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Pamidronate Side Effects

Medically reviewed by Drugs.com. Last updated on Apr 11, 2023.

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

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:

More common

Less common

Rare

Incidence not known

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:

More common

Less common

For Healthcare Professionals

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

General

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

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%): Anemia, thrombocytopenia, lymphocytopenia, leukopenia[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

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]

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]

References

1. Gallacher SJ, Ralston SH, Patel U, Boyle IT. Side-effects of pamidronate. Lancet. 1989;2:42-3.

2. Product Information. Aredia (pamidronate). Novartis Pharmaceuticals. 2001.

3. Purohit OP, Radstone CR, Anthony C, Kanis JA, Coleman RE. A randomised double-blind comparison of intravenous pamidronate and clodronate in the hypercalcaemia of malignancy. Br J Cancer. 1995;72:1289-93.

4. Lourwood DL. The pharmacology and therapeutic utility of bisphosphonates. Pharmacotherapy. 1998;18:779-89.

5. Cerner Multum, Inc. UK Summary of Product Characteristics.

6. Cerner Multum, Inc. Australian Product Information.

7. Product Information. Pamidronate Disodium (pamidronate). Teva Pharmaceuticals USA. 2016.

8. Mautalen CA, Casco CA, Gonzalez D, Ghiringhelli GR, Massironi C, Fromm GA, Plantalech L. Side effects of disodium aminohydroxypropylidenediphosphonate (APD) during treatment of bone diseases. Br Med J (Clin Res Ed). 1984;288:828-9.

9. Spivacow FR, Zanchetta JR, Kerzberg EM, Frigeri A, Fiasche R, Roldan EJA. Tolerability of oral pamidronate in elderly patients with osteoporosis and other metabolic bone diseases. Curr Ther Res Clin Exp. 1996;57:123-30.

10. Theriault RL, Lipton A, Hortobagyi GN, Leff R, Gluck S, Stewart JF, Costello S, Kennedy I, Simeone J, Seaman JJ, Knight RD,. Pamidronate reduces skeletal morbidity in women with advanced breast cancer and lytic bone lesions: A randomized, placebo-controlled trial. J Clin Oncol. 1999;17:846-54.

11. Herrera JA, Sarabia MO, Gonzalez MM. Effects of treatment with bisphosphonates on gastrointestinal and esophageal mucosa in patients with osteoporosis: Pamidronate versus alendronate. Curr Ther Res Clin Exp. 1999;60:307-13.

12. Jodrell DI, Iveson TJ, Smith IE. Symptomatic hypocalcaemia after treatment with high-dose aminohydroxypropylidene diphosphonate. Lancet. 1987;1:622.

13. Lipton A, Theriault RL, Hortobagyi GN, Simeone J, Knight RD, Mellars K, Reitsma DJ, Heffernan M, Seaman JJ. Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases - Long term follow-up of two randomized, placebo-controlled trials. Cancer. 2000;88:1082-90.

14. Rosen CJ, Brown S. Severe hypocalcemia after intravenous bisphosphonate therapy in occult vitamin D deficiency. N Engl J Med. 2003;348:1503-4.

15. Palmieri C, Dhillon T, Coombes C, Vigushin D. Hypocalcaemia after intravenous bisphosphonate: adjuvant bisphosphonate is not currently accepted practice. BMJ. 2004;328:1439; author reply 1439-40.

16. Kellihan MJ, Mangino PD. Pamidronate. Ann Pharmacother. 1992;26:1262-9.

17. Adamson BB, Gallacher SJ, Byars J, Ralston SH, Boyle IT, Boyce BF. Mineralisation defects with pamidronate therapy for paget's disease. Lancet. 1993;342:1459-60.

18. Reid IR, Cundy T, Ibbertson HK, King AR. Osteomalacia after pamidronate for pagets disease. Lancet. 1994;343:855.

19. Liens D, Delmas PD, Meunier PJ. Long-term effects of intravenous pamidronate in fibrous dysplasia of bone. Lancet. 1994;343:953-4.

20. Malnick SD, Ariel-Ronen S, Evron E, Sthoeger ZM. Acute pseudogout as a complication of pamidronate. Ann Pharmacother. 1997;31:499-500.

21. Bamias A, Kastritis E, Bamia C, et al. Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol. 2005;23:8580-7.

22. Foley-Nolan D, Daly MJ, Williams D, Wasti A, Martin M. Pamidronate associated hallucinations. Ann Rheum Dis. 1992;51:927-8.

23. Ghose K, Waterworth R, Trolove P, Highton J. Uveitis associated with pamidronate. Aust N Z J Med. 1994;24:320.

24. Macarol V, Fraunfelder FT. Pamidronate disodium and possible ocular adverse drug reactions. Am J Ophthalmol. 1994;118:220-4.

25. De S, Meyer P, Crisp AJ. Pamidronate and uveitis. Br J Rheumatol. 1995;34:479.

26. Odonnell NP, Rao GP, Aguisfernandez A. Paget's disease: ocular complications of disodium pamidronate treatment. Br J Clin Pract. 1995;49:272-3.

27. Stewart GO, Stuckey BGA, Ward LC, Prince RL, Gutteridge DH, Constable IJ. Iritis following intravenous pamidronate. Aust N Z J Med. 1996;26:414-5.

28. Machado CE, Flombaum CD. Safety of pamidronate in patients with renal failure and hypercalcemia. Clin Nephrol. 1996;45:175-9.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.