Is Pamidronate Disodium compatible with breastfeeding? Do we have alternatives for Pamidronate Disodium?

Pamidronate Disodium

November 1, 2015 (Very Low Risk)

It is composed by bisphosphonates

Most bisphosphonates are acidic compounds that achieve low plasma concentration. Both features make it unlikely excretion into the milk in clinically significant amount.

Intestinal absorption of bisphosphonates is very low even during fasting and is considered negligible in the presence of milk due to formation with the calcium of non absorbable compounds.

Pamidronate is excreted into breast milk in clinically insignificant amount and no problems have been observed in infants whose mothers were treated, except some cases of mild and asymptomatic hypocalcemia in infants whose mothers had been already treated before and / or during pregnancy, so some authors suggest regular monitoring of serum calcium.

Alternatives

We do not have alternatives for Pamidronate Disodium since it is relatively safe.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Pamidronic Acid

Writings

  • Παμιδρονικό Δινάτριο (Greek)
  • حمض باميدرونيك (Arabic)
  • Динатрий Памидронат (Cyrillic)
  • 帕米膦酸 (Chinese)
  • パミドロン酸 (Japanese)
  • C3H9NNa2O7P2,5H2O (Molecular formula)

References

  1. Green SB, Pappas AL. Effects of maternal bisphosphonate use on fetal and neonatal outcomes. Am J Health Syst Pharm. 2014Abstract
  2. Stathopoulos IP, Liakou CG, Katsalira A, Trovas G, Lyritis GG, Papaioannou NA, Tournis S. The use of bisphosphonates in women prior to or during pregnancy and lactation. Hormones (Athens). 2011Abstract Full text (link to original source) Full text (in our servers)
  3. Shenker NG, Shaikh MF, Jawad AS. Transient osteoporosis associated with pregnancy: use of bisphosphonate in treating a lactating mother. BMJ Case Rep. 2010Abstract Full text (link to original source) Full text (in our servers)
  4. Mastaglia SR, Watman NP, Oliveri B. Intravenous bisphosphonate treatment and pregnancy: its effects on mother and infant bone health. Osteoporos Int. 2010Abstract
  5. Hassen-Zrour S, Korbâa W, Béjia I, Saidani Z, Bergaoui N. Maternal and fetal outcome after long-term bisphosphonate exposure before conception. Osteoporos Int. 2010Abstract
  6. Chan B, Zacharin M. Maternal and infant outcome after pamidronate treatment of polyostotic fibrous dysplasia and osteogenesis imperfecta before conception: a report of four cases. J Clin Endocrinol Metab. 2006Abstract Full text (link to original source) Full text (in our servers)
  7. Munns CF, Rauch F, Ward L, Glorieux FH. Maternal and fetal outcome after long-term pamidronate treatment before conception: a report of two cases. J Bone Miner Res. 2004Abstract Full text (link to original source) Full text (in our servers)
  8. French AE, Kaplan N, Lishner M, Koren G. Taking bisphosphonates during pregnancy. Can Fam Physician. 2003Abstract Full text (link to original source) Full text (in our servers)
  9. Siminoski K, Fitzgerald AA, Flesch G, Gross MS. Intravenous pamidronate for treatment of reflex sympathetic dystrophy during breast feeding. J Bone Miner Res. 2000Abstract Full text (link to original source) Full text (in our servers)