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pamidronate

Pronunciation

Generic Name: pamidronate (PAM i DROE nate)
Brand Name: Aredia

What is pamidronate?

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 purposes not listed in this medication guide.

What is the most important information I should know about pamidronate?

Do not use pamidronate if you are pregnant. It could harm the unborn baby.

You should not use this medication if you are allergic to pamidronate or to other bisphosphonates such as alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel), tiludronate (Skelid), or zoledronic acid (Reclast, Zometa).

Before using pamidronate, tell your doctor if you have kidney disease, a history of thyroid surgery, or low levels of platelets or red blood cells.

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Some people using medicines similar to pamidronate have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms 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 a pre-existing dental problem.

Pamidronate can harm your kidneys, and this effect is increased when you also use certain other medicines harmful to the kidneys. Before using pamidronate, tell your doctor about all other medications you use. Many other drugs (including some over-the-counter medicines) can be harmful to the kidneys.

Serious side effects of pamidronate include high 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, or seizure.

What should I discuss with my healthcare provider before using pamidronate?

You should not use this medication if you are allergic to pamidronate or to other bisphosphonates such as alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel), tiludronate (Skelid), or zoledronic acid (Reclast, Zometa).

To make sure you can safely use pamidronate, tell your doctor if you have any of these other conditions:

  • kidney disease;

  • a history of thyroid surgery; or

  • low levels of platelets or red blood cells.

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.

FDA pregnancy category D. Do not use pamidronate if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

It is not known whether pamidronate passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using pamidronate.

How is pamidronate given?

Pamidronate is injected into a vein through an IV. This medication must be given slowly, and the IV infusion can take 2 to 24 hours to complete. You may be shown how to use an IV at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject 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.

Use a disposable needle only once. 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.

To be sure this medicine is helping your condition and is not causing harmful effects, your blood will need to be tested often. Visit your doctor regularly.

Store unmixed pamidronate at room temperature away from moisture and heat.

After mixing pamidronate with a diluent, store in the refrigerator and use it within 24 hours. Do not freeze. Do not use the medication if it has changed colors or has particles in it. Call your doctor for a new prescription.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of pamidronate.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using pamidronate?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Pamidronate side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • high fever;

  • severe joint, bone, or muscle pain;

  • new or unusual pain in your thigh or hip;

  • urinating less than usual or not at all;

  • swelling, rapid weight gain;

  • pain or burning when you urinate;

  • seizure (convulsions);

  • eye pain, vision changes;

  • pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or

  • confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling, or jerking muscle movements.

Less serious side effects may include:

  • low fever;

  • stomach pain, loss of appetite, nausea, vomiting;

  • constipation; or

  • pain, redness, swelling or a hard painful lump under your skin around the IV needle.

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.

See also: Side effects (in more detail)

Pamidronate dosing information

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.

What other drugs will affect pamidronate?

Pamidronate can harm your kidneys. This effect is increased when you also use other medicines harmful to the kidneys. You may need dose adjustments or special tests if you have recently used:

  • lithium (Lithobid);

  • 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 cyclosporine (Gengraf, Neoral, Sandimmune), 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 other drugs may interact with pamidronate. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about pamidronate.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.01. Revision Date: 2012-07-06, 3:28:08 PM.

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