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Pamidronate

(pam-id-ruh-nate)

Trade/other name(s): Aredia, pamidronate disodium, APD

Why would this drug be used?

Pamidronate is a type of drug known as a bisphosphonate. It is used to lower high blood calcium levels, especially in people who have cancer in the bones. It is also used to help treat cancer that has spread to the bones, usually along with other treatments such as chemotherapy. It lowers the risk of fractures and other bone problems.

Pamidronate may also be used to treat some non-cancerous conditions, such as Paget's disease of the bone.

How does this drug work?

Some cancers that start in the bones (such as multiple myeloma) or that can spread to the bones (such as breast cancer) can break down bone materials and release large amounts of calcium into the blood. This condition, known as hypercalcemia, can be dangerous. Cancer in the bones can also lead to fractures and other problems.

Pamidronate stops bone cells called osteoclasts from breaking down the hard mineral structure of bone. This slows the release of calcium into the blood, which helps lower calcium levels in the body. It also slows the growth of tumors in the bone.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any mouth or teeth problems, or if you are planning any dental procedures. This drug has been linked to serious damage of the jawbone in some people, especially if they have had recent dental work (see "Precautions" below).
  • If you have ever had kidney problems. This drug may affect the kidneys, and should be used with extreme caution in people with serious kidney problems.
  • If you have ever had surgery on your thyroid gland (at the front of the neck). This may affect the parathyroid gland and increase your risk of low calcium levels.
  • If you have any other medical conditions such as liver disease (including hepatitis), heart disease, congestive heart failure, lung disease, diabetes, gout, or infections. You may need closer monitoring of these conditions while being treated.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause problems if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine. This drug should not be used during pregnancy.
  • If you are breast-feeding. The only study done so far did not show that this drug passed into breast milk, but more research is needed. Talk with your doctor about the possible risks of breast-feeding while taking this drug.
  • If you think you might want to have children in the future. It is not known whether or not this drug can affect fertility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Using pamidronate along with other drugs that can affect the kidneys could result in serious kidney problems. These drugs include amphotericin B, aminoglycoside antibiotics (streptomycin, tobramycin, amikacin, neomycin, gentamicin, etc.), and platinum-based chemotherapy drugs (cisplatin, oxaliplatin), among others.

Use of this drug with chemotherapy and/or steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone) may raise the risk of damage to the bones in the jaw.

Check with your doctor, nurse, or pharmacist about all of your medicines, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether some foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Pamidronate is given as an injection into a vein (intravenous, or IV) over 2 to 24 hours. The dose and timing will depend on the reason you are getting the drug. For example, when pamidronate is used to treat high blood calcium levels it is often given as a one-time dose. To help treat tumors in the bones, it is often given once every 3 to 4 weeks.

You will likely be given IV fluids and/or advised to drink plenty of fluids while getting this drug to keep you hydrated and reduce the chance of kidney damage. Your doctor may also recommend that you take a multi-vitamin (with vitamin D) and a calcium supplement each day. Take the supplements as your doctor directs.

Your doctor may delay or even stop this drug if kidney function tests are abnormal.

Precautions

This drug may affect your kidney function. Your doctor will do blood tests to track your kidney function closely while you're being treated and may need to delay or stop treatment if these tests become abnormal. Your doctor may also recommend that you get plenty of fluids while getting this drug to reduce the chance of kidney damage. Tell your doctor or nurse right away if you notice blood in the urine, lowered urine output, increased thirst, nausea, or vomiting.

In rare cases, this drug can damage the bones in the jaw, a condition called osteonecrosis of the jaw (ONJ). Most cases have been in people who had recent dental procedures such as having a tooth pulled while taking the drug. Your doctor may recommend that you get a thorough dental exam before you start taking this drug. Talk with your dentist about the best ways to prevent problems while on pamidronate. While you are getting treatment, be sure to check with your doctor before having any dental procedures done. Tell your doctor if you notice loose teeth, swollen gums, or pain or numbness in your jaw.

In rare cases, taking this drug could lead to low blood calcium levels (hypocalcemia). Possible symptoms could include muscle spasms or cramps, muscle or joint pains, changes in sensations on the face, hands or feet, confusion, or seizures. Tell your doctor right away if you notice any of these symptoms.

Your doctor will test your blood frequently throughout your treatment, looking for possible effects of the drug on blood chemistry levels. Based on the test results, your doctor may need to change your treatment plan. Be sure to keep all your appointments for lab tests and doctor visits.

In rare cases, this drug may cause allergic reactions when the drug is given. Mild reactions may consist of hives or fever and chills. More serious reactions are rare, but can be dangerous. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), fever, chills, hives, nausea, itching, headache, coughing, shortness of breath, or swelling of the face, tongue, or throat. Tell your doctor or nurse right away if you notice any of these symptoms during or after being given the drug.

Avoid pregnancy while taking this drug and for some time afterward. The drug can stay in your body for years after you stop taking it, because it becomes part of your bones and is released slowly over time. Talk with your doctor about this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Flu-like symptoms (fever, chills, headache, bone and muscle aches)
  • Pain or redness at injection site

Less common

  • Bone or joint pain
  • Muscle aches
  • Runny nose
  • Cough
  • Nausea/vomiting
  • Loss of appetite
  • Constipation
  • Diarrhea
  • Shortness of breath
  • Feeling dizzy or faint
  • Feeling tired
  • Blood test results showing the drug may be affecting your kidneys (Your doctor will explain the importance of these findings, if any.)*

Rare

  • low blood calcium levels (could lead to muscle pain, cramps, or spasms; abnormal sensations on the face, hands, or feet; or seizures)*
  • Damage to bones in jaw*
  • Allergic reactions*
  • Broken femur (thigh bone) after little or no injury, starting with groin or thigh pain
  • Eye irritation or redness
  • Irregular heartbeat (atrial fibrillation)

*See the "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1991.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 06/21/2012
Last Revised: 06/21/2012