Pamidronate can lower calcium levels in the blood and strengthen bones and relieve pain in people with some secondary bone cancers.
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Pamidronate (Aredia®) belongs to a group of drugs called bisphosphonates. It can be used to treat:
- high levels of calcium in the blood caused by cancer that has spread to the bones
- bone weakness or pain caused by myeloma or by breast cancer that has spread to the bones.
Cancer that has spread to the bones is called secondary bone cancer. It happens when cells from the original (primary) cancer spread to form a new tumour (secondary cancer or metastasis) in the bone.
Myeloma is a cancer of a type of blood cell called plasma cells. The abnormal plasma cells build up inside bones causing pain and weakness.
Pamidronate can be given with other cancer treatments.
In normal bones, two types of cell work together to keep your bones healthy. They are:
- osteoclasts, which destroy old bone
- osteoblasts, which build new bone.
Myeloma and some secondary bone cancers make chemicals that cause osteoclasts to work harder. This means that more bone is destroyed than rebuilt. The affected bone becomes weak and painful and can break more easily.
Bones contain calcium, which gives them strength. A bone affected by secondary cancer or myeloma may lose calcium into the blood. A raised level of calcium in the blood is called hypercalcaemia. This may cause you to have symptoms including:
Pamidronate reduces the activity of osteoclasts. This can help reduce pain and strengthen the bone.
Pamidronate also reduces the amount of calcium that is lost from the bones. This helps calcium levels in the blood return to normal.
Pamidronate is given by a drip (infusion) into a vein through a fine tube called a cannula. It is usually given in the outpatient department at the hospital. The infusion can take from 1 hour to several hours, depending on the dose. Your cancer doctor or specialist nurse will tell you how long your treatment will take. It is usually given every 3 to 4 weeks.
How long pamidronate is given for depends on why you are having the treatment:
- If you are having pamidronate to reduce pain or strengthen your bones, your doctor will talk to you about how long you may need to take it for. You need to have it for as long as it seems to be working.
- If you are having pamidronate to lower calcium levels in your blood, it is usually given as a single dose. Or you may have several infusions over 2 to 4 days.
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Some people have very few side effects while others may have more. The side effects described here will not affect everyone taking pamidronate. If you are taking other drugs, you may have some side effects that we do not list here.
We explain the most common side effects here but have not included those that are rare and therefore unlikely to affect you. If you notice any side effects that are not listed below, tell your doctor or nurse.
These include having:
- a high temperature
- pains in your muscles or joints.
Let your doctor know if these effects are troublesome. It may be helpful to take mild painkillers such as paracetamol. Your doctor, nurse or pharmacist can give you advice.
Sometimes pain in the affected bone gets worse for a short time when you start taking pamidronate. If this happens, your doctor can prescribe painkillers until it gets better.
Numbness or tingling
You may notice numbness or tingling around the mouth or in the fingers and toes. This may be caused by low levels of calcium in your blood. You will have regular blood tests to check your calcium levels. Contact your doctor straight away if you have any of this symptom. You may be asked to take calcium and vitamin D supplements, unless you are having this treatment to lower the levels of calcium in your blood. Your doctor will let you know if any supplements are needed.
You may feel sick or be sick (vomit) during treatment for pamidronate. This is usually mild. Your doctor can give you anti-sickness tablets to help. These are also called anti-emetic tablets.
Take the drugs exactly as your nurse or pharmacist tells you to. It is easier to prevent sickness than treat it after it has started.
Diarrhoea or constipation
Red or sore eyes
Tell your doctor if you have red or sore eyes. They can prescribe eye drops to help.
Pain at injection site
Tell your doctor if you have redness at the injection site, or if any of your veins are painful.
Rarely, this treatment may cause an allergic reaction.
Signs of an allergic reaction can include:
- a faster heartbeat
- swelling in your face
- skin reactions
- pain in your back, tummy or chest
- a rash or bruising on your skin
- flu-like symptoms.
Tell the nurse straight away if you think you may be having an allergic reaction. If you develop these symptoms when you are at home, contact the hospital straight away on the number you have been given. They can give you advice.
Effect on kidneys
Pamidronate can affect how your kidneys work. The effects are generally mild. Drinking plenty of fluids will help your kidneys work well. Your doctor will check how well your kidneys are working with regular blood tests.
Tell your doctor if:
- you feel generally unwell
- you have any swelling of your face, arms, legs or tummy
- you notice a change in how often you pass urine (pee).
This is not common, but it is important to tell your doctor if you are getting headaches. They will advise you about what medicines to take. It is also important to drink plenty of fluids.
Pain in the thigh, hip or groin
Rarely, people taking pamidronate develop a break (fracture) in their thigh bone without any obvious cause. Sometimes both thigh bones are affected.
If you have any thigh, hip or groin pain, tell your doctor and mention that you are taking bisphosphonates. They can arrange tests to check the thigh bones for any signs of weakness or fracture.
Rarely, this treatment can affect the jaw bone. Healthy bone in the jaw becomes damaged and dies. This is called osteonecrosis of the jaw (ONJ). It can cause:
- loosening of the teeth
- problems with the way the gums heal.
The risk of jaw problems is higher after some types of dental treatment and in people who have gum disease or dentures that do not fit well.
It is important to avoid having a dental treatment that could affect your jaw bone when you are having bisphosphonates. This includes having a tooth or root removed or dental implants put in. It is fine to have fillings, gum treatments or a scale and polish.
To reduce your risk of developing jaw problems your doctor will advise you to:
- have a full dental check-up before starting treatment
- look after your teeth and gums during treatment (ask your dentist for advice)
- tell your dentist you are taking a bisphosphonate before having any dental treatment.
Tell your cancer specialist and dentist straight away if you at any time you develop:
- swelling or redness in your gums
- numbness or heaviness in your jaw
- loose teeth.
Very rarely, bones in the outer ear may be affected by this treatment. Always tell your cancer doctor if you have any:
- ear pain
- discharge from your ear
- ear infections.
You should also tell your doctor if you notice any other changes in your ears or hearing.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they are not mentioned above.
Admission to hospital
If you are admitted to hospital for a reason not related to the cancer, it is important to tell the doctors and nurses that you are having treatment with bisphosphonates. You should tell them the name of your cancer specialist. This is so that they can talk to them for advice.
It is a good idea to find out who you should contact if you have any problems or troublesome side effects when you are at home. The doctor or nurse at the hospital can advise you about this.
Some medicines can increase the side effects of this treatment or make it work less well. This includes medicines and supplements you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, herbal drugs and complementary therapies.
Pregnancy and breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Women are also advised not to breastfeed if taking pamidronate. This is because the medicine may be passed to the baby through the breast milk.