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Details

Stereochemistry ACHIRAL
Molecular Formula C3H11NO7P2
Molecular Weight 235.0695
Optical Activity NONE
Defined Stereocenters 0 / 0
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of PAMIDRONIC ACID

SMILES

NCCC(O)(P(O)(O)=O)P(O)(O)=O

InChI

InChIKey=WRUUGTRCQOWXEG-UHFFFAOYSA-N
InChI=1S/C3H11NO7P2/c4-2-1-3(5,12(6,7)8)13(9,10)11/h5H,1-2,4H2,(H2,6,7,8)(H2,9,10,11)

HIDE SMILES / InChI
Pamidronic acid (Pamidronate Disodium) is a bone resorption inhibitor. The principal pharmacologic action of pamidronate disodium is inhibition of bone resorption. Although the mechanism of antiresorptive action is not completely understood, several factors are thought to contribute to this action. Pamidronate disodium adsorbs to calcium phosphate (hydroxyapatite) crystals in bone and may directly block dissolution of this mineral component of bone. In vitro studies also suggest that inhibition of osteoclast activity contributes to inhibition of bone resorption. In animal studies, at doses recommended for the treatment of hypercalcemia, pamidronate disodium inhibits bone resorption apparently without inhibiting bone formation and mineralization. Of relevance to the treatment of hypercalcemia of malignancy is the finding that pamidronate disodium inhibits the accelerated bone resorption that results from osteoclast hyperactivity induced by various tumors in animal studies. 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. Pamidronate disodium is indicated for the treatment of patients with moderate to severe Paget’s disease of bone. Pamidronate disodium is indicated, in conjunction with standard antineoplastic therapy, for the treatment of osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma.

Approval Year

TargetsConditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
PAMIDRONATE DISODIUM

Approved Use

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. Vigorous saline hydration, an integral part of hypercalcemia therapy, should be initiated promptly and an attempt should be made to restore the urine output to about 2 L/day throughout treatment. Mild or asymptomatic hypercalcemia may be treated with conservative measures (i.e., saline hydration, with or without loop diuretics). Patients should be hydrated adequately throughout the treatment, but overhydration, especially in those patients who have cardiac failure, must be avoided. Diuretic therapy should not be employed prior to correction of hypovolemia. The safety and efficacy of pamidronate disodium in the treatment of hypercalcemia associated with hyperparathyroidism or with other non-tumor-related conditions has not been established. Paget’s Disease Pamidronate disodium is indicated for the treatment of patients with moderate to severe Paget’s disease of bone. The effectiveness of pamidronate disodium was demonstrated primarily in patients with serum alkaline phosphatase ≥3 times the upper limit of normal. Pamidronate disodium therapy in patients with Paget’s disease has been effective in reducing serum alkaline phosphatase and urinary hydroxyproline levels by ≥50% in at least 50% of patients, and by ≥30% in at least 80% of patients. Pamidronate disodium therapy has also been effective in reducing these biochemical markers in patients with Paget’s disease who failed to respond, or no longer responded to other treatments. Osteolytic Bone Metastases of Breast Cancer and Osteolytic Lesions of Multiple Myeloma Pamidronate disodium is indicated, in conjunction with standard antineoplastic therapy, for the treatment of osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma. The pamidronate disodium treatment effect appeared to be smaller in the study of breast cancer patients receiving hormonal therapy than in the study of those receiving chemotherapy, however, overall evidence of clinical benefit has been demonstrated.

