Pamidronate (Intravenous)

Pamidronate, available under the brand name Aredia, belongs in a group of medicines known as bisphosphonates and is used to treat bone damage and Paget’s disease.

Overview

Pamidronate is an FDA-approved drug that is used to alter the bone formation cycle to manage high calcium levels in the blood, which is a condition that is often caused as a result of cancer treatment. It also treats Paget's disease. This drug is not used in the treatment of cancer. Pamidronate is available in three forms: 3 mg/mL, 6 mg/mL, and 9 mg/mL. The ingredients include mannitol, phosphoric acid, and injection water.

Patients should alert their healthcare providers of all types of allergic reactions they suffer from before they start using pamidronate. These may include animals, preservatives, foods, and dyes. Dosage for pamidronate depends on the patient's disease. This drug is mixed with other liquids known as diluents before it's injected into the body. Pamidronate should never be combined with solutions containing calcium or with different types of medicine in one bag. When you start using this drug, consult your doctor before stopping.

This medication should not be shared; do not give your medicine to anyone, even if the person exhibits similar symptoms to yours. The use of pamidronate without a doctor's prescription is prohibited.

Contact your doctor immediately in case you forget to take a dose. Unless the doctor advises you to change your diet, a regular menu will suffice while receiving pamidronate treatment. Even though this drug is effective in treating the bone, it can cause some unpleasant side effects. There is usually pain around the spot where the medicine was injected and loss of appetite after treatment. However, these side effects often disappear within a few days.

Conditions Treated

  • Hypercalcemia
  • Bone metastases
  • Bone lesions
  • Paget's disease

Type Of Medicine

  • Bisphosphonate

Side Effects

Pamidronate is an active drug that helps people with bone deformation and high levels of calcium to enjoy a healthier life again. However, the medicine has been linked to numerous side effects that mainly occur during treatment. A few side effects may occur after treatment has been completed. Clinical studies reveal that adverse effects are associated with larger doses of pamidronate (90 mg). Only 41% of the patients observed exhibited the symptoms, which generally diminish within 48 hours.

Be on the lookout for these side effects and if you spot any, seek medical attention. Some more common side effects of pamidronate that are severe and should be reported to a nurse or doctor include:

  • Blood-stained stools or urine
  • Abdominal pain
  • Confusion
  • Seizures
  • Chest pain
  • Blurred vision
  • Drowsiness
  • Black stools
  • Difficulty in urinating
  • Fainting
  • Dizziness
  • Migraine
  • Dehydration
  • Vomiting or nausea
  • Appetite loss
  • Fever
  • Irregular heartbeat
  • Fainting
  • Nervousness
  • Muscle spasms
  • Red spots on skin
  • Numbness in lips, hands, or feet
  • Noisy breathing
  • Trembling
  • Swelling of the feet, hands, or fingers
  • Weight gain
  • Fatigue
  • Unusual bruising or bleeding
  • Thumping in the ears
  • Vomiting blood

The above side effects are severe so consult a healthcare provider if they persist for more than a few days after you receive the injection. On the other hand, some other undesired effects are less common. The less frequent (but still severe) side effects of pamidronate include the following:

  • Persistent cough
  • Extreme fatigue
  • Shortness of breath
  • Pale skin
  • Expanded neck veins
  • White spots, sores, or ulcers in the mouth
  • Painful urination
  • Pain in the lower back

Some rare side effects are still severe. These include the following:

  • Poor vision, especially at night
  • Eye redness
  • Eye tenderness or pain
  • Difficulty in swallowing
  • Hives
  • Eyes sensitivity to light
  • Itchiness
  • Skin rash
  • Chest tightness
  • Excessive sweating
  • Swelling of the sex organs
  • Occasional incapacitating muscle pain in the bones or joints
  • Faintness when suddenly standing from a sitting or lying position

There are some less severe side effects of pamidronate that do not require medical attention. These are effects that often occur as a result of your body reacting to the medication. Furthermore, discuss with your healthcare provider ways in which you can reduce or prevent these undesirable effects.

