Pamidronic acid

Pamidronic acid or pamidronate disodium or APD (marketed as Aredia among others), is a nitrogen-containing bisphosphonate used to prevent osteoporosis.

Pamidronic acid
Clinical data
Trade namesAredia, Pamimed, among others
Other namesPamidronate disodium pentahydrate, pamidronate disodium
AHFS/Drugs.comInternational Drug Names
MedlinePlusa601163
Pregnancy
category
  • AU: B3
Routes of
administration		Intravenous
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailabilityn/a
Protein binding54%
MetabolismNil
Elimination half-life28 ± 7 hours
ExcretionRenal
Identifiers
IUPAC name
  • (3-amino-1-hydroxypropane-1,1-diyl)bis(phosphonic acid)
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.049.897
Chemical and physical data
FormulaC3H11NO7P2
Molar mass235.069 g·mol−1
3D model (JSmol)
SMILES
  • O=P(O)(O)C(O)(CCN)P(=O)(O)O
InChI
  • 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) Y
  • Key:WRUUGTRCQOWXEG-UHFFFAOYSA-N Y
  (verify)

It was patented in 1971 and approved for medical use in 1987.[1]

Medical uses

It is used to prevent bone loss, and treat osteoporosis. It is also used to strengthen bone in Paget's disease, to prevent bone loss due to steroid use, and in certain cancers with high propensity to bone, such as multiple myeloma. Due to its ability to sequester calcium in bone, it is also used to treat high calcium levels. It is also used as an experimental treatment of the bone disorder osteogenesis imperfecta. It has been studied in the treatment of complex regional pain syndrome.[2]

Administration

Intravenous, usually 90 mg monthly. 30 mg, 60 mg, 90 mg and for hospitals, 120 mg vials are available, mixed with mannitol.

Side effects

Common side effects include bone pain, low calcium levels, nausea, and dizziness. Osteonecrosis of the jaw is a rare complication which has been associated with the use of bisphosphonates, including pamidronate.[3]

Pamidronate activates human γδ T cells in vitro and in vivo, which may lead to flu-like symptoms upon administration.

Pharmacology
Relative potency[4]
Bisphosphonate Relative potency
Etidronate 1
Tiludronate 10
Pamidronate 100
Alendronate 100-500
Ibandronate 500-1000
Risedronate 1000
Zoledronate 5000

References
  1. Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 523. ISBN 9783527607495.
  2. I. Kubalek; O. Fain; J. Paries; A. Kettaneh; M. Thomas (2001). "Treatment of reflex sympathetic dystrophy with pamidronate: 29 cases". Rheumatology. 40 (12): 1394–1397. doi:10.1093/rheumatology/40.12.1394. PMID 11752511.
  3. Zarychanski R, Elphee E, Walton P, Johnston J (2006). "Osteonecrosis of the jaw associated with pamidronate therapy". Am J Hematol. 81 (1): 73–5. doi:10.1002/ajh.20481. PMID 16369966. S2CID 11830192.
  4. D., Tripathi, K. (2013-09-30). Essentials of medical pharmacology (Seventh ed.). New Delhi. ISBN 9789350259375. OCLC 868299888.


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