Launch Date

1991
Primary
PAMIDRONATE DISODIUM

Approved Use

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. Vigorous saline hydration, an integral part of hypercalcemia therapy, should be initiated promptly and an attempt should be made to restore the urine output to about 2 L/day throughout treatment. Mild or asymptomatic hypercalcemia may be treated with conservative measures (i.e., saline hydration, with or without loop diuretics). Patients should be hydrated adequately throughout the treatment, but overhydration, especially in those patients who have cardiac failure, must be avoided. Diuretic therapy should not be employed prior to correction of hypovolemia. The safety and efficacy of pamidronate disodium in the treatment of hypercalcemia associated with hyperparathyroidism or with other non-tumor-related conditions has not been established. Paget’s Disease Pamidronate disodium is indicated for the treatment of patients with moderate to severe Paget’s disease of bone. The effectiveness of pamidronate disodium was demonstrated primarily in patients with serum alkaline phosphatase ≥3 times the upper limit of normal. Pamidronate disodium therapy in patients with Paget’s disease has been effective in reducing serum alkaline phosphatase and urinary hydroxyproline levels by ≥50% in at least 50% of patients, and by ≥30% in at least 80% of patients. Pamidronate disodium therapy has also been effective in reducing these biochemical markers in patients with Paget’s disease who failed to respond, or no longer responded to other treatments. Osteolytic Bone Metastases of Breast Cancer and Osteolytic Lesions of Multiple Myeloma Pamidronate disodium is indicated, in conjunction with standard antineoplastic therapy, for the treatment of osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma. The pamidronate disodium treatment effect appeared to be smaller in the study of breast cancer patients receiving hormonal therapy than in the study of those receiving chemotherapy, however, overall evidence of clinical benefit has been demonstrated.

Launch Date

1991
Primary
PAMIDRONATE DISODIUM

Approved Use

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. Vigorous saline hydration, an integral part of hypercalcemia therapy, should be initiated promptly and an attempt should be made to restore the urine output to about 2 L/day throughout treatment. Mild or asymptomatic hypercalcemia may be treated with conservative measures (i.e., saline hydration, with or without loop diuretics). Patients should be hydrated adequately throughout the treatment, but overhydration, especially in those patients who have cardiac failure, must be avoided. Diuretic therapy should not be employed prior to correction of hypovolemia. The safety and efficacy of pamidronate disodium in the treatment of hypercalcemia associated with hyperparathyroidism or with other non-tumor-related conditions has not been established. Paget’s Disease Pamidronate disodium is indicated for the treatment of patients with moderate to severe Paget’s disease of bone. The effectiveness of pamidronate disodium was demonstrated primarily in patients with serum alkaline phosphatase ≥3 times the upper limit of normal. Pamidronate disodium therapy in patients with Paget’s disease has been effective in reducing serum alkaline phosphatase and urinary hydroxyproline levels by ≥50% in at least 50% of patients, and by ≥30% in at least 80% of patients. Pamidronate disodium therapy has also been effective in reducing these biochemical markers in patients with Paget’s disease who failed to respond, or no longer responded to other treatments. Osteolytic Bone Metastases of Breast Cancer and Osteolytic Lesions of Multiple Myeloma Pamidronate disodium is indicated, in conjunction with standard antineoplastic therapy, for the treatment of osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma. The pamidronate disodium treatment effect appeared to be smaller in the study of breast cancer patients receiving hormonal therapy than in the study of those receiving chemotherapy, however, overall evidence of clinical benefit has been demonstrated.

Launch Date

1991
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
1.92 μg/mL
90 mg single, intravenous
dose: 90 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
PAMIDRONATE DISODIUM plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
1.44 μg/mL
60 mg single, intravenous
dose: 60 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
PAMIDRONATE DISODIUM unknown
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
2.61 μg/mL
90 mg single, intravenous
dose: 90 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
PAMIDRONATE DISODIUM unknown
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
0.73 μg/mL
30 mg single, intravenous
dose: 30 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
PAMIDRONATE DISODIUM unknown
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
10.2 μg × h/mL
90 mg single, intravenous
dose: 90 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
PAMIDRONATE DISODIUM plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
28 h
60 mg single, intravenous
dose: 60 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
PAMIDRONATE DISODIUM unknown
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
28 h
90 mg single, intravenous
dose: 90 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
PAMIDRONATE DISODIUM unknown
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
28 h
30 mg single, intravenous
dose: 30 mg
route of administration: Intravenous
experiment type: SINGLE
co-administered:
PAMIDRONATE DISODIUM unknown
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
Doses

