Omnadren cycleacid is an inhibitor of bone resorption, mediated by osteoclasts. Pamidronic acid forms a stable compound with the hydroxyapatite crystals of bone tissue and inhibits the dissolution of these in vitro crystals.
It is believed that in vivo inhibition of bone resorption is at least partly explained by the binding of pamidronic acid with minerals.
Acid inhibits delivery osteoclast precursors in bone tissue, and their subsequent conversion into mature osteoclasts responsible for resorption of the tissue.
in patients with malignancies pamidronic acid inhibits osteolysis in the presence of hypercalcemia, tumor-induced, reduces the levels of calcium and phosphorus in the serum and decreases their excretion and the excretion hydroxyproline in the urine.
By reducing the severity of hypercalcemia, increases glomerular filtration rate, that the majority of patients accompanied by a decrease of initially increased concentration in serum creatinine.
After initiation of the infusion concentration of pamidronic acid in the plasma is rapidly increased, and at the end of infusion – as quickly decreases. The apparent half-life of pamidronic acid in plasma is about 0.8 hours. Therefore, equilibrium concentration is achieved with pamidronic acid duration of infusion over 2-3 hours.
Cumulation pamidronic acid in bone volume is not limited to this tissue, and depends solely on the total dose of drug administered.
Communication pamidronic acid with circulating plasma proteins is approximately 54% and increased in case of exceeding the upper limit value of the normal blood calcium concentration.
it is believed that not pamidronic acid biotransformation and excreted almost exclusively by the kidneys. After intravenous infusion of about 20-55% of the administered dose pamidronic acid detected in the urine within 72 hours as unchanged.
The remaining amount of omnadren cycle delay in the body indefinitely.
Excretion pamidronic acid excretion dwuhfazno visible half-lives are, respectively, 1.6 and 27 hours.
If abnormal liver function had higher mean values of area under the curve “concentration-time” (AUC) (39.7%) and Cmax (28.6%). However, pamidronic acid still rapidly cleared from plasma. After 12-36 hours after the infusion of the drug was not detected in plasma. Since the drug is used only 1 time per month, cumulation pamidronic acid does not occur.
With significant renal impairment (creatinine clearance <30 mL / min) the average AUC is increased approximately 3-fold. Although the rate of excretion pamidronic acid reduced by the creatinine clearance, total pamidronic acid outputted by the kidneys, while not significantly changed.
– Hypercalcemia due to malignancy.
– Diseases accompanied by increased activity of osteoclasts:. Bone metastases of malignant tumors (predominantly osteolytic nature) and multiple myeloma
– bone Paget’s disease.
– Hypersensitivity to pamidronic acid or other bisphosphonates, as well as the other ingredients in the drug.
– Pregnancy (unless hypercalcemia life-threatening) and lactation.
– Children’s age (experience of the children are not present)
Precautions : renal impairment.
Pregnancy and lactation
No significant clinical trials of the drug in pregnant women have been conducted. Pamidronic acid may be harmful to the embryo. Do not use the drug during pregnancy, except in cases of hypercalcemia, life-threatening (in animals is not observed teratogenicity omnadren cycle pamidronic acid, as well as the negative impact of the reproductive function and fertility).
Upon receipt of pamidronic acid during lactation, breast-feeding should be discontinued.
Dosing and Administration
Intravenous infusion at a rate not more than administration of 1 mg / min.
Use in adults and elderly patients with hypercalcemia due to malignancy. Before starting the application Pomegary or during therapy is recommended to the patient rehydration using 0.9% sodium chloride solution. Pomegary total dose used for treatment depends on the initial level of calcium in the blood serum of the patient. The following table provides guidelines for the selection of the required dose pamidronic acid, depending on the concentration of calcium in the blood serum values.
Pomegary total dose can be administered both at once, and as several infusions carried out for 2-4 consecutive days. The maximum dose exchange rate (for the first and for subsequent courses of treatment) is 90 mg.
A significant decrease in the concentration of calcium in the blood serum usually occurs 24-48 hours after administration pamidronic acid, normalization of this index -in within 3-7 days. If normalizing blood calcium levels within the specified time is not reached, the introduction of additional possible medication. Duration preserve the effects in individual patients is different. With the resumption of hypercalcemia, a second course of therapy pamidronic acid. With an increasing number of courses introducing efficiency pamidronic acid may decrease.
Bone metastases of malignant tumors (predominantly osteolytic character) and multiple myeloma. The recommended dose is 90 mg once every 4 weeks. In patients with bone metastases of malignant tumors receiving chemotherapy with a 3-week omnadren cycle intervals, Pomegara at a dose of 90 mg may also be used with a 3-week intervals.