Intravenous Pamidronate in Pagets Disease

Wirral Hospital NHS Trust

Protocol for Rheumatology Daycase Patients

Dose

Disodium Pamidronate 90mg to be given by IV infusion on TWO occasions with a two week interval.

On Admission

1. Check that the daycase card or patient notes do not indicate that a medical review is required.
2. Check blood investigations:
1. Fbc
2. Urea and Electrolytes
3. Calcium and Phosphate levels
   These should be done within one month prior to the first infusion (will usually have been done in OPD)
   If blood results are outside normal parameters, medical staff should be contacted.
3. Pamidronate prescribed by medical staff on IV card or PCIS.
4. Monitor pulse and blood pressure before and after infusion. If abnormal contact medical staff for advice.
   

Infusion

Disodium Pamidronate 90mg to be dissolved in 10ml water for injection.
Add to 500ml normal saline 0.9%.
Infuse over 2 hours.

Side Effects/Patient Advice

1. May experience fever and flu like symptoms within the first 24-48 hours.
   Experience within the ward suggests that if this occurs it is usually with the first infusion only.
2. Flushing
3. Nausea and less commonly vomiting
4. May develop local infusion site reaction
   

Follow Up

1. Home after 1 hour following end of infusion if well and pulse and blood pressure satisfactory.
2. Consider keeping patient in for a few extra hours if unwell. Contact medical staff if in any doubt.
3. Arrange further admission in 2 weeks (total of 2 infusions to be administered only)
4. Arrange OPD review after 2nd infusion

Document Information
Expiry Date: 11/04/04
Author: Richards, Sue. Sr
Organisation: Wirral Hospital Trust