Aredia Side Effects

Generic Name: pamidronate

Please note - some side effects for Aredia may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Aredia - for the Consumer

Aredia

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Aredia:

Back pain; constipation; coughing; dizziness; drowsiness; headache; increased sweating; indigestion; loss of appetite; mild bone, joint, or muscle pain; mild fever for 24 to 48 hours; nausea; stomach pain; stuffy or runny nose; trouble sleeping; unusual tiredness; vomiting.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); confusion; decreased urination; fainting; fast or irregular heartbeat; frequent or painful urination; hallucinations; jaw pain or swelling; mental or mood changes; muscle cramps or spasms; numbness or tingling of the skin; pain, swelling, or redness at injection site; persistent or high fever; seizures; severe or persistent stomach pain, headache, or dizziness; severe or persistent tiredness or weakness; severe or prolonged bone, joint, or muscle pain; shortness of breath; vision changes; white patches in the mouth.

Aredia Side Effects - for the Professional

Aredia

Clinical Studies

Transient mild elevation of temperature by at least 1°C was noted 24 to 48 hours after administration of Aredia in 34% of patients in clinical trials. In the saline trial, 18% of patients had a temperature elevation of at least 1°C 24 to 48 hours after treatment.

      Drug-related local soft-tissue symptoms (redness, swelling or induration and pain on palpation) at the site of catheter insertion were most common in patients treated with 90 mg of Aredia. Symptomatic treatment resulted in rapid resolution in all patients.

      Rare cases of uveitis, iritis, scleritis, and episcleritis have been reported, including one case of scleritis, and one case of uveitis upon separate rechallenges.

      Five of 231 patients (2%) who received Aredia during the four U.S. controlled hypercalcemia clinical studies were reported to have had seizures, 2 of whom had preexisting seizure disorders. None of the seizures were considered to be drug-related by the investigators. However, a possible relationship between the drug and the occurrence of seizures cannot be ruled out. It should be noted that in the saline arm 1 patient (4%) had a seizure.

      There are no controlled clinical trials comparing the efficacy and safety of 90-mg Aredia over 24 hours to 2 hours in patients with hypercalcemia of malignancy. However, a comparison of data from separate clinical trials suggests that the overall safety profile in patients who received 90-mg Aredia over 24 hours is similar to those who received 90-mg Aredia over 2 hours. The only notable differences observed were an increase in the proportion of patients in the Aredia 24-hour group who experienced fluid overload and electrolyte/mineral abnormalities.

      At least 15% of patients treated with Aredia for hypercalcemia of malignancy also experienced the following adverse events during a clinical trial:

     General: Fluid overload, generalized pain

     Cardiovascular: Hypertension

     Gastrointestinal: Abdominal pain, anorexia, constipation, nausea, vomiting

     Genitourinary: Urinary tract infection

     Musculoskeletal: Bone pain

     Laboratory Abnormality: Anemia, hypokalemia, hypomagnesemia, hypophosphatemia

      Many of these adverse experiences may have been related to the underlying disease state.       The following table lists the adverse experiences considered to be treatment-related during comparative, controlled U.S. trials.

Transient mild elevation of temperature >1°C above pretreatment baseline was noted within 48 hours after completion of treatment in 21% of the patients treated with 90 mg of Aredia in clinical trials.

      Drug-related musculoskeletal pain and nervous system symptoms (dizziness, headache, paresthesia, increased sweating) were more common in patients with Paget’s disease treated with 90 mg of Aredia than in patients with hypercalcemia of malignancy treated with the same dose.

      Adverse experiences considered to be related to trial drug, which occurred in at least 5% of patients with Paget’s disease treated with 90 mg of Aredia in two U.S. clinical trials, were fever, nausea, back pain, and bone pain.

      At least 10% of all Aredia-treated patients with Paget’s disease also experienced the following adverse experiences during clinical trials:

     Cardiovascular: Hypertension

     Musculoskeletal: Arthrosis, bone pain

     Nervous system: Headache

      Most of these adverse experiences may have been related to the underlying disease state.

The most commonly reported (>15%) adverse experiences occurred with similar frequencies in the Aredia- and placebo-treatment groups, and most of these adverse experiences may have been related to the underlying disease state or cancer therapy.

