BISPHOSHONATES: PAMIDRONATE DISODIUM (AREDIA®), ALENDRONIC ACID (FOSAMAX®), IBANDRONATE, ZOLENDRONATE (ZOMETA®), RISEDRONATE SODIUM (ACTONEL®), CLODRONATE (BONEFOS®), ETIDRONATE DISODIUM (DIDROCAL®) AND OLPADRONATE
BISPHOSHONATES: PAMIDRONATE
DISODIUM (AREDIA®), ALENDRONIC ACID (FOSAMAX®),
IBANDRONATE, ZOLENDRONATE (ZOMETA®), RISEDRONATE SODIUM (ACTONEL®),
CLODRONATE (BONEFOS®), ETIDRONATE DISODIUM (DIDROCAL®)
AND OLPADRONATE
Pamidronate
disodium (3-amino-1-hydroxy propy-lidene, disodium salt pentahydrate) inhibits
bone resorption in the management of hypercalcemia of malignancy, osteolytic
bone metastases of both breast cancer and multiple myeloma and Paget’s disease
of the bone.
This
class of drug has been reported to cause anterior uveitis and non-specific
conjunctivitis. There are case reports of episcleritis, nerve palsy, ptosis,
retrobulbar neuritis and yellow vision. We previously reported a case of
anterior scleritis and a case of poste-rior scleritis associated with
pamidronate use, with-out rechallenge data. The most studied drug in this
class, pamidronate, has caused 17 cases of unilateral scleritis and one case of
bilateral scleritis. Onset is usually within 6–48 h of intravenous drug
adminis-tration. Six patients had positive rechallenge testing, with scleritis
recurring after repeat drug exposure. Other ocular side effects with positive
rechallenge data include blurred vision, non-specific conjunc-tivitis, ocular
pain, bilateral anterior uveitis and episcleritis.
• Blurred vision
• Ocular irritation
• Non-specific conjunctivitis
• Pain
• Epiphoria
• Photophobia
• Anterior uveitis (rare – posterior)
• Anterior scleritis (rare – posterior)
• Episcleritis
• Periocular, lid and/or orbital edema
• Retrobulbar neuritis
• Yellow vision
• Diplopia
• Cranial nerve palsy
• Ptosis
• Visual hallucinations
This
is the only class of drug proven to cause scle-ritis. Bisphosphonates can cause
vision-threatening diseases. The seriousness of these conditions may dictate
discontinuation of the drug in some uveitis cases and, in this series, all
cases of scleritis. Further guidelines are as follows:
• If there is ocular pain or persistent
decrease in vision, the patient should see an ophthalmologist.
• Bilateral anterior uveitis or, rarely,
posterior or bilateral uveitis may occur and can vary markedly in severity.
Many cases require intensive topical ocular or systemic medication. In some
instances, the drug must be discontinued for the uveitis to resolve.
• Episcleritis may require topical ocular
medication; however, pamidronate may be continued.
• In this series, for the scleritis to resolve,
even on full medical therapy, the intravenous pamidronate had to be
discontinued.
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