COMBINATION OF CALCITONIN AND PAMIDRONATE FOR EMERGENCY TREATMENT OF MALIGNANT HYPERCALCEMIA

To combine the rapid hypocalcemic effects of calcitonin with the delay ed effects of pamidronate, a combination of a single dose of pamidrona te and serial doses of eel calcitonin was administered to five patient s with malignant hypercalcemia for 2 to 5 days. The serum calcium leve ls of all five patients fell within 24 h after administration of pamid ronate and the first dose of calcitonin and decreased to normal within 4 days. The mean level of corrected serum calcium fell from 15.3 mg/d l (range 14.1-16.4) to 9.2 mg/dl (8.9-9.6) at the nadir. No toxicity o r side effects were found. The results of this study demonstrate the v alue of combining the rapidly acting antiresorptive and renal calciure tic effects of calcitonin with the slower, but more potent effects of pamidronate. The combination of-calcitonin and pamidronate allowed rap id, long-term control of hypercalcemia and it is regarded as the first choice of treatment in severe hypercalcemia.