How does this medication work? What will it do for me?

Pamidronate belongs to the family of medications known as bisphosphonates. It is used to treat hypercalcemia (high blood calcium) by people who have cancer. Pamidronate is also used to treat cancer that has spread to bones (bone metastases) due to different types of tumours and multiple myeloma (cancer of the bone marrow). Pamidronate is also used to treat the symptoms of Paget's disease of bone.

This medication works by reducing the breakdown of bone.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

3 mg/mL
Each mL contains 3 mg of pamidronate disodium. Nonmedicinal ingredients: mannitol, water for injection, sodium hydroxide, and phosphoric acid. This preparation contains no preservatives.

6 mg/mL
Each mL contains 6 mg of pamidronate disodium. Nonmedicinal ingredients: mannitol, water for injection, sodium hydroxide, and phosphoric acid. This preparation contains no preservatives.

9 mg/mL
Each mL contains 9 mg of pamidronate disodium. Nonmedicinal ingredients: mannitol, water for injection, sodium hydroxide, and phosphoric acid. This preparation contains no preservatives.

How should I use this medication?

The dosage of this medication depends on the condition that is being treated.

For hypercalcemia due to cancer (high calcium levels in the blood), the recommended total dose of pamidronate per treatment course will depend on the starting levels of calcium in the blood. The recommended maximum dose per treatment course is 90 mg, which can be given as a single intravenous (into the vein) infusion of 90 mg or multiple infusions spread over 2 to 4 days.

For bone metastases and multiple myeloma, the recommended dose of pamidronate is 90 mg given as a single-dose intravenous infusion every 4 weeks. The dose should be given over a period of 2 to 4 hours. People who receive chemotherapy every 3 weeks may receive 90 mg of pamidronate every 3 weeks.

For Paget's disease of bone, the recommended dose of pamidronate ranges from 180 mg to 210 mg given as intravenous infusions. The initial dosing schedule may be either 6 doses of 30 mg once a week (total dose 180 mg), or 30 mg for the first dose and 3 doses of 60 mg every second week (total dose 210 mg). Once this dosing schedule is complete, it can be repeated after 6 months. For repeat dosing, pamidronate is usually given as 3 doses of 60 mg every second week (total dose 180 mg).

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications.

It is important that this medication be given exactly as prescribed by your doctor.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Pamidronate should not be used by anyone who is allergic to pamidronate, other bisphosphonates (e.g., alendronate, etidronate, risedronate), or to any of the ingredients of this medication.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • bone pain
  • constipation
  • diarrhea
  • difficulty sleeping
  • dizziness
  • drowsiness
  • flu-like symptoms (fever, chills, muscle pain)
  • headache
  • indigestion
  • loss of appetite
  • nausea
  • pain, redness, or swelling at the injection site
  • unusual tiredness or weakness
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • agitation
  • confusion
  • eye pain or irritation
  • itching
  • jaw, mouth, or teeth pain
  • muscle pain or cramps
  • numbness or tingling in the hands, feet or lips
  • sensitivity to light
  • skin rash
  • vision changes

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • seizures
  • symptoms of a severe allergic reaction (difficulty breathing, hives, swelling of the mouth or throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Deterioration of the jaw bone: People with cancer treated with pamidronate (or other bisphosphonates) may rarely develop osteonecrosis of the jaw (deterioration of the jaw bone). If you experience any pain, swelling, or infection of the jaw, report this to your doctor. Before starting treatment with pamidronate, your doctor may recommend that you see a dentist for an examination and any necessary dental treatment. While receiving pamidronate, people should avoid invasive dental procedures such as tooth extractions.

Drowsiness/reduced alertness: Pamidronate may cause drowsiness and dizziness. Avoid driving, operating potentially dangerous machinery, or participating in other activities that may be hazardous until you know how this medication affects you.

Kidney problems: People with reduced kidney function should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. You doctor will monitor your kidney function during and after intravenous infusions of pamidronate.

Low calcium levels: Pamidronate may cause low calcium levels. You will need to have regular blood tests while taking pamidronate to monitor your calcium levels.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if pamidronate passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between pamidronate and any of the following:

  • aminoglycosides (e.g., gentamicin, tobramycin)
  • calcitonin
  • calcium supplements
  • nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen, ketoprofen)
  • other bisphosphonates (e.g., alendronate, risedronate, etidronate)
  • thalidomide
  • vitamin supplements

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.