Pamidronate
Pamidronate is used to treat and prevent problems caused by the effect of cancer on the bones.
On this page
What is pamidronate?
Pamidronate 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 (secondary bone cancer)
- bone weakness or pain caused by myeloma or by breast cancer that has spread to the bones.
Pamidronate can be given with other cancer treatments.
More information about this treatment
This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.
You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.
The effect of cancer on the bones
Bones are living tissue. They have a blood and nerve supply to keep them healthy. Bones are constantly being renewed. This helps maintain their strength and shape.
Inside the bones, there are 2 types of bone cell:
- Osteoclasts break down and remove old bone.
- Osteoblasts build new bone.
When we are children and young adults, our bones keep getting thicker and stronger. But as we get older, osteoclasts begin to remove more bone than osteoblasts make. This means our bones slowly become thinner (less dense). In some people, too much bone is lost and they have an increased risk of bone fractures.
Myeloma and some secondary bone cancers make chemicals that cause osteoclasts to destroy more bone. This means that more bone is destroyed than rebuilt. The affected bone becomes weak and painful. They can break more easily.
Bones contain calcium, which gives them strength. A bone affected by secondary cancer or myeloma may lose calcium from the bones into the blood. A raised level of calcium in the blood is called hypercalcaemia. This may cause the following symptoms:
- feeling sick (nausea)
- feeling thirsty
- tiredness or feeling drowsy
- feeling irritable
- feeling confused
- constipation and tummy pain.
How pamidronate works
Pamidronate reduces the activity of osteoclasts. This can help to reduce pain and strengthen the bone.
Pamidronate also reduces the amount of calcium lost from the bones. This helps calcium levels in the blood return to normal.
How pamidronate is given
You will be given pamidronate in the outpatient department at the hospital. You will have blood tests before starting treatment and during treatment. These check several things, including:
- how your kidneys are working
- your calcium levels.
Your urine may also be checked.
Pamidronate is given by a drip (infusion) into a vein. The infusion may be given over between 90 minutes and 4 hours. Your doctor or 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
If you are having pamidronate to reduce pain or strengthen your bones, you may continue it for as long as it helps manage the symptoms.
If pamidronate is given to lower calcium levels, it is usually given as a single dose. Or you may be given several infusions over 2 to 4 days.
About side effects
We explain the most common side effects of this treatment here. We also include some less common side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Serious and life-threatening side effects
Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.
Contact the hospital
Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
Dental check-up before treatment
Rarely, this treatment can affect the jawbone. You can read more about this in our information about side effects.
Having a healthy mouth and teeth reduces your risk of jaw problems. You usually need a dental check-up to check for any problems before you start treatment.
If you need urgent treatment to lower high calcium levels in your blood, you do not usually need a dental check-up first.
Common side effects
Flu-like symptoms
Some people have flu-like symptoms, such as:
- a high temperature
- chills
- pains in your muscles or joints.
Tell your doctor if these effects are causing problems. It may help to take mild painkillers, such as paracetamol. Your doctor, nurse or pharmacist can give you advice.
Increased bone pain
Sometimes pain in the affected bone gets worse for a short time when you start taking this treatment. If this happens, your doctor can prescribe painkillers to help.
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 these symptoms.
Your doctor may ask you 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 you need any supplements.
Feeling sick
You may feel sick or be sick (vomit) during treatment. This is usually mild. Your doctor can prescribe anti-sickness tablets to help.
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
Tell your doctor if you have diarrhoea or constipation. They can give you medicine to help with this. Try to drink at least 2 litres (3½ pints) of fluids each day.
Red or sore eyes
Pain along the vein
This treatment can cause pain:
- at the place where the drip (infusion) is given
- along the vein.
If you feel pain, tell your nurse straight away. They can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.
Skin changes
Blood pressure changes
This treatment can affect your blood pressure. It can cause high blood pressure and sometimes low blood pressure. Tell your doctor if you:
- have problems with your blood pressure
- have headaches
- feel dizzy.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- nosebleeds
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin.
If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:
- very low in energy
- breathless
- dizzy and light-headed.
If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Less common side effects
Allergic reaction
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- shivering
- itching
- a skin rash
- feeling dizzy or sick
- a headache
- feeling breathless or wheezy
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, they can treat it quickly.
Sometimes a reaction happens a few hours after treatment. If you develop any of these signs or feel unwell after you get home, contact the hospital straight away on the 24-hour number.
Always call 999 if swelling happens suddenly or you are struggling to breathe.
Effects on the kidneys
This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your kidneys are working.
It is important to drink at least 2 litres (3½ pints) of fluids each day to help protect your kidneys.
Headaches
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
It is also important to drink plenty of fluids.
Jaw problems
Rarely, this treatment can affect the jawbone. Healthy bone in the jaw becomes damaged and dies. This is called osteonecrosis of the jaw (ONJ). It can cause:
- pain
- loosening of the teeth
- problems with the way the gums heal.
The risk of jaw problems is higher after some types of dental treatment. It is also higher in people who smoke, have gum disease or have dentures that do not fit well.
It is important to avoid having any dental treatment that could affect your jawbone when you are having bisphosphonates. This includes having a tooth or root removed or dental implants put in. You can still 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 doctor and dentist straight away if at any time you develop:
- pain
- swelling or redness in your gums
- numbness or heaviness in your jaw
- loose teeth.
Pain in the thigh, hip or groin
Rarely, people taking clodronate develop a break (fracture) in their thigh bone without any obvious cause. Sometimes both thigh bones are affected.
If you have any pain in the thigh, hip or groin, 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.
Ear problems
Very rarely, bones in the outer ear may be affected by this treatment. Always tell your doctor if you have any:
- ear pain
- discharge from your ear
- ear infections.
You should also let them know if you notice any other changes in your ears or hearing.
Other information
Going into hospital
Other medicines
Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop, pharmacy or online
- vitamins or supplements
- herbal drugs and complementary or homeopathic therapies
- recreational drugs – for example, cannabis.
Pregnancy
Ask your doctor or pharmacist for advice before taking this medicine if you:
- are pregnant
- think you may be pregnant
- are planning to have a baby.
Breastfeeding
You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk.
Your doctor, nurse or pharmacist can give you more information.
About our information
-
References
Visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for more detailed information. The leaflet lists all known side effects.
-
Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
- explain medical words
- use short sentences
- use illustrations to explain text
- structure the information clearly
- make sure important points are clear.
We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.