To combine the rapid hypocalcemic effects of calcitonin with the delayed effects of pamidronate, a combination of a single dose of pamidronate and serial doses of eel calcitonin was administered to five patients with malignant hypercalcemia for 2 to 5 days. The serum calcium levels of all five patients fell within 24 h after administration of pamidronate 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/dl (range 14.1-16.4 ) to 9.2 mg/dl (8.9-9. 6) at the nadir. No toxicity or side effects were found. The results of this study demonstrate the value of combining the rapidly acting antiresorptive and renal calciuretic effects of calcitonin with the slower, but more potent effects of pamidronate. The combination of calcitonin and pamidronate allowed rapid, long-term control of hypercalcemia and it is regarded as the first choice of treatment in severe hypercalcemia.

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