The more common side effects that are less severe include the following:

  • Belching
  • Bone pain
  • Cloudy urine
  • Sour stomach
  • Mild body pain
  • Bladder pain
  • Constipation
  • Diarrhea
  • Fear
  • Ear congestion
  • Heartburn
  • Frequent urination
  • Indigestion
  • Lack of strength
  • Joint pain
  • Muscle cramps or stiffness
  • Difficulty moving
  • Nasal congestion
  • Nervousness
  • Pain or swelling in the area of injection
  • Heat sensitivity
  • Sneezing
  • Stomach discomfort
  • Sweating
  • Shivering
  • Trouble sleeping
  • Swollen joints

Some less common side effects that are also less severe include:

  • Unusual behavior
  • Swelling of the mouth
  • Hallucinations
  • Paranoia
  • Ammonia-like breath odor
  • Feeling cold

Dosage

Pamidronate is given through IV infusion and must be administered slowly; a treatment session can last anywhere from 2 to 24 hours. The IV can be injected at a clinic, hospital or home. Nevertheless, patients who do not fully understand how to self-inject and dispose of used needles correctly should go to a hospital.

The dosage and infusion time depend on some factors such as the condition being treated, the patient's medical history and responsiveness. Pamidronate is once in a while given only one time and as a single dose. The drug can also be administered over 3 three consecutive days or injected once after a duration of 3 or 4 weeks. Follow the doctor's orders.

The dose for moderate hypercalcemia is 12 mg/dL to 13.5 mg/dL. This means that 60 to 90 mg of pamidronate should be injected into the patients' veins in a period of 2 to 24 hours.

The dose for severe hypercalcemia is usually more than 13.5 mg/dL. This is administered as a 90 mg single dose over a period of 2 to 24 hours.

The dose for Paget's disease (moderate to severe) is 30 mg, which is injected for three consecutive days; the total dose is 90 mg. The treatment is administered for 4 hours daily.

The dose for bone lesions is 90 mg; it's administered for 2 hours every month. For general benefits, the drug is injected for 24 months.

For bone metastases, the prescribed dose is 90 mg to be administered for 2 hours every 3 weeks. The therapy lasts for 24 months.

Retreatment is for patients whose calcium levels do not go back to normal after the treatment has been administered. Allow 7 days before getting another treatment so that the dose injected can function. Retreatment is identical to the initial dose.

Major drug interactions

Pamidronate interacts with numerous other over-the-counter medications to cause severe side effects. Keep a list of all your prescription drugs, herbal products, supplements, etc. and share it with your healthcare provider. When receiving this treatment, do not alter dosages, start, or stop other medicines. Pamidronate usually interacts with other bisphosphonates and kidney medication.

Here is a list of drugs that will interact with pamidronate:

  • Calcium supplements
  • Calcitonin
  • Anti-inflammatory medication
  • Thalidomide
  • Vitamin supplements
  • Aminoglycosides
  • Antibiotics
  • Methotrexate

Patients who are using the mentioned drugs should consult a healthcare provider for a full benefit of overall enhanced health. The doctor may advise any of the following:

  • Stop taking any of the drugs that react with pamidronate
  • Switch one of the medications by finding a suitable alternative
  • Alter the manner in which you're currently administering both types of drugs
  • Do not change the current situation

It's important to note that when an interaction between two types of drugs occurs, it does not always mean that the patient must stop taking either one. Consult a doctor to learn how these interactions can be managed appropriately for improved health to be realized.

Other medications not mentioned in this guide may also interact with pamidronate. Alcohol, caffeine, cigarettes, and street drugs can all interact with the medicine to cause severe side effects. Alert your healthcare provider if you use any of these.

Warnings

After it's received from the manufacturer, pamidronate must be mixed with diluents before it's injected into the patient's body. Patients who are injecting themselves at home need to properly understand how to mix, administer and store the medicine correctly. Pamidronate should never be mixed with other drugs in the same IV bag or with other solutions, especially those containing calcium, for example lactated Ringer's solution.

