever (or flu-like symptoms) may also contribute to the development of this complication.
In order to reduce the risk of hypocalcemia in patients with bone Paget’s disease, in whom the risk of elevated calcium deficit of vitamin D, should be further prescribed these drugs inside.
Pamidronic acid should not be used in conjunction with other bisphosphonate, since the consequences of such combination treatment have not been studied.
cases of osteonecrosis of the jaw in cancer patients treated with bisphosphonates (including pamidronic acid).
in this regard, before the appointment of oncology patients pamidronic acid, like other bisphosphonates, patients should be undergo dental examination and carry out all necessary maintenance procedures.During treatment strictly observe good oral hygiene and if jelfa omnadren 250 possible to avoid dental procedures. prohormonen