Generic Name: pamidronate (PAM i DROE nate)Brand Names: Aredia
Pamidronate is in a group of medicines called bisphosphonates (bis FOS fo nayts). It alters the cycle of bone formation and breakdown in the body.
Pamidronate is used to treat high levels of calcium in the blood related to cancer (also called hypercalcemia of malignancy). Pamidronate is also used to treat Paget's disease of bone.
Pamidronate is used to treat bone damage caused by certain types of cancer such as breast cancer or bone marrow cancer. Pamidronate does not treat cancer. Use all other medications your doctor has prescribed for those conditions.
Pamidronate may also be used for other purposes not listed in this medication guide.
Before using pamidronate, tell your doctor if you have kidney disease, a history of thyroid surgery, or if you are also taking thalidomide to treat bone marrow cancer.Do not use pamidronate without telling your doctor if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.
Some people using medicines similar to pamidronate have developed bone loss in the jaw, also called osteonecrosis of the jaw. Call your doctor if you have symptoms such as jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums.
Pamidronate can be harmful to the kidneys, and these effects are increased when pamidronate is used together with other medicines that can harm the kidneys. Before taking pamidronate, tell your doctor about all other medications you use. Many drugs (including some over-the-counter medicines) can be harmful to the kidneys.Serious side effects of pamidronate include fever, severe bone pain, severe joint or muscle pain, urinating less than usual or not at all, swelling, rapid weight gain, eye pain, vision changes, confusion, uneven heart rate, extreme thirst, muscle weakness or limp feeling, and fainting or seizure.
If you have any of these other conditions, you may need a dose adjustment or special tests to safely use pamidronate:
a history of thyroid surgery; or
if you are also taking thalidomide to treat bone marrow cancer.
Some people using medicines similar to pamidronate have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms of this condition may include jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums.
You may be more likely to develop osteonecrosis of the jaw if you have cancer or have been treated with chemotherapy, radiation, or steroids. Other conditions associated with osteonecrosis of the jaw include blood clotting disorders, anemia (low red blood cells), and dental surgery or pre-existing dental problems.
Pamidronate is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. The medicine must be given slowly through an IV infusion, and can take up from 2 to 24 hours to complete.
Your doctor, nurse, or other healthcare provider will give you this injection. You may be shown how to use your medicine at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of needles, IV tubing, and other items used in giving the medicine.
Pamidronate is sometimes given as a single dose only one time. It may also be repeated over 3 days in a row, or given once every 3 to 4 weeks. How often you receive this medication and the length of your infusion time will depend on the condition being treated. Follow your doctor's instructions.
You may need to mix pamidronate with a liquid (diluent) in an IV bag before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medication. Never mix pamidronate with a solution that contains calcium (such as lactated Ringer's solution) or with other drugs in the same IV bag or line.After mixing pamidronate with a diluent, you may store the mixture in the refrigerator and use it within 24 hours. Do not freeze. Do not use the mixed medication if it has changed colors or has any particles in it.
Use each disposable needle only one time. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.If you do not have hypercalcemia, your doctor may want you to take calcium or vitamin D supplements by mouth while you are using pamidronate. Do not take any vitamin or mineral supplements that your doctor has not prescribed.
Call your doctor for instructions if you miss an appointment for your pamidronate injection.
Symptoms of a pamidronate overdose are not known.
Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are using pamidronate.
severe joint, bone, or muscle pain;
jaw pain, numbness, or swelling;
painful or difficult urination;
urinating less than usual or not at all;
swelling, rapid weight gain;
confusion, hallucinations, unusual thoughts or behavior;
feeling like you might pass out;
pale skin, easy bruising or bleeding, flu symptoms;
eye pain, vision changes, increased sensitivity to light; or
uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling.
Less serious side effects may include:
mild heartburn or stomach upset, loss of appetite;
nausea, vomiting, stomach pain, gas, diarrhea, constipation;
runny or stuffy nose, cough;
numbness or tingly feeling;
pain, redness, swelling or a hard painful lump under your skin around the IV needle;
dizziness, drowsiness, weakness, tired feeling;
mild joint or back pain; or
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Usual Adult Dose for Hypercalcemia of Malignancy:
60 to 90 mg as a single dose, intravenously by slow infusion over 2 to 24 hours one time. Longer infusions (i.e., > 2 hours) may reduce the risk for renal toxicity, particularly in patients with preexisting renal insufficiency. If significant hypercalcemia persists or recurs, a second dose, identical to the first, may be considered. A minimum of 7 days should elapse between doses. Response to subsequent doses may be diminished. Patients with frequent recurrences of hypercalcemia may require infusions of pamidronate every 2 to 3 weeks to maintain normocalcemia.
Usual Adult Dose for Paget's Disease:
30 mg intravenously as a 4 hour infusion on 3 consecutive days. A limited number of patients have received more than one treatment with the same dosage.
Usual Adult Dose for Osteolytic Bone Lesions of Multiple Myeloma:
90 mg intravenously as a 4 hour infusion given on a monthly basis for up to 9 months.
Usual Adult Dose for Osteolytic Bone Metastases of Breast Cancer:
90 mg intravenously as a 2 hour infusion given every 3 to 4 weeks.
Usual Pediatric Dose for Hypercalcemia:
> 1 year:0.5 to 1 mg/kg intravenously by slow infusion over 24 hours one time. If significant hypercalcemia persists or recurs, a second dose, identical to the first, may be considered. A minimum of 7 days should elapse between doses.
Pamidronate can be harmful to the kidneys, and these effects are increased when pamidronate is used together with other medicines that can harm the kidneys. Before taking pamidronate, tell your doctor if you are also using:
methotrexate (Rheumatrex, Trexall);
pain or arthritis medicines such as aspirin (Anacin, Excedrin), acetaminophen (Tylenol), diclofenac (Cataflam, Voltaren), etodolac (Lodine), ibuprofen (Advil, Motrin), indomethacin (Indocin), naproxen (Aleve, Naprosyn), and others;
medicines used to treat ulcerative colitis, such as mesalamine (Pentasa) or sulfasalazine (Azulfidine);
medicines used to prevent organ transplant rejection, such as sirolimus (Rapamune) or tacrolimus (Prograf);
IV antibiotics such as amphotericin B (Fungizone, AmBisome, Amphotec, Abelcet), amikacin (Amikin), bacitracin (Baci-IM), capreomycin (Capastat), gentamicin (Garamycin), kanamycin (Kantrex), streptomycin, or vancomycin (Vancocin, Vancoled);
antiviral medicines such as adefovir (Hepsera), cidofovir (Vistide), or foscarnet (Foscavir); or
cancer medicine such as aldesleukin (Proleukin), carmustine (BiCNU, Gliadel), cisplatin (Platinol), ifosfamide (Ifex), oxaliplatin (Eloxatin), streptozocin (Zanosar), or tretinoin (Vesanoid).
This list is not complete and there may be other drugs that can interact with pamidronate. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.