Doses

DosePopulationAdverse events​
5.6 mg/kg 3 times / day multiple, oral
Highest studied dose
Dose: 5.6 mg/kg, 3 times / day
Route: oral
Route: multiple
Dose: 5.6 mg/kg, 3 times / day
Sources:
unhealthy, adult
n = 9
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: M+F
Population Size: 9
Sources:
Disc. AE: Diarrhea...
AEs leading to
discontinuation/dose reduction:
Diarrhea
Sources:
120 mg/kg 1 times / day multiple, intravenous
Overdose
Dose: 120 mg/kg, 1 times / day
Route: intravenous
Route: multiple
Dose: 120 mg/kg, 1 times / day
Sources:
unhealthy, adult
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sources:
Disc. AE: Hypocalcemia...
AEs leading to
discontinuation/dose reduction:
Hypocalcemia
Sources:
285 mg/kg 1 times / day multiple, intravenous
Overdose
Dose: 285 mg/kg, 1 times / day
Route: intravenous
Route: multiple
Dose: 285 mg/kg, 1 times / day
Sources:
unhealthy, adult
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: F
Sources:
Disc. AE: Fever, Hypotension...
AEs leading to
discontinuation/dose reduction:
Fever
Hypotension
Taste perversion
Sources:
90 mg/kg 1 times / day single, intravenous
Recommended
Dose: 90 mg/kg, 1 times / day
Route: intravenous
Route: single
Dose: 90 mg/kg, 1 times / day
Sources:
unhealthy, adult
n = 182
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: M+F
Population Size: 182
Sources:
Disc. AE: Interstitial pneumonitis, Hypocalcemia...
AEs leading to
discontinuation/dose reduction:
Interstitial pneumonitis
Hypocalcemia
Bone pain
Sources:
AEs

AEs

AESignificanceDosePopulation
Diarrhea Disc. AE
5.6 mg/kg 3 times / day multiple, oral
Highest studied dose
Dose: 5.6 mg/kg, 3 times / day
Route: oral
Route: multiple
Dose: 5.6 mg/kg, 3 times / day
Sources:
unhealthy, adult
n = 9
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: M+F
Population Size: 9
Sources:
Hypocalcemia Disc. AE
120 mg/kg 1 times / day multiple, intravenous
Overdose
Dose: 120 mg/kg, 1 times / day
Route: intravenous
Route: multiple
Dose: 120 mg/kg, 1 times / day
Sources:
unhealthy, adult
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sources:
Fever Disc. AE
285 mg/kg 1 times / day multiple, intravenous
Overdose
Dose: 285 mg/kg, 1 times / day
Route: intravenous
Route: multiple
Dose: 285 mg/kg, 1 times / day
Sources:
unhealthy, adult
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: F
Sources:
Hypotension Disc. AE
285 mg/kg 1 times / day multiple, intravenous
Overdose
Dose: 285 mg/kg, 1 times / day
Route: intravenous
Route: multiple
Dose: 285 mg/kg, 1 times / day
Sources:
unhealthy, adult
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: F
Sources:
Taste perversion Disc. AE
285 mg/kg 1 times / day multiple, intravenous
Overdose
Dose: 285 mg/kg, 1 times / day
Route: intravenous
Route: multiple
Dose: 285 mg/kg, 1 times / day
Sources:
unhealthy, adult
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: F
Sources:
Bone pain Disc. AE
90 mg/kg 1 times / day single, intravenous
Recommended
Dose: 90 mg/kg, 1 times / day
Route: intravenous
Route: single
Dose: 90 mg/kg, 1 times / day
Sources:
unhealthy, adult
n = 182
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: M+F
Population Size: 182
Sources:
Hypocalcemia Disc. AE
90 mg/kg 1 times / day single, intravenous
Recommended
Dose: 90 mg/kg, 1 times / day
Route: intravenous
Route: single
Dose: 90 mg/kg, 1 times / day
Sources:
unhealthy, adult
n = 182
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: M+F
Population Size: 182
Sources:
Interstitial pneumonitis Disc. AE
90 mg/kg 1 times / day single, intravenous
Recommended
Dose: 90 mg/kg, 1 times / day
Route: intravenous
Route: single
Dose: 90 mg/kg, 1 times / day
Sources:
unhealthy, adult
n = 182
Health Status: unhealthy
Condition: hypercalcemia
Age Group: adult
Sex: M+F
Population Size: 182
Sources:
Overview

