Pamidronate

Pamidronate is a prescription medication used to treat high blood levels of calcium (hypercalcemia) in patients with cancer and Paget's disease. Pamidronate belongs to a group of drugs called bisphosphonates. These medications work by slowing the breakdown of bone, increasing bone density, and decreasing the amount of calcium released from the bones.

This medication comes in an injectable form that is injected slowly into a vein (IV), over 2 to 24 hours. It is usually given in a doctor's office, hospital, or clinic.

Pamidronate is a prescription medication approved for the treatment of high blood levels of calcium that may be caused by certain types of cancer and Paget's disease. It is also approved to prevent or delay bone damage caused by multiple myeloma or breast cancer.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Pamidronate may be found in some form under the following brand names:

• Aredia

See "Drug Precautions" section for serious side effects.

The following is a list of common, less severe pamidronate side effects. Tell your doctor if any of these symptoms are bothersome or do not go away:

• nausea
• vomiting
• excessive tiredness
• fever
• anemia
• upper respiratory tract infection (for example the common cold)
• redness, swelling, or pain in the injection site
• stomach pain
• loss of appetite
• constipation
• heartburn
• change in ability to taste food
• sores in the mouth
• fever
• headache
• dizziness
• difficulty falling asleep or staying asleep
• cough
• difficulty urinating or painful urination
• swelling of the hands, arms, feet, ankles, or lower legs

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• painful or swollen gums
• loosening of the teeth
• tooth or jaw problems
• poor healing of the jaw
• vomit that is bloody or looks like coffee grounds
• bloody or black and tarry stools
• shortness of breath
• high blood pressure
• fast heartbeat
• fainting
• sudden tightening of muscles
• numbness or tingling around the mouth
• eye pain or tearing
• signs of allergic reaction including rash, itching, hives, swelling of face or throat, or difficulty breathing

This is not a complete list of pamidronate side effects. Ask your doctor or pharmacist for more information.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• medications that affect the kidneys including:
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve),
  • certain diuretics ("water pills"),
  • thalidomide (Thalomid),
  • vancomycin (Vancocin),
  • cancer chemotherapy medications,
  • certain antibiotics
• oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone)

This is not a complete list of pamidronate drug interactions. Ask your doctor or pharmacist for more information.

Pamidronate may cause serious side effects including:

• kidney damage. Your doctor will monitor your kidney function using a blood test. To minimize the risk of kidney damage, pamidronate infusions should be given over a period of at least 2 hours and the dose should not exceed 90 mg.
• severe bone, muscle, or joint pain that can begin within days, months or years after your first pamidronate injection. If, during treatment, you experience severe pain tell your doctor right away.
• a rare, but serious jaw problem, called osteonecrosis of the jaw. Your risk of developing this jaw problem is increased if you have dental surgery or treatment while you are receiving pamidronate injections. Talk to your doctor before having dental treatments while you are receiving this medication.
• low blood calcium, phosphate, and magnesium which your doctor will monitor using a blood test.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of pamidronate there are no specific foods that you must exclude from your diet when receiving this medication.

Before receiving pamidronate, tell your doctor about all of your medical conditions including if you:

• have low blood calcium (hypocalcemia)
• are being treated with radiation therapy
• have or have ever had thyroid surgery
• have a history of seizures
• have kidney or liver disease
• are pregnant or breastfeeding
• are planning to have dental treatments
• are allergic to pamidronate or any other medicines

Tell your doctor about all of the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category D. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if pamidronate is excreted in human breast milk or if it will harm your nursing baby.

Pamidronate comes as a liquid to be infused slowly into a vein, over 2 to 24 hours, depending on the condition being treated. It is usually given by a healthcare provider in a hospital or other medical facility such as a hospital or medical clinic.

If you do not have high blood calcium (hypercalcemia), your doctor may recommend you take a calcium supplement and vitamin D supplements during your treatment. Take these supplements as instructed by your doctor.

To protect your kidneys, good hydration is important. Your doctor may order an IV fluid that will provide your body with additional fluids for kidney protection.

Paget's disease: the recommended pamidronate dosage is 30 mg daily for three days.

Multiple myeloma: the usual dosage is 90 mg once a month.

Breast cancer that has spread to bones: the recommended dosage is 90 mg every three to four weeks.

High blood calcium: the recommended dosage varies from 60 to 90 mg, as a single dose. Sometimes a second dose is necessary.

Pamidronate is usually administered by a healthcare provider in a medical setting making it unlikely for an overdose to occur. However, if overdose is suspected, seek emergency medical attention.