帕米膦酸二鈉
Pamidronate Disodium
Pamidronate disodium
別名: Aredia · Aminomux · Aredronet · Ostepam · Pamidran · ADP sodium · AHPrBP sodium · GCP23339A
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Refractory hypercalcemia | 1 mg/kg IV given over 2 hours in 250 mL of normal saline | IV | every 4 weeks | — | 🌎 NA |
| 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 | — | 🌎 NA |
| Treatment of cholecalciferol-induced toxicosis | 0.65-2 mg/kg in 0.9% NaCl | IV | on days 1 and 4 post-ingestion | — | 🌎 NA |
| 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 | — | 🌎 NA |
| Pain associated with skeletal neoplasias | 1-2 mg/kg IV over 2 hours | IV | every 21-28 days | — | 🌎 NA |
| Calcipotriene toxicosis | 1.3-2 mg/kg slow IV infusion | IV | single dose | — | 🌎 NA |
| Control of hypercalcemia | 1.05-2 mg/kg IV over 4 hours | IV | — | — | 🌎 NA |
- Control of hypercalcemia: Consider if parenteral saline, furosemide and corticosteroids do not resolve the issue.
- Pain associated with skeletal neoplasias: Has been shown to provide pain relief in ~50% of dogs with skeletal neoplasia.
- Calcipotriene toxicosis: 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: From a retrospective study of 7 dogs.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Control of hypercalcemia | 1.5-2 mg/kg IV over 4 hours | IV | — | — | 🌎 NA |
- Control of hypercalcemia: From a retrospective study of 2 cats.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
帕米膦酸二鈉 (Pamidronate disodium) 是一種第二代含氮雙膦酸鹽類藥物，在獸醫學中主要用於治療嚴重或難治性高血鈣症，特別是與惡性腫瘤（如淋巴瘤或頂泌腺肛門囊腺癌）及維生素D類似物中毒（如膽鈣化醇殺鼠劑、卡泊三醇）相關的高血鈣症。
主要臨床應用包括：
- 高血鈣症管理：當標準療法（靜脈注射生理食鹽水、呋塞米、皮質類固醇）效果不佳時，能迅速降低危險的高血清鈣濃度。
- 骨肉瘤與骨骼腫瘤：被研究作為輔助治療以直接針對微小轉移，並廣泛用作姑息治療藥物，以減輕與溶骨性病變相關的嚴重骨痛。
臨床要點：由於帕米膦酸二鈉是強效的骨吸收抑制劑，其對血清鈣的影響深遠且持久。必須將其稀釋於不含鈣的晶體溶液中，並進行緩慢的靜脈輸注（通常歷時 2 至 4 小時），以盡量降低急性腎毒性的風險。
作用機制
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.
安全性與警告
禁忌症
- Hypersensitivity to pamidronate or other bisphosphonates
- Severe renal impairment (use with extreme caution; not tested in humans with serum creatinine > 5 mg/dL)
不良反應
- 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)
注意事項
Important Warnings and Precautions:
- Renal Toxicity: Pamidronate can cause acute renal failure. The risk is minimized by ensuring adequate patient hydration and infusing the drug slowly over at least 2 to 4 hours.
- Fluid Compatibility: Do NOT mix with any intravenous fluid containing calcium (e.g., Lactated Ringer's). Must be diluted in 0.9% NaCl, 0.45% NaCl, or D5W.
- Pregnancy: FDA Category D. Has produced maternal and embryo/fetal toxicity in laboratory animals. Use only if benefits outweigh risks, with informed owner consent.
- Nursing: Unknown if excreted in milk; use with caution.
- Electrolyte Shifts: Can cause profound hypocalcemia and hypomagnesemia. Baseline and post-infusion monitoring is critical.
藥物相互作用
Can affect calcium levels; requires careful monitoring when used concurrently.
Potential for increased risk of nephrotoxicity; use with caution.
監測
- 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
藥物動力學
吸收
After intravenous infusion, 50-60% of the dose is rapidly absorbed by bone. Bone uptake is highest in areas of rapid bone turnover.
分佈
Highly localized to bone tissue.
代謝
Not significantly metabolized.
排除
The kidneys very slowly eliminate the drug.
過量
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.
可用產品
劑型
- Lyophilized Powder for Injection
- Injection solution
人用標示
- Pamidronate Disodium Lyophilized Powder for Injection: 30 mg & 90 mg (with mannitol)
- Pamidronate Disodium Injection: 3 mg/mL, 6 mg/mL & 9 mg/mL in 10 mL vials
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Do not store at temperatures greater than 30°C (86°F). Once the lyophilized powder is reconstituted with sterile water, it may be stored in the refrigerator for 24 hours. Ensure complete dissolution before use. Do not mix with calcium-containing fluids (e.g., Ringer's).
飼主須知
寵物主人指引：
- 需要住院：此藥物必須在獸醫院內給藥。為了保護您寵物的腎臟，藥物會以非常緩慢的靜脈點滴方式輸入，通常需要 2 到 4 小時。
- 用途：帕米膦酸二鈉能非常有效地降低危險的高血鈣濃度（通常由某些癌症或毒素引起），並能顯著緩解與骨腫瘤（如骨肉瘤）相關的嚴重骨痛。
- 監測：在每次治療前，您的獸醫需要進行血液和尿液檢查，以確保寵物的腎臟功能良好，並檢查電解質（如鈣和鎂）的濃度。
- 費用：由於這是一種需要密集監測和緩慢靜脈輸注的專業人類醫院用藥，飼主應對藥物及相關住院照護的費用有所準備。
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