Overview

CYP3A4CYP2C9CYP2D6hERG

OverviewOther

Other InhibitorOther SubstrateOther Inducer




Drug as perpetrator​Drug as victim
Sourcing

Sourcing

Vendor/AggregatorIDURL
PubMed

PubMed

TitleDatePubMed
Bisphosphonates in multiple myeloma.
2001
Bisphosphonates for osteoporosis in people with cystic fibrosis.
2001
Incremental cost analysis of ambulatory clinic and home-based intravenous therapy for patients with multiple myeloma.
2001
The clinical and cost considerations of bisphosphonates in preventing bone complications in patients with metastatic breast cancer or multiple myeloma.
2001
Tumor 'flare' hypercalcemia--an additional indication for bisphosphonates?
2001
Chemical and biological prerequisites for novel bisphosphonate molecules: results of comparative preclinical studies.
2001 Apr
Intravenous bisphosphonate for hypercalcemia accompanying subcutaneous fat necrosis: a novel treatment approach.
2001 Apr
New advances in the biology and treatment of myeloma bone disease.
2001 Apr
Adjuvant bisphosphonate therapy: the future.
2001 Aug
Idiopathic orbital inflammation following intravenous pamidronate.
2001 Aug
Pamidronate in incident pain due to bone metastases.
2001 Aug
Scintigraphic evaluation of pamidronate and corticosteroid therapy in a patient with progressive diaphyseal dysplasia (Camurati-Engelmann disease).
2001 Aug
Pamidronate-related nephrotoxicity (tubulointerstitial nephritis) in a patient with osteolytic bone metastases.
2001 Dec
Structure-activity relationships for inhibition of farnesyl diphosphate synthase in vitro and inhibition of bone resorption in vivo by nitrogen-containing bisphosphonates.
2001 Feb
Primary prevention of glucocorticoid-induced osteoporosis with intravenous pamidronate and calcium: a prospective controlled 1-year study comparing a single infusion, an infusion given once every 3 months, and calcium alone.
2001 Jan
A newly developed bisphosphonate, YM529, is a potent apoptosis inducer of human myeloma cells.
2001 Jan
Pamidronate for bone pain from osteolytic lesions in Langerhans'-cell histiocytosis.
2001 Jul 19
Ocular adverse effects of alendronic acid.
2001 Jun
Collapsing focal segmental glomerulosclerosis following treatment with high-dose pamidronate.
2001 Jun
Osteogenesis imperfecta: lifelong management is imperative and feasible.
2001 Mar
Pamidronate increases markers of bone formation in patients with multiple myeloma in plateau phase under interferon-alpha treatment.
2001 May
Visualization of bisphosphonate-induced caspase-3 activity in apoptotic osteoclasts in vitro.
2001 May
Essential requirement of antigen presentation by monocyte lineage cells for the activation of primary human gamma delta T cells by aminobisphosphonate antigen.
2001 May 1
[Two cases of effective weekly paclitaxel administration for metastatic breast cancer].
2001 Nov
Bisphosphonates in the treatment of Charcot neuroarthropathy: a double-blind randomised controlled trial.
2001 Nov
Extracellular signal-regulated kinases and calcium channels are involved in the proliferative effect of bisphosphonates on osteoblastic cells in vitro.
2001 Nov
Antibacterial effect of human V gamma 2V delta 2 T cells in vivo.
2001 Nov
Targeting of tumor cells for human gammadelta T cells by nonpeptide antigens.
2001 Nov 1
Paget's disease of the spine and its management.
2001 Oct
A microcosting analysis of zoledronic acid and pamidronate therapy in patients with metastatic bone disease.
2001 Oct
Nitrogen-containing bisphosphonates induce apoptosis of Caco-2 cells in vitro by inhibiting the mevalonate pathway: a model of bisphosphonate-induced gastrointestinal toxicity.
2001 Oct
Pamidronate-induced remission of pain associated with hypertrophic pulmonary osteoarthropathy in chemoendocrine therapy-refractory inoperable metastatic breast carcinoma.
2001 Oct
Prevention of bone loss and fracture after lung transplantation: a pilot study.
2001 Oct 15
Hypercalcemia in patients with oral squamous cell carcinoma.
2001 Sep
Intravenous pamidronate reduces osteoporosis and improves formation of the regenerate during distraction osteogenesis. A study in immature rabbits.
2001 Sep
Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase III, double-blind, comparative trial.
2001 Sep-Oct
Bone mineral density response to long-term bisphosphonate therapy in fibrous dysplasia.
2001 Summer
Patents

