Protocol for the administration of Pamidronate Infusions in paediatric Rheumatology

NHS Scotland Protocol for the administration of Pamidronate Infusions in paediatric Rheumatology 

Pamidronate is a bisphosphonate drug (2nd generation) used to treat conditions associated with osteoporosis, multiple fractures and bone pain. Bisphosphonates bind strongly to bone mineral and interfere with bone remodelling by slowing the process of osteoclastic bone resorption and bone turnover.

Indications for use in rheumatology

• Chronic recurrent multifocal osteomyelitis (CRMO) - symptomatic relief (pain) and anti-inflammatory effect *
• SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) - symptomatic relief (pain) and anti-inflammatory effect
• Severe osteoporosis associated with active inflammatory disease or steroid use - aim is to reduce long term fracture risk and improve bone health.

* Hypophosphatasia can mimic CRMO and can be exacerbated by Bisphosphonates. Always ensure Alkaline Phosphatase (ALP) is not below normal limits for age.

Caution must be used if child has renal impairment. Pamidronate should not be given if creatinine clearance <30mL/min/1.73m2. Patients should be well hydrated pre pamidronate and not receiving aminoglycoside antibiotics.