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Pamidronate Side Effects

In Summary

Commonly reported side effects of pamidronate include: urinary tract infection, cough, dyspepsia, dyspnea, myalgia, abdominal pain, anemia, anxiety, constipation, diarrhea, fatigue, fever, hypervolemia, hypocalcemia, hypokalemia, hypomagnesemia, hypophosphatemia, infusion site reaction, insomnia, nausea, ostealgia, pain, thrombocytopenia, vomiting, and anorexia. Other side effects include: atrial fibrillation, candidiasis, psychosis, syncope, uremia, drowsiness, gastrointestinal hemorrhage, hypertension, hypothyroidism, leukopenia, rales, rhinitis, and tachycardia. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to pamidronate: intravenous powder for solution, intravenous solution

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:

More common
  • Abdominal or stomach cramps
  • black, tarry stools
  • bloody in the urine or stools
  • blurred vision
  • chest pain
  • chills
  • confusion
  • convulsions (seizures)
  • decrease in the amount of urine
  • dizziness
  • drowsiness
  • fainting
  • fast or irregular heartbeat
  • fever
  • headache
  • increased thirst
  • loss of appetite
  • muscle pain, cramps, spasms, or twitching
  • nausea or vomiting
  • nervousness
  • noisy, rattling breathing
  • numbness or tingling in the hands, feet, or lips
  • pinpoint red spots on the skin
  • pounding in the ears
  • shortness of breath
  • slow or fast heartbeat
  • swelling of the fingers, hands, feet, or lower legs
  • trembling
  • troubled breathing at rest
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting of blood or material that looks like coffee grounds
  • weight gain
Less common
  • Cough
  • dilated neck veins
  • extreme fatigue
  • irregular breathing
  • lower back or side pain
  • painful or difficult urination
  • pale skin
  • swelling
  • ulcers, sores, or white spots in the mouth
  • Decreased vision
  • difficulty with swallowing
  • eye pain or tenderness
  • eye redness
  • hives
  • itching
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • sensitivity of the eye to light
  • skin rash
  • sweating
  • tearing of the eye
  • tightness in the chest
Incidence not known
  • Bone, joint, or muscle pain, severe and occasionally incapacitating
  • faintness, or lightheadedness when getting up suddenly from a lying or sitting position

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:

More common
  • Acid or sour stomach
  • belching
  • bladder pain
  • bloody or cloudy urine
  • body aches or pain
  • bone pain
  • constipation
  • cracks in the skin at the corners of mouth
  • diarrhea
  • difficult, burning, or painful urination
  • difficult or labored breathing
  • difficulty moving
  • ear congestion
  • fear
  • frequent urge to urinate
  • heartburn
  • indigestion
  • joint pain
  • lack or loss of strength
  • lower back or side pain
  • muscle aching, cramping, pains, or stiffness
  • nasal congestion
  • nervousness
  • pain and swelling at the injection site
  • sensitivity to heat
  • shivering
  • sneezing
  • soreness or redness around the fingernails and toenails
  • stomach discomfort, upset, or pain
  • sweating
  • swollen joints
  • trouble sleeping
  • weight loss
Less common
  • Ammonia-like breath odor
  • feeling, seeing, or hearing things that are not there
  • feeling that others are watching you or controlling your behavior
  • feeling that others can hear your thoughts
  • feeling unusually cold
  • swelling or inflammation of the mouth
  • unusual behavior

For Healthcare Professionals

Applies to pamidronate: intravenous powder for injection, intravenous solution


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]


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


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

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]


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]


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]


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]


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]


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


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]


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]


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]

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]


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


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]


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


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


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]


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Some side effects of pamidronate may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

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