pamidronate disodium
Pamidronate is a prescription injection used to treat certain cancers that have spread to the bones. It’s also FDA approved to treat high calcium levels caused by cancer and a bone condition called Paget’s disease. You receive it as an intravenous (IV) injection, usually once a month or sometimes as a one-time dose, depending on your condition. Side effects include fever, nausea, and a rare but serious risk called osteonecrosis of the jaw (ONJ).
What is Pamidronate?
What is Pamidronate used for?
- High calcium levels in the blood due to cancer (hypercalcemia of malignancy)
- Paget’s disease
- Bone damage caused by breast cancer that’s spread to the bones
- Bone damage caused by multiple myeloma
How Pamidronate works
Pamidronate is a bisphosphonate. It works by blocking bone cells called osteoclasts, which break down bone. Some cancers and conditions like Paget’s disease can cause your bones to break down too quickly. This medication helps slow that process so your bones stay stronger.
If you have high calcium levels from cancer, pamidronate lowers the amount of calcium in your blood by reducing how much calcium is released from your bones. This can help prevent problems caused by high calcium levels.
Drug facts
| Common Brands | Aredia |
|---|---|
| Drug Class | Bisphosphonate |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
More on Pamidronate essentials
Side effects of Pamidronate
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
High calcium levels due to cancer:
- Fever (18-26%)
- Nausea (4-18%)
- Infusion-site reactions (4-18%)
- Electrolyte imbalance (Up to 18%)
Paget’s disease: Side effects reported in at least 10% of people in studies
- High blood pressure
- Joint pain
- Bone pain
- Headache
Bone damage due to cancer:
- Bone pain (67%)
- Nausea (54%)
- Anemia (43%)
- Fever (39%)
- Tiredness (37%)
- Vomiting (36%)
- Shortness of breath (30%)
Less Common Side Effects
High calcium levels due to cancer:
- Reduced appetite
- Tiredness
- Constipation
- Runny nose
- Sleepiness
Paget’s disease:
- Fever
- Nausea
- Back pain
- Dizziness
Bone damage due to cancer:
- Weakness
- Reduced appetite
- Diarrhea
- Indigestion
- Stomach pain
- Joint pain
- Headache
Pamidronate serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Low calcium levels: irregular heartbeat, muscle spasms, numbness, seizures
- Severe jaw bone problems (osteonecrosis): jaw pain or swelling, loose teeth, numbness in the jaw, exposed bone, gum infection
- Fractures: sudden or sharp pain, trouble moving the area, swelling or bruising
The following Pamidronate side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Abdominal or stomach cramps
black, tarry stools
bloody in the urine or stools
blurred vision
chills
confusion
convulsions (seizures)
decrease in the amount of urine
dizziness
drowsiness
fainting
fast or irregular heartbeat
headache
increased thirst
loss of appetite
muscle pain, cramps, spasms, or twitching
nausea or vomiting
nervousness
noisy, rattling breathing
numbness or tingling in the hands, feet, or lips
pinpoint red spots on the skin
pounding in the ears
shortness of breath
slow or fast heartbeat
swelling of the fingers, hands, feet, or lower legs
trembling
troubled breathing at rest
unusual bleeding or bruising
unusual tiredness or weakness
vomiting of blood or material that looks like coffee grounds
Less common
dilated neck veins
extreme fatigue
irregular breathing
lower back or side pain
painful or difficult urination
pale skin
swelling
ulcers, sores, or white spots in the mouth
Rare
Decreased vision
difficulty with swallowing
eye pain or tenderness
eye redness
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
sensitivity of the eye to light
skin rash
sweating
tearing of the eye
tightness in the chest
Incidence not known
Bone, joint, or muscle pain, severe and occasionally incapacitating
faintness, or lightheadedness when getting up suddenly from a lying or sitting position
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Acid or sour stomach
belching
bladder pain
bloody or cloudy urine
body aches or pain
bone pain
cracks in the skin at the corners of mouth
difficult, burning, or painful urination
difficult or labored breathing
difficulty moving
ear congestion
fear
frequent urge to urinate
indigestion
joint pain
lack or loss of strength
lower back or side pain
muscle aching, cramping, pains, or stiffness
nervousness
pain and swelling at the injection site
sensitivity to heat
shivering
soreness or redness around the fingernails and toenails
stomach discomfort, upset, or pain
sweating
swollen joints
trouble sleeping
Less common
Ammonia-like breath odor
feeling, seeing, or hearing things that are not there
feeling that others are watching you or controlling your behavior
feeling that others can hear your thoughts
feeling unusually cold
swelling or inflammation of the mouth
unusual behavior
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Pamidronate
Pros
- Helps reduce bone damage and complications in certain cancers
- Lowers high calcium caused by cancer
- Typically given once a month or sometimes as a single dose
Cons
- Risk of a serious side effect called osteonecrosis of the jaw
- Might not be a good option for people with kidney problems
- Must be given by IV infusion
Pharmacist tips for Pamidronate
- If you take pamidronate to protect your bones or Paget’s disease, your prescriber might recommend you take calcium and vitamin D supplements. This helps prevent your calcium level from dropping too low.
