Pamidronic acid

{{Drugbox

| verifiedrevid = 476996826

| IUPAC_name = (3-amino-1-hydroxypropane-1,1-diyl)bis(phosphonic acid)

| image = Pamidronic acid.svg

| synonyms = Pamidronate disodium pentahydrate, pamidronate disodium

| tradename = Aredia, Pamimed, among others

| Drugs.com = {{drugs.com|international|pamidronic-acid}}

| MedlinePlus = a601163

| pregnancy_AU = B3

| pregnancy_US = D

| legal_AU =

| legal_UK = POM

| legal_US = Rx-only

| routes_of_administration = Intravenous

| bioavailability = n/a

| protein_bound = 54%

| metabolism = Nil

| elimination_half-life = 28 ± 7 hours

| excretion = Renal

| IUPHAR_ligand = 7259

| CAS_number_Ref = {{cascite|correct|??}}

| CAS_number = 40391-99-9

| ATC_prefix = M05

| ATC_suffix = BA03

| PubChem = 4674

| DrugBank_Ref = {{drugbankcite|correct|drugbank}}

| DrugBank = DB00282

| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}

| ChemSpiderID = 4512

| UNII_Ref = {{fdacite|correct|FDA}}

| UNII = OYY3447OMC

| KEGG_Ref = {{keggcite|correct|kegg}}

| KEGG = D07281

| ChEMBL_Ref = {{ebicite|correct|EBI}}

| ChEMBL = 834

| C=3 | H=11 | N=1 | O=7 | P=2

| smiles = O=P(O)(O)C(O)(CCN)P(=O)(O)O

| StdInChI_Ref = {{stdinchicite|correct|chemspider}}

| StdInChI = 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)

| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}

| StdInChIKey = WRUUGTRCQOWXEG-UHFFFAOYSA-N

}}

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

It was patented in 1971 and approved for medical use in 1987.{{cite book | vauthors = Fischer J, Ganellin CR |title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=9783527607495 |page=523 |url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA523 |language=en}}

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.{{cite journal | vauthors = Kubalek I, Fain O, Paries J, Kettaneh A, Thomas M | title = Treatment of reflex sympathetic dystrophy with pamidronate: 29 cases | journal = Rheumatology | volume = 40 | issue = 12 | pages = 1394–1397 | date = December 2001 | pmid = 11752511 | doi = 10.1093/rheumatology/40.12.1394 | doi-access = free }}

=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.{{cite journal | vauthors = Zarychanski R, Elphee E, Walton P, Johnston J | title = Osteonecrosis of the jaw associated with pamidronate therapy | journal = American Journal of Hematology | volume = 81 | issue = 1 | pages = 73–75 | date = January 2006 | pmid = 16369966 | doi = 10.1002/ajh.20481 | s2cid = 11830192 | doi-access = free }}

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

Pharmacology

class="wikitable"

|+Relative potency{{Cite book|title=Essentials of medical pharmacology| vauthors = Tripathi KD |isbn=9789350259375|edition= Seventh|location=New Delhi | publisher = Jaypee Brothers Medical Publishers Pvt. Limited |oclc=868299888|date = 2013-09-30}}

!Bisphosphonate

!Relative potency

Etidronate

Tiludronate

|10

Pamidronate

|100

Alendronate

|100-500

Ibandronate

|500-1000

Risedronate