Pamidronate
Pamidronate disodium
Also known as: Aredia · Pamidronate disodium · Pamidronic acid
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypercalcaemia / Bone tumour pain | 0.65-2 mg/kg (typically 1 mg/kg) slow infusion with NaCl 0.9% over 2-4 hours | IV | q28days if required | As needed | 🌍 EU |
| Cholecalciferol-induced toxicosis | 0.65-2 mg/kg (typically 1 mg/kg) slow infusion with NaCl 0.9% over 2-4 hours | IV | On days 1 and 4 post-ingestion | 2 doses | 🌍 EU |
- Hypercalcaemia / Bone tumour pain: Some clinicians advocate 0.9% NaCl i.v. for 2 hours before and after the infusion.
- Cholecalciferol-induced toxicosis: Some clinicians advocate 0.9% NaCl i.v. for 2 hours before and after the infusion.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypercalcaemia | 1.0-2.0 mg/kg slow (over 4 hours) infusion | IV | Single dose | Over 4 hours | 🌍 EU |
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Pamidronate is a bisphosphonate medication primarily used in veterinary medicine for the management of hypercalcaemia, particularly when associated with vitamin D toxicosis (e.g., cholecalciferol rodenticide ingestion) or hypercalcaemia of malignancy.
Clinical Warning: Pamidronate can cause renal toxicity and is contraindicated in patients with pre-existing renal dysfunction. Adequate hydration is essential during administration.
Clinical Pearl: In addition to treating hypercalcaemia, pamidronate is frequently utilized as an adjunctive analgesic to manage pain associated with malignant osteolysis and bone tumours (such as osteosarcoma) in dogs.
Mechanism of action
Pamidronate binds strongly to hydroxyapatite crystals in the bone matrix. It inhibits osteoclast activity and induces osteoclast apoptosis → decreases bone resorption → lowers serum calcium concentrations and reduces osteolytic bone destruction and associated pain.
Safety & warnings
Contraindications
- Renal dysfunction
Adverse effects
- Renal toxicity
- Nausea
- Diarrhoea
- Hypocalcaemia
- Hypophosphataemia
- Hypomagnesaemia
- Hypersensitivity reactions
- Ophthalmic syndromes (reported in humans)
- Bone pain (reported in humans)
- Electrolyte abnormalities (reported in humans)
- Blood dyscrasias (reported in humans)
Precautions
Normal handling precautions should be observed. Adequate hydration is critical. Monitor renal parameters (BUN, creatinine) and serum electrolytes (calcium, phosphorus, magnesium) closely. Administer strictly as a slow intravenous infusion (over 2-4 hours) diluted in 0.9% NaCl to minimize nephrotoxicity.
Drug interactions
Concurrent use may result in severe hypocalcaemia
Increased risk of renal toxicity; use with caution
Monitoring
- Serum calcium (ionized and total)
- Serum phosphorus
- Serum magnesium
- Renal function panel (BUN, Creatinine, USG)
- Hydration status
Pharmacokinetics
Absorption
Administered intravenously; 100% bioavailability.
Distribution
Rapidly partitions to bone, binding to hydroxyapatite crystals.
Metabolism
Not metabolized.
Elimination
Excreted unchanged primarily via the kidneys.
Overdose
Overdosage may lead to severe hypocalcaemia, hypophosphataemia, and hypomagnesaemia, as well as acute renal failure. Treatment is supportive, including intravenous fluids and electrolyte supplementation (e.g., calcium gluconate) as dictated by serum monitoring.
Available products
Formulations
- 15 mg powder for reconstitution (injectable)
- 30 mg powder for reconstitution (injectable)
- 90 mg powder for reconstitution (injectable)
Human-labeled
- Aredia 15 mg powder for reconstitution
- Aredia 30 mg powder for reconstitution
- Aredia 90 mg powder for reconstitution
Regulatory status
Human authorized product used off-label under the cascade (POM).
Human authorized product used off-label under the cascade (POM).
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store intact vials at room temperature. Reconstituted solutions should be diluted in 0.9% NaCl and used according to manufacturer guidelines, typically within 24 hours if refrigerated.
Client information
Pamidronate is administered as a slow intravenous drip at the veterinary hospital.
- It is used to treat dangerously high blood calcium levels or to help relieve pain from bone cancer.
- Because it can affect the kidneys and blood salt levels, your veterinarian will likely recommend blood tests before and after treatment to monitor kidney function, calcium, and phosphorus levels.
- Let your vet know immediately if your pet experiences vomiting, diarrhea, muscle twitching, or extreme lethargy after treatment.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.