파미드론산 이나트륨

비스포스포네이트계

**파미드론산 이나트륨(Pamidronate disodium)**은 수의학에서 주로 악성 종양(예: 림프종 또는 아포크린선 항문낭 선암종) 및 비타민 D 유사체 중독(예: 콜레칼시페롤 살서제, 칼시포트리엔)과 관련된 중증 또는 난치성 **고칼슘혈증**을 관리하는 데 사용되는 2세대 질소 함유 비스포스포네이트계 약물입니다. 주요 임상 적용: * **고칼슘혈증 관리**: 표준 치료(정맥 생리식염수, 푸로세마이드, 코르티코스테로이드)가 불충분할 때 위험할 정도로 높은 혈청 칼슘 수치를 빠르게 낮춥니다. * **골육종 및 골격계 종양**: 미세 전이를 직접 표적으로 하는 보조 치료제로 연구되고 있으며, 골용해성 병변과 관련된 심각한 뼈 통증을 줄이기 위한 완화제로 널리 사용됩니다. > **임상 요점**: 파미드론산은 강력한 골흡수 억제제이므로 혈청 칼슘에 미치는 영향이 크고 오래 지속됩니다. 급성 신독성의 위험을 최소화하기 위해 칼슘이 없는 수액에 희석하여 천천히(일반적으로 2~4시간에 걸쳐) 정맥 주입해야 합니다.

작용 기전: Pamidronate is a nitrogen-containing bisphosphonate that strongly binds to **hydroxyapatite crystals** in the bone matrix, specifically targeting areas of active bone turnover. * **Inhibition of Bone Resorption**: Once internalized by osteoclasts during bone resorption, pamidronate inhibits the enzyme **farnesyl pyrophosphate synthase (FPPS)** in the mevalonate pathway. * **Osteoclast Apoptosis**: Inhibition of FPPS prevents the prenylation of small GTPase proteins (like **Ras** and **Rho**) → disruption of osteoclast cytoskeletal function and ruffled border formation → **induction of osteoclast apoptosis**. * **Antineoplastic Effects**: In vitro, it exhibits direct cytotoxic and cytostatic effects on human osteosarcoma cell lines, potentially exerting antiangiogenic effects and inhibiting tumor cell migration.

동물 종별 용량

Cats

Control of hypercalcemia · 1.5-2 mg/kg IV over 4 hours · IV · From a retrospective study of 2 cats.

Dogs

Refractory hypercalcemia · 1 mg/kg IV given over 2 hours in 250 mL of normal saline · IV · every 4 weeks
Control of hypercalcemia · 1.32 mg/kg in 150 mL of 0.9% saline with a 2 hour IV infusion · IV · can repeat in 1-3 weeks · Consider if parenteral saline, furosemide and corticosteroids do not resolve the issue.
Treatment of cholecalciferol-induced toxicosis · 0.65-2 mg/kg in 0.9% NaCl · IV · on days 1 and 4 post-ingestion
Attempting to reduce bone pain associated with osteosarcoma in combination with an NSAID · 1-2 mg/kg; diluted into 250 mL of 0.9% sodium chloride and administered as a CRI over 2 hours · IV · every 28 days
Pain associated with skeletal neoplasias · 1-2 mg/kg IV over 2 hours · IV · every 21-28 days · Has been shown to provide pain relief in ~50% of dogs with skeletal neoplasia.
Calcipotriene toxicosis · 1.3-2 mg/kg slow IV infusion · IV · single dose · In most cases, a single dose will lower calcium levels back to normal. Monitor calcium daily for at least 10 days after returning to normal.
Control of hypercalcemia · 1.05-2 mg/kg IV over 4 hours · IV · From a retrospective study of 7 dogs.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

Hypersensitivity to pamidronate or other bisphosphonates
Severe renal impairment (use with extreme caution; not tested in humans with serum creatinine > 5 mg/dL)

이상반응

Electrolyte abnormalities (hypomagnesemia, hypocalcemia, hypophosphatemia)
Cardiac arrhythmias (secondary to electrolyte shifts)
Renal toxicity (especially with rapid infusion)
Transient bone pain
Anemia
Thrombocytopenia
Granulocytosis
Ophthalmic syndromes (e.g., scleritis - reported in humans)

약물 상호작용

Calcium-affecting drugs (e.g., furosemide, corticosteroids) · Can affect calcium levels; requires careful monitoring when used concurrently.
Nephrotoxic drugs (e.g., cisplatin, aminoglycosides) · Potential for increased risk of nephrotoxicity; use with caution.

모니터링

Renal function (serum creatinine, BUN) and hydration status before treatment and prior to each dose
Serum calcium (ionized preferred), phosphate, magnesium, and potassium
CBC (baseline and continued if ongoing treatment)
Urinalysis

과용량

Overdosage of pamidronate may cause profound **hypocalcemia**, which can manifest clinically as muscle tremors, facial rubbing, seizures, or **tetany**. * **Treatment**: Should severe hypocalcemia occur, treat immediately with short-term, intravenous calcium supplementation (e.g., calcium gluconate) while monitoring the ECG.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.