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pamidronate disodium for injection usp 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 for injection usp 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 for injection usp in the treatment of hypercalcemia associated with hyperparathyroidism or with other non tumor related conditions has not been established pamidronate disodium for injection usp is indicated for the treatment of patients with moderate to severe paget s disease of bone the effectiveness of pamidronate disodium for injection usp was demonstrated primarily in patients with serum alkaline phosphatase 3 times the upper limit of normal pamidronate disodium for injection usp therapy in patients with paget s disease has been effective in reducing serum alkaline phosphatase and urinary hydroxyproline levels by 5 in at least 5 of patients and by 3 in at least 8 of patients pamidronate disodium for injection usp 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 pamidronate disodium for injection usp 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 for injection usp 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 see clinical pharmacology osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma clinical trials
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