This section gives an overview of the commonly used drugs (excluding opioids) to manage symptoms in patients with terminal illnesses. The information includes basic dosage information as well as indications for use and potential side effects. Please note that non-opioid drugs commonly used in palliative care in Singapore are shown here but the list is NOT exhaustive and neither are the side effects nor indications. Doses are for adults only. Please check with pharmacy colleagues for dose adjustments (if any) in renal or liver impairment. Unless otherwise indicated, use water for injection for dilution in continuous subcutaneous infusions.
*For information on opioids, please search and refer to the drugs with their given context.
Pamidronate
Route, Dosage and Frequency
ROUTE
|
DOSAGE AND FREQUENCY
|
| IV |
30-90mg in 500ml 0.9% saline over 2-4h |
Other Information
Indications
Reduction of skeletal events from bony metastasis (including bone pain), Hypercalcemia.
Side-Effects
Transient pyrexia and flu-like symptoms, Fatigue, Headache, Renal impairment, Jaw osteonecrosis (if long term use, poor dental health or dental procedures during treatment with Pamidronate).
Remarks
Takes 5-7days to produce maximal effect which lasts 2 to 3 weeks. Repeat every 3-4weeks as long as benefit maintained for bone pain; repeat in a week if calcium levels not better. Reduce dose in renal impairment. Add oral supplements of elemental calcium and Vit D unless treated for hypercalcaemia.
Reference
- Watson M. Oxford Handbook of Palliative Care. Oxford, NY: Oxford University Press; 2009.