      Of the toxicities commonly associated with chemotherapy, the frequency of vomiting, anorexia, and anemia were slightly more common in the Aredia patients whereas stomatitis and alopecia occurred at a frequency similar to that in placebo patients. In the breast cancer trials, mild elevations of serum creatinine occurred in 18.5% of Aredia patients and 12.3% of placebo patients. Mineral and electrolyte disturbances, including hypocalcemia, were reported rarely and in similar percentages of Aredia-treated patients compared with those in the placebo group. The reported frequencies of hypocalcemia, hypokalemia, hypophosphatemia, and hypomagnesemia for Aredia-treated patients were 3.3%, 10.5%, 1.7%, and 4.4%, respectively, and for placebo-treated patients were 1.2%, 12%, 1.7%, and 4.5%, respectively. In previous hypercalcemia of malignancy trials, patients treated with Aredia (60 or 90 mg over 24 hours) developed electrolyte abnormalities more frequently.

      Arthralgias and myalgias were reported slightly more frequently in the Aredia group than in the placebo group (13.6% and 26% vs 10.8% and 20.1%, respectively).

      In multiple myeloma patients, there were five Aredia-related serious and unexpected adverse experiences. Four of these were reported during the 12-month extension of the multiple myeloma trial. Three of the reports were of worsening renal function developing in patients with progressive multiple myeloma or multiple myeloma-associated amyloidosis. The fourth report was the adult respiratory distress syndrome developing in a patient recovering from pneumonia and acute gangrenous cholecystitis. One Aredia-treated patient experienced an allergic reaction characterized by swollen and itchy eyes, runny nose, and scratchy throat within 24 hours after the sixth infusion.

      In the breast cancer trials, there were four Aredia-related adverse experiences, all moderate in severity, that caused a patient to discontinue participation in the trial. One was due to interstitial pneumonitis, another to malaise and dyspnea. One Aredia patient discontinued the trial due to a symptomatic hypocalcemia. Another Aredia patient discontinued therapy due to severe bone pain after each infusion, which the investigator felt was trial-drug-related.

In a study of the safety and efficacy of Aredia 90 mg (2-hour infusion) vs Zometa 4 mg (15-minute infusion) in bone metastases patients with multiple myeloma or breast cancer, renal deterioration was defined as an increase in serum creatinine of 0.5 mg/dL for patients with normal baseline creatinine (<1.4 mg/dL) or an increase of 1.0 mg/dL for patients with an abnormal baseline creatinine (≥1.4 mg/dL). The following are data on the incidence of renal deterioration in patients in this trial. See table below.

*Patients were randomized following the 15-minute infusion amendment for the Zometa arm.

Post-Marketing Experience

      The following adverse reactions have been reported in post-marketing use: General: reactivation of Herpes simplex and Herpes zoster, influenza-like symptoms; CNS: confusion and visual hallucinations, sometimes in the presence of electrolyte imbalance; Skin: rash, pruritus; Special senses:conjunctivitis; Renal: focal segmental glomerulosclerosis including the collapsing variant, nephrotic syndrome; Laboratory abnormalities: hyperkalemia, hypernatremia, hematuria. Rare instances of allergic manifestations have been reported, including hypotension, dyspnea, or angioedema, and, very rarely, anaphylactic shock. Aredia is contraindicated in patients with clinically significant hypersensitivity to Aredia or other bisphosphonates.

      Cases of osteonecrosis (primarily of the jaws) have been reported since market introduction. Osteonecrosis of the jaws has other well documented multiple risk factors. It is not possible to determine if these events are related to Aredia or other bisphosphonates, to concomitant drugs or other therapies (e.g., chemotherapy, radiotherapy, corticosteroid), to patient’s underlying disease, or to other comorbid risk factors (e.g., anemia, infection, preexisting oral disease).

Side Effects by Body System

General

Pamidronate has been generally well tolerated and many adverse effects that occurred during treatment may have been related to the underlying disease state. Adverse effects have been most often associated with larger (90 mg) doses of pamidronate. The most common adverse effect has been fever, occurring in up to 41% of patients. The fever was generally mild and transient. Onset was typically within the first 48 hours after infusion and resolution was within another 48 hours.

In patients with osteolytic bone involvement associated with breast cancer and multiple myeloma, the most commonly reported (>15%) adverse effects occurred with similar frequency in pamidronate and placebo treatment groups.