The disposable needles should only be used once. According to local laws of handling toxic waste material, the needles must be thrown in a special container that is puncture-proof to avoid infections while handling syringes and needles. If you're administering the injections at home, ask your healthcare provider where you can get the containers. Keep the container away from pets and children.

Patients who are not suffering from hypercalcemia may be prescribed vitamin D or calcium supplements to take orally when pamidronate is injected. Caution: You should only take the supplements prescribed by a healthcare professional. The patient's blood should regularly be tested to monitor the effects and major drug interactions while ensuring that the medicine is not causing any detrimental effects.

To get the full benefits of pamidronate, observe the following precautions:

  • Seek medical intervention if the health complications do not improve or the symptoms worsen. Allow for up to 24 months to enjoy better health from the full treatment.
  • Do not share your pamidronate dosage with other people (even if they're exhibiting similar symptoms) and avoid taking someone else's drugs.
  • Keep a list of all medication you're using such as vitamins, natural products, and over-the-counter medicines to give to a healthcare provider before going for a treatment session. Do not alter the dosage for the other drugs as well; discuss with your doctor the correct dose amounts to prevent possible interactions with pamidronate.
  • Discuss with your doctor before taking a new type of medicine such as supplements and prescription pills.
  • Keep the medication safely in a place that is out of reach for kids and pets. In case your loved one swallows the medicine, call poison control or rush them to the hospital and take with you the package of the ingested medication.
  • Confirm with your local regulations on the appropriate way to dispose of unused drugs and needles. Ensure that you handle the needles and other waste products with protective gloves to avoid infections.
  • Do not use pamidronate if you're pregnant or planning to get pregnant, breastfeeding, or planning to go for a dental procedure. Studies reveal that pamidronate can cause harmful effects to both the fetus and mother.
  • To limit the risk of kidney damage, the drug should be given slowly for not less than 2 hours. Patients with kidney disease should not use pamidronate.
  • Do not use this medication if it has foreign particles inside or its color has changed. When contaminated, especially with other types of drugs, pamidronate can cause severe side effects that can be fatal. In case this happens, contact your doctor for a replacement of your prescription.

Storage

Pamidronate is supplied as a powder by the manufacturer, and it should be stored below 30°C (86°F). It does not require refrigeration; the expiration date is 24 months after the manufacturing date.

Powder that has been mixed with the diluents can be stored under refrigeration with temperatures ranging from 36° to 46°F. When the drug is in liquid form, it can only last for 24 hours. Dispose of accordingly any remaining medication after this period.

You can store unmixed pamidronate at room temperature, but away from heat and moisture. Store in a dry place away from other medicine, solutions, and foods; these may contaminate the drug. Keep the drug out of reach of children and pets.

For all storage details, inquire from your healthcare provider. Do not pour unused drugs down the drain; discard expired medicine correctly through a waste disposal company according to the local regulations.

Summary

Pamidronate belongs to a group of drugs known as bisphosphonates. The drug is used to treat hypercalcemia, which is a condition characterized by high calcium levels in the blood and is usually brought about as a result of chemotherapy. The medicine is also used to treat bone deformations and Paget's disease. Pamidronate slows down the osteoclasts, which are cancer cells responsible for eating away bones. It then prevents high calcium levels, fractures, or bone pains.

The dosage amount given depends on the type of condition being treated, the patient's medical history and overall responsiveness. The medicine is mixed with other liquids in an IV bag and administered as an injection. Pamidronate should not be shared and in case of an overdose, make a call to your local poison control center or take the victim to the nearest hospital.

For the patient to experience full benefits of the drug, it has to be used for a period of up to 24 months. However, pamidronate also causes some severe side effects while it is delivering treatment to the body. Seek medical assistance if you start showing any of the symptoms. Alert your healthcare provider with regards to other over-the-counter medication that you may be using. Keep a list of herbal products, supplements, and street drugs as well. Ensure that your blood is tested regularly when being treated with pamidronate to establish whether the condition is improving or deteriorating.