Pamidronate is a type of drug called a bisphosphonate. It’s used to treat osteoporosis.  This is a condition when the bones become thinner or weaker. Some illnesses, like myeloma or secondary cancer of the bone, can cause weakness in the bones.
Normally, two kinds of bone cell work together to keep bones healthy:

  • osteoclasts destroy old bone
  • osteoblasts build new bone.

Some cancers can cause osteoclasts to work too hard, destