New Zealand Formulary
Menu Close Menu

Fewer cancers.
Better survival.
Equity for all.

Systemic Anti-Cancer Therapy Regimen Library

Home > PCN MM - pamidronate 90mg Q4W

PCN MM - pamidronate 90mg Q4W

Treatment Overview

Pamidronate may be administered as 30 mg to 90mg once every 28 days for 2 years. [See PCN MM - pamidronate 30mg Q4W for 30mg dose regimen].

  • 30mg dose equally effective in randomised trial but was given for 3 years (cite Gimsing).
  • 90mg dose shown to be safe and effective with creatinine allowed up to 447 in randomised trial (cite Berenson); consider dose reduction from 90mg if severe renal dysfunction (cite 2018 ASCO guidelines).

Cycles 1 to 24 - 28 days

Cycle length:
28
  • Consider oral supplementation of at least 500 mg elemental calcium daily and vitamin D equivalent to 400 units daily (e.g. colecalciferol 1.25 mg orally ONCE a month) for the duration of treatment. 
  • Dental check-up recommended prior to starting, and at 6-monthly intervals during treatment.
  • Patients should be encouraged to maintain good oral hygiene and report any adverse oral symptoms.

Cycle details

Cycles 1 to 24 - 28 days

Medication Dose Route Days Max Duration
pamidronate disodium 90 mg intravenous 1 240 minutes Min: 90 minutes
  • Consider oral supplementation of at least 500 mg elemental calcium daily and vitamin D equivalent to 400 units daily (e.g. colecalciferol 1.25 mg orally ONCE a month) for the duration of treatment. 
  • Dental check-up recommended prior to starting, and at 6-monthly intervals during treatment.
  • Patients should be encouraged to maintain good oral hygiene and report any adverse oral symptoms.

Full details

Cycles 1 to 24 - 28 days

Day: 1

Medication Dose Route Max duration Details
pamidronate disodium 90 mg intravenous 240 minutes Min: 90 minutes
Instructions:
  • Consider oral supplementation of at least 500 mg elemental calcium daily and vitamin D equivalent to 400 units daily (e.g. colecalciferol 1.25 mg orally ONCE a month) for the duration of treatment.
  • Dental check-up recommended prior to starting, and at 6-monthly intervals during treatment.

Supportive Care Factors

No supportive care factors specified

References

Berenson, J. R., A. Lichtenstein, L. Porter, et al. 1996. "Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. Myeloma Aredia Study Group." N.Engl.J.Med. 334(8):488-493. , PMID: 8559201

Petcu, EB, Schug, SA, Smith, H. 2002 "Clinical evaluation of onset of analgesia using intravenous pamidronate in metastatic bone pain." J Pain Symptom Manage ; 24:281., PMID: 12458105

Lee OL, Horvath N, et al. Bisphosphonate guidelines for treatment and prevention of myeloma bone disease. Intern Med J. 2017 Aug;47(8):938-951. doi: 10.1111/imj.13502., PMID: 28782211

Gimsing P, Carlson K, et al. Effect of pamidronate 30 mg versus 90 mg on physical function in patients with newly diagnosed multiple myeloma (Nordic Myeloma Study Group): a double-blind, randomised controlled trial. Lancet Oncol. 2010 Oct;11(10):973-82. doi: 10.1016/S1470-2045(10)70198-4., PMID: 20863761

Berenson, J. R., A. Lichtenstein, L. Porter, et al. 1998. "Long-term pamidronate treatment of advanced multiple myeloma patients reduces skeletal events. Myeloma Aredia Study Group." J.Clin Oncol. 16(2):593-602., PMID: 9469347

Dhodapkar MV, Singh J, Mehta J et al. 1998.Anti-myeloma activity of pamidronate in vivo. Br J Haematol Nov;103(2):530-2 , PMID: 9827929

Anderson K, Ismaila N, et al. Role of Bone-Modifying Agents in Multiple Myeloma: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2018 Mar 10;36(8):812-818. doi: 10.1200/JCO.2017.76.6402. Epub 2018 Jan 17., PMID: 29341831

Pfizer New Zealand Ltd. Pamisol 19 May 2020 New Zealand Medicine Datasheet https://www.medsafe.govt.nz/profs/datasheet/p/Pamisolinj.pdf (Accessed 8 April 2022).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.