Pamidronate Side Effects

Medically reviewed by Drugs.com. Last updated on Aug 15, 2024.

Applies to pamidronate: intravenous powder for solution, intravenous solution.

Precautions

It is important that your doctor check your progress at regular visits after you have received pamidronate injection. If your condition has improved, your progress must still be checked. The results of laboratory tests or the occurrence of certain symptoms will tell your doctor if your condition is coming back and a second treatment is needed.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

For patients using this medicine for hypercalcemia (too much calcium in the blood):

• Your doctor may want you to follow a low-calcium diet. If you have any questions about this, check with your doctor.

Your doctor will need to know if you have a history of problems with your mouth or teeth (e.g., gum disease). Make sure your doctor knows if you have been treated with a bisphosphonate medicine, such as alendronate (Fosamax®), etidronate (Didronel®), pamidronate (Aredia®), risedronate (Actonel®), or tiludronate (Skelid®) in the past.

You may need to have a dental exam before you start using this medicine.

It is important that you check with your doctor before having any dental procedures or surgeries done while you are receiving pamidronate. Tell your doctor right away if you have jaw tightness, swelling, numbing, or pain or a loose tooth. This could be symptoms of a severe problem of your jaw.

Make sure you tell your doctor about any new medical problems, especially with your teeth or jaws. Tell your doctor right away if you have severe bone, joint, or muscle pain after receiving this medicine.

This medicine may increase your risk of developing fractures of the thigh bone. This may be more common if you use it for a long time. Check with your doctor right away if you have a dull or aching pain in the thighs, groin, or hips.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Serious side effects of pamidronate

Along with its needed effects, pamidronate may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking pamidronate:

Other side effects of pamidronate

Some side effects of pamidronate may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

For healthcare professionals

Applies to pamidronate: intravenous powder for injection, intravenous solution.

General adverse events

This drug 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.^[Ref]

Gastrointestinal

• Very common (10% or more): Nausea, vomiting, abdominal pain, diarrhea, constipation, gastritis, dyspepsia^[Ref]

Genitourinary

• Very common (10% or more): Urinary tract infection (15%)
• Common (1% to 10%): Moniliasis^[Ref]

Metabolic

• Very common (10% or more): Hypocalcemia, hypophosphatemia, anorexia, fluid overload
• Common (1% to 10%): Hypokalemia, hypomagnesemia
• Very rare (less than 0.01%): Hyperkalemia, hypernatremia^[Ref]

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.^[Ref]

Musculoskeletal

• Very common (10% or more): Arthrosis
• Common (1% to 10%): Transient bone pain, arthralgia, myalgia, generalized pain
• Uncommon (0.1% to 1%): Muscle cramps, osteonecrosis
• Postmarketing reports: Atypical subtrochanteric and diaphyseal femoral fractures^[Ref]

Other

• Very common (10% or more): Fever and influenza-like symptoms sometimes accompanied by malaise, rigor, fatigue, flushes, asthenia
• Very rare (less than 0.01%): Reactivation of Herpes simplex, reactivation of Herpes zoster^[Ref]

Respiratory

• Very rare (less than 0.01%): Acute respiratory distress syndrome, interstitial lung disease
• Postmarketing reports: Adult respiratory distress syndrome (ARDS), interstitial lung disease (ILD)^[Ref]

Cardiovascular

• Common (1% to 10%): Atrial fibrillation, hypertension
• Uncommon (0.1% to 1%): Hypotension
• Very rare (less than 0.01%): Left ventricular failure (dyspnea, pulmonary edema), congestive heart failure (edema) due to fluid overload^[Ref]

Dermatologic

• Common (1% to 10%): Rash
• Uncommon (0.1% to 1%): Pruritus^[Ref]

Hematologic

• Common (1% to 10%): Anemia, thrombocytopenia, lymphocytopenia, leukopenia^[Ref]

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.^[Ref]

Local

• Common (1% to 10%): Reactions at the infusion site (pain, redness, swelling, induration, phlebitis, thrombophlebitis)^[Ref]

Nervous system

• Common (1% to 10%): Symptomatic hypocalcemia (tetany, paresthesia), headache
• Uncommon (0.1% to 1%): Seizures, lethargy, dizziness
• Very rare (less than 0.01%): Confusion^[Ref]

Ocular

• Common (1% to 10%): Conjunctivitis
• Uncommon (0.1% to 1%): Uveitis (iritis, iridocyclitis)
• Very rare (less than 0.01%): Scleritis, episcleritis, xanthopsia
• Frequency not reported: Optic neuritis
• Postmarketing reports: Orbital inflammation^[Ref]

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.^[Ref]

Psychiatric

• Common (1% to 10%): Insomnia
• Uncommon (0.1% to 1%): Agitation
• Very rare (less than 0.01%): Visual hallucinations^[Ref]

Renal

• Common (1% to 10%): Increase in serum creatinine
• Uncommon (0.1% to 1%): Increase in serum urea, acute renal failure
• Rare (0.01% to 0.1%): Focal segmental glomerulosclerosis including the collapsing variant, nephrotic syndrome
• Very rare (less than 0.01%): Deterioration of pre-existing renal disease, hematuria, renal tubular disorder, tubulointerstitial nephritis, glomerulonephropathy^[Ref]

Endocrine

• Uncommon (0.1% to 1%): Hypothyroidism in patients receiving doses of 90 mg^[Ref]

Hepatic

• Uncommon (0.1% to 1%): Abnormal liver function test^[Ref]

Hypersensitivity

• Uncommon (0.1% to 1%): Allergic reactions including anaphylactoid reactions, bronchospasm/dyspnea, Quincke's (angioneurotic) edema
• Very rare (less than 0.01%): Anaphylactic shock^[Ref]

See also:

Further information

Pamidronate side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer