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Overview: Pamidronate an injectable medicine used for high calcium levels from cancer or bone problems, including Paget's disease and bone metastases. It works by slowing your body's breakdown of bone. Common side effects may include fever, nausea, loss of appetite, tiredness, or stomach pain. Serious side effects are less likely, but may include low calcium levels or kidney problems. Contact your health care provider right away if you have swelling in your feet, ankles, or legs, unusual weakness or tiredness, or numbness, tingling, or burning sensation in your arms, feet, or face.

Uses

What is pamidronate used for?

Pamidronate is commonly used for the following conditions.

  • Treatment of high calcium levels (hypercalcemia) caused by with cancer
  • Treatment of Paget’s Disease, a condition in which your body’s natural bone-building process is disrupted, causing your bones to become weak and misshapen
  • Treatment of bone damage (osteolytic bone metastases or osteolytic lesions) caused by certain types of cancer

Pamidronate may also be used for other conditions as determined by your health care provider.

How does pamidronate work (mechanism of action)?

Pamidronate slows the natural breakdown of your bones, which helps relieve the bone-damaging effects of conditions such as Paget’s Disease or cancer. This also slows down the body’s process of releasing calcium from broken down bones into your blood. 

How is pamidronate supplied (dosage forms)?

Pamidronate is available in the following dosage forms that are injected into a blood vessel.

  • 3 mg/mL solution for injection
  • 6 mg/mL solution for injection
  • 9 mg/mL solution for injection

How should I store pamidronate?

Pamidronate is usually given by a health care provider in a hospital or clinic. If you will store pamidronate at home, follow the instructions given by your health care provider.

Side Effects

What are the most common side effects of pamidronate?

The most common side effects of pamidronate are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Fever
  • Nausea
  • Loss of appetite 
  • Fatigue
  • Flu-like symptoms 
  • Stomach pain or indigestion 
  • Headache
  • Bone, joint, or muscle pain (see below)

There may be other side effects of pamidronate that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of pamidronate?

While less common, the most serious side effects of pamidronate are described below, along with what to do if they happen.

Severe Allergic Reactions. Pamidronate may cause allergic reactions, which can be serious. Stop using pamidronate and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Kidney Damage.Kidney damage can happen when using pamidronate. Call your health care provider right away if you have any of the following symptoms of kidney damage.

  • Reduced need to pee
  • Swelling in your feet, ankles, or legs
  • Weakness or unusual tiredness
  • Trouble catching your breath or chest pain/pressure
  • Confusion
  • Nausea
  • Seizures

Low Calcium Level (Hypocalcemia). Pamidronate can cause low calcium levels, also known as hypocalcemia, which can be serious. Decreased calcium levels can cause a rare dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium, or who take some medicines for other heart rhythm problems. Call your health care provider if you have any of the following symptoms.

  • Changes in your heart rate or rhythm, such as fast or skipping heartbeat
  • Fainting
  • Numbness, tingling, or burning sensation in your arms, feet, or face (paresthesia)
  • Muscle pain, spasms, twitching, or cramps
  • Seizures

Severe Pain in the Bones, Joints, or Muscles. Pamidronate may cause severe pain in the bones, joints, or muscles (musculoskeletal pain). The pain can be severe enough that it could be hard to carry out normal activities. Call your health care provider if you experience severe pain while on pamidronate.

Severe Jawbone Problems (Osteonecrosis). Pamidronate can rarely cause severe jawbone problems, also called osteonecrosis of the jaw. In this condition, your jawbone may get damaged due to reduced blood flow. You may be at higher risk if you are undergoing certain dental procedures (such as a tooth extraction or dental implants), if you have poor oral health, or if you have cancer or certain other conditions. You may be told to see a dentist before starting pamidronate and to practice good mouth care. Call your health care provider right away if you experience any of the following symptoms of jaw osteonecrosis.

  • Jaw pain or discomfort
  • Mouth sores
  • Loose teeth

Unusual Thigh Bone Fractures. Pamidronate may cause an increased risk for fractures in your thigh bone, even with a light force. Call your health care provider if you experience new or unusual pain in your thigh, hip, or groin.

Warnings & Precautions

Who should not use pamidronate?

Allergies to Ingredients. People who are allergic to any of the following should not use pamidronate.

  • Pamidronate
  • Any other medicine known as a bisphosphonate
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific pamidronate products they stock.

Kidney Problems. Pamidronate should not be used to treat cancer that has spread to the bones (bone metastasis) if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your health care provider may do tests to know if they are working well enough for you to take this medicine.

What should I know about pamidronate before using it?

Do not use pamidronate unless it has been prescribed to you by a health care provider. Use it as prescribed. If you store pamidronate at home, keep it out of the reach of children. This medicine is to be injected into a blood vessel and should be given to you by a trained health care professional who understands how to properly prepare and use it. If you have any questions, talk to your health care provider.

If you are using pamidronate to treat Paget’s Disease or cancer-related bone damage, your health care provider may tell you to take calcium and vitamin D supplements during the treatment.

Your health care provider may recommend that you have a dental exam before starting treatment with risedronate.

What should I tell my health care provider before using pamidronate?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if pamidronate is right for you.

In particular, make sure that you discuss any of the following.

Planned Dental Surgery. Tell your health care provider if you are planning to undergo any dental treatments, such as tooth extraction or dental implant surgery, while using pamidronate. Certain dental procedures may increase the risk of osteonecrosis of the jaw.

Other Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Low calcium levels (hypocalcemia)
  • Kidney problems
  • Poor oral health or dental problems (including use of dentures)
  • Past thyroid surgery
  • Cancer
  • Blood disorders

Pregnancy. It is not known if or how pamidronate could affect pregnancy or harm a fetus. Tell your health care provider if you are pregnant or plan to become pregnant. Your health care provider will let you know if you should use pamidronate while you are pregnant or trying to get pregnant. 

Breastfeeding. It is not known if pamidronate passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does pamidronate interact with foods or drinks?

There are no known interactions between pamidronate and foods or drinks.

It is unknown if drinking alcohol will affect pamidronate.

Does pamidronate interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using pamidronate.

  • A medicine that can harm your kidneys, including certain cancer drugs (such as cisplatin), antibiotics (such as vancomycin), antifungals (such as amphotericin B), and nonsteroidal anti-inflammatory drugs (NSAID) (such as ibuprofen, naproxen, and others, which are contained in many prescription and OTC products for pain, swelling, and fever)
  • Thalidomide, which is a medicine used for multiple myeloma (a type of blood cancer)
  • Other chemotherapy or radiation for treating cancer
  • A corticosteroid, which is a medicine for certain inflammatory conditions

This may not be a complete list of medicines that can interact with pamidronate. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much pamidronate?

If you or someone else has used too much pamidronate, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of pamidronate?

Pamidronate is usually given by a health care provider in a hospital. Your health care provider will make sure you are receiving pamidronate as scheduled.

If you miss an appointment to get your pamidronate dose, call to make another appointment as soon as possible.