Five pamidronate-associated serious and unexpected adverse events occurred in multiple myeloma patients during clinical trials. Symptoms included worsening renal function or multiple myeloma-associated amyloidosis (3), adult respiratory distress syndrome (1), and an allergic reaction after the sixth infusion (1).

Four breast cancer patients discontinued pamidronate because of serious adverse events including interstitial pneumonitis, malaise, dyspnea, symptomatic hypocalcemia, and severe bone pain.

Local

Local side effects associated with intravenous infusion have been reported in up to 18% of patients and included phlebitis as well as redness, swelling, and pain at the injection site.

Metabolic

Metabolic side effects have included hypophosphatemia (18%), hypokalemia (18%), hypocalcemia (12%), and hypomagnesemia (12%). While usually asymptomatic, rare cases of symptomatic hypocalcemia have been reported.

Presentation of hypocalcemia may be delayed. In one case report, the patient presented with fingertip paresthesias and a serum calcium of 6.8 mEq/L (7.8 mEq/mL, corrected) 13 days after a single infusion of pamidronate.

Hematologic

Leukopenia was generally mild and transient. In one study, granulocytopenia occurred in 4.2% of patients but completely resolved after discontinuation of pamidronate therapy. Patients with anemia, leukopenia, or thrombocytopenia prior to initiation of pamidronate should be carefully monitored during the first 2 weeks of therapy.

Hematologic side effects have included anemia, mild leukopenia, and granulocytopenia. Chronic idiopathic thrombocytopenic purpura has also been cited in a case report.

Renal

Renal side effects have included postmarketing reports of focal segmental glomerulosclerosis including the collapsing variant and nephrotic syndrome. Monitoring of renal function during and following pamidronate therapy is recommended.

Ocular

Ocular side effects have included abnormal vision as well as uveitis, iritis, episcleritis, scleritis, and nonspecific transitory conjunctivitis.

Uveitis generally occurs within 24 to 48 hours after administration of pamidronate. The uveitis may be bilateral, and reversible, partial 3rd and 4th nerve palsies have been reported with the uveitis. Recurrences have occurred with rechallenge of the drug. Therapy with pamidronate should be discontinued if uveitis occurs. Although severe cases have been reported, most symptoms have resolved on discontinuation of pamidronate with minimal or no intervention.

A nonspecific conjunctivitis has been reported with pamidronate use. The conjunctivitis may consist of any or all of the following symptoms: conjunctival hyperemia, irritation, epiphora, discharge, and blurred vision. These symptoms may appear within the first 6 to 48 hours after administration of the drug and generally resolve within a few days after drug discontinuation.

Musculoskeletal

Musculoskeletal side effects have included worsening of bone pain, arthralgias, and myalgias. In addition, cases of osteomalacia and mineralization defects have been reported. Post marketing reports have included cases of osteonecrosis, primarily of the jaws.

Nervous system

Nervous system side effects have included headache in 15% of patients with Paget's disease receiving pamidronate. Insomnia, somnolence, and psychoses have also been reported. Seizures have been reported although causality has not been established. Postmarketing reports have included confusion and visual hallucinations, sometimes in the presence of electrolyte imbalance.

Gastrointestinal

In one study, 4.7% of patients taking oral pamidronate required interruption of therapy due to gastrointestinal side effects.

Gastrointestinal side effects have been more frequently reported with oral pamidronate (not available in the United States) than with the IV formulation and have included abdominal pain, anorexia, constipation, diarrhea, stomatitis, gastrointestinal hemorrhage, nausea, and vomiting.

Other

Other side effects have included rigors (3% to 8%) and general malaise (9% to 12%).

Cardiovascular

Cardiovascular side effects such as fluid overload and hypertension have occurred in at least 15% of patients treated with pamidronate during clinical trials. Rare cases of atrial fibrillation, atrial flutter, tachycardia, syncope, and cardiac failure have been reported.

Genitourinary

Genitourinary side effects have included urinary tract infections (15%) and moniliasis (6%).

Respiratory

Respiratory side effects including dyspnea, rales, rhinitis, and upper respiratory infections have been uncommon and occurred more frequently with larger doses of pamidronate.

Endocrine

Endocrine side effects have been uncommon. Hypothyroidism has been reported in patients receiving 90 mg of pamidronate .

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This information does not endorse drugs, diagnose patients, or recommend therapy. This drug information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug of drug combination is safe, effective, or appropriate for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of information provided. 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.