Patents

Sample Use Guides

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.
Route of Administration: Intravenous
In Vitro Use Guide
Curator's Comment: Bone marrow stromal cells were isolated from the marrow aspirates obtained from the long/iliac bones, and cultured in medium supplemented with 1 ng/ml bFGF.
BMSCs proliferation was significantly inhibited with 10(−4) M Pamidronic acid (pamidronate) after 72h and 168h, and with 6 × 10(−5) M pamidronate after 168h. Alveolar osteoblasts cultured in osteogenic medium exhibited significantly lower alkaline phosphatase (AP) activities with 6 × 10(−5) M and 10(−4) M pamidronate (39% and 16% of the unsupplemented group) as compared to all lower concentration groups after 168h.
Name Type Language
PAMIDRONIC ACID
INN   MI   WHO-DD  
INN  
Official Name English
(3-AMINO-1-HYDROXYPROPYLIDENE)BISPHOSPHONIC ACID
Systematic Name English
DIHYDROGEN (3-AMINO-1-HYDROXYPROPYLIDENE)DIPHOSPHONATE
Systematic Name English
(3-AMINO-1-HYDROXYPROPYLIDENE)DIPHOSPHONIC ACID
Systematic Name English
PAMIDRONIC ACID [MI]
Common Name English
pamidronic acid [INN]
Common Name English
3-AMINO-1-HYDROXYPROPANE-1,1-DIPHOSPHONIC ACID
Systematic Name English
Pamidronic acid [WHO-DD]
Common Name English
PHOSPHONIC ACID, (3-AMINO-1-HYDROXYPROPYLIDENE)BIS-
Common Name English
PAMIDRONATE [VANDF]
Common Name English
PAMIDRONATE
MART.   VANDF  
Common Name English
RIBODROAT
Brand Name English
PAMIDRONATE [MART.]
Common Name English
Classification Tree Code System Code
NDF-RT N0000007707
Created by admin on Sat Dec 16 05:00:19 GMT 2023 , Edited by admin on Sat Dec 16 05:00:19 GMT 2023
NCI_THESAURUS C67439
Created by admin on Sat Dec 16 05:00:19 GMT 2023 , Edited by admin on Sat Dec 16 05:00:19 GMT 2023
NCI_THESAURUS C443
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WHO-VATC QM05BA03
Created by admin on Sat Dec 16 05:00:19 GMT 2023 , Edited by admin on Sat Dec 16 05:00:19 GMT 2023
LIVERTOX 735
Created by admin on Sat Dec 16 05:00:19 GMT 2023 , Edited by admin on Sat Dec 16 05:00:19 GMT 2023
NDF-RT N0000175579
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WHO-ATC M05BA03
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Code System Code Type Description
MESH
C019248
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PRIMARY
ChEMBL
CHEMBL834
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PRIMARY
INN
6305
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PRIMARY
WIKIPEDIA
Pamidronic acid
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PRIMARY
ECHA (EC/EINECS)
254-905-2
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PRIMARY
NCI_THESAURUS
C61875
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PRIMARY
EVMPD
SUB09598MIG
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PRIMARY
CAS
40391-99-9
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PRIMARY
LACTMED
Pamidronate
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PRIMARY
DAILYMED
OYY3447OMC
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PRIMARY
PUBCHEM
4674
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PRIMARY
EPA CompTox
DTXSID4023414
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PRIMARY
RXCUI
1546406
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PRIMARY
RXCUI
11473
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ALTERNATIVE
FDA UNII
OYY3447OMC
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PRIMARY
IUPHAR
7259
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PRIMARY
MERCK INDEX
m8374
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PRIMARY Merck Index
SMS_ID
100000092288
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PRIMARY
DRUG CENTRAL
2048
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PRIMARY
DRUG BANK
DB00282
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PRIMARY