- Your prescriber will check your kidney health and electrolyte levels with blood tests during treatment with pamidronate. Keep all lab appointments as recommended.
- Call your care team right away if you have muscle spasms, stiffness, numbness, or changes in your heartbeat while taking pamidronate. These can be signs of low calcium in your blood.
- Tell your care team if you have new thigh or groin pain while receiving pamidronate. Rarely, this medication has been linked to unusual thigh bone fractures.
- Pamidronate can rarely cause a serious jaw problem called osteonecrosis of the jaw. Your risk is higher if you have dental problems or need major dental surgery. See your dentist before starting treatment and keep up with regular dental care.
- Pamidronate can harm an unborn baby and can stay in your bones for years. Use effective birth control during treatment and tell your prescriber right away if you become pregnant.
- Pamidronate might affect fertility in both men and women. Talk to your prescriber if you have concerns about future pregnancy.
Risks and warnings for Pamidronate
Pamidronate can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Kidney problems
- Risk factors: History of kidney problems | High doses of pamidronate
Your body removes pamidronate through your kidneys. If your kidneys aren’t working well, the medication can stay in your body longer than it should. This can raise your risk of kidney problems, including worsening kidney function or even kidney failure.
If you receive pamidronate regularly, your prescriber will check your kidney function with a blood test before each dose. If you develop kidney problems, you might need to pause treatment. But if your kidney problems don’t get better, you might have to stop taking it altogether.
Harm to unborn baby
Pamidronate can harm an unborn baby. In animal studies, it caused problems for both the mother and the developing baby. Because of how it works, it can affect a baby’s bone development.
Pamidronate stays in your bones and can be slowly released over months or even years. This means there could still be a risk to a baby even after you stop treatment. If you’re able to get pregnant, use effective birth control during treatment. Tell your care team right away if you become pregnant.
Low electrolytes in blood
People taking pamidronate can develop low levels of electrolytes in the blood, including calcium, potassium, magnesium, and phosphorus. Your care team will check these levels with blood tests, often as part of a complete metabolic panel.
Low calcium is the most common and can cause muscle cramps, numbness, an irregular heartbeat, or, in severe cases, seizures. If your electrolyte levels drop too low, you might need to pause pamidronate and take supplements to bring them back to normal.
Severe jaw bone problems
- Risk factors: Also receiving chemotherapy and corticosteroids | Certain tumors | Poor dental health | Dentures that don’t fit well | Dental surgery
Rarely, people taking pamidronate have developed osteonecrosis of the jaw (ONJ). This is a condition where the bone tissue in the jaw starts to break down. People are at higher risk for ONJ if they have poor dental health, wear dentures that don’t fit well, or who have serious dental procedures (such as having a tooth pulled) while taking pamidronate.
Make sure you take good care of your teeth and mouth, and see your dentist regularly while taking pamidronate. It’s also a good idea to see your dentist before you start treatment. If you have any ONJ symptoms such as jaw pain, an infection in your mouth, or swelling in the jaw, contact your prescriber right away.
Thigh bone fractures
- Risk factors: Also receiving corticosteroids
Rare thigh bone fractures have been reported in people taking bisphosphonates like pamidronate. These fractures can happen with little or no injury. Some people feel dull, aching pain in the thigh or groin for weeks or months before the bone fully breaks. These fractures can happen in both legs and could heal slowly. If you're taking pamidronate and develop new thigh or groin pain without an injury, tell your care team right away. You might need imaging tests to check for a possible fracture.
Pamidronate dosage
Typical dosage for Pamidronate
- Hypercalcemia of malignancy: The typical dose is 60 or 90 mg infused as a single IV infusion. If needed, you might receive another infusion in 7 days, depending on how severe your condition is.
- Paget’s disease: The typical dose is 30 mg infused IV once a day for 3 days.
- Bone damage from breast cancer: The typical dose is 90 mg infused IV every 3 to 4 weeks
- Bone damage from multiple myeloma: The typical dose is 90 mg infused IV every 4 weeks.
Interactions between Pamidronate and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
Pamidronate contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Pamidronate will not be safe for you to take.
- Allergic to bisphosphonates or mannitol
