Pamidronate disodium

Pamidronate disodium is a type of bisphosphonate. You pronounce it as pa-mid-row-nate dye-so-dee-um.

It is a treatment for cancers that break down bone cells or have spread to the bones. It can help treat or prevent bone problems such as breaks or pain.

You might also have pamidronate disodium to treat high levels of calcium in the blood (hypercalcaemia) caused by secondary bone cancer. 

How does pamidronate disodium work?

Pamidronate disodium sticks to the bone and helps to reduce bone loss.

How do you have pamidronate disodium?

You have pamidronate disodium as a drip into your bloodstream (intravenously).

You have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

When do you have pamidronate disodium?

You might have pamidronate disodium as a one off treatment to reduce calcium levels in your blood. Or you might have it every 3 to 4 weeks as a regular treatment to prevent or reduce bone damage.

Each treatment lasts from one to several hours depending on the dose.

Tests

You have blood tests before starting treatment and during your treatment. They check your blood calcium levels and how your kidneys are working. You might also need to do urine samples for testing and have tests to check how well your heart is working.

What are the side effects of pamidronate disodium?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Flu like symptoms

You might have flu-like symptoms including a high temperature (fever), chills, feeling tired and weak, headache and you might have sudden reddening of your face and neck. A mild fever can last up to 48 hours after your treatment.  

Low levels of calcium and phosphate in the blood

Low calcium levels in the blood can cause painful spasms, cramps or twitching in your muscles. You might also get numbness or tingling in your feet, hands or around your mouth.

Low levels of phosphate can cause muscle weakness and confusion.

You have blood tests to check the levels of calcium and phosphate, as well as other substances.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• redness, swelling, pain or leaking at your drip site – tell your nurse straight away if you have this

• low levels of red blood cells in your blood (anaemia) can make you feel breathless and look pale

• low levels of magnesium and potassium - let your doctor or nurse know if you have cramping in your arm or leg muscles, tingling or numbness, palpitations, or if you feel faint

• low platelets levels in your blood can cause nosebleeds, bruising or bleeding gums

• headaches

• difficulty sleeping

• feeling drowsy or you might find it difficult to stay awake - don’t drive or operate machinery if you have this, you shouldn’t drive yourself home after your treatment. This usually improves after 24 hours

• constipation or diarrhoea

• feeling sick or being sick

• loss of appetite

• eye problems such as reddening, pain, changes in vision, itching, feeling gritty or burning feeling. Let your healthcare team know of any eye issues

• a skin rash that can be itchy, but this is rare

• kidney problems due to high levels of creatinine in your blood. Creatinine is a waste product made by the muscles that your kidneys remove this from our blood. You have blood tests to check these levels

• pain in different parts of the body such as the stomach, bones, joints and muscle

• changes in your blood pressure, it might go up causing headaches, blurred vision, chest pain, shortness of breath. Rarely it might drop making you feel lightheaded, faint or weak

• muscle cramps and twitches

• tingling, numbness or pins and needles

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• allergic reaction which includes a rash, shortness of breath, redness or swelling of the face, feeling hot, dizziness or a sudden need to pass urine

• kidney failure with can cause breathlessness and swelling in different parts of the body

• fluid build-up may cause swelling in your arms, hands, ankles, legs, face and other parts of the body

• feeling tired

• seizures (fits)

• feeling dizzy

• mood changes which include feeling agitated, confused, or seeing things that aren't real

• lung problems such as difficulty breathing and coughing

• indigestion symptoms include heartburn, bloating, and burping

• liver changes that are usually mild and unlikely to cause symptoms – you will have regular blood tests to check for any changes in the way your liver is working

Bone problems

Damage to the bones (for example in the jaw or thigh) is a rare but serious side effect. Contact your medical team if you have any of the following:

• ear pain

• discharge from your ear

• an ear infection

• pain in the mouth, teeth or jaw

• loosening of a tooth

• pain or weakness in your hip, thigh or groin

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Let your team know straight away if you or your partner become pregnant while having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. 

Dental treatment

It is important to see your dentist before you start pamidronate disodium, and regularly during your treatment. You should avoid any invasive dental treatment such as extractions while you are having pamidronate disodium. You can have fillings and routine cleaning.

If you need dental treatment talk to your specialist about whether you should stop your bisphosphonates beforehand. But don't stop taking them without talking to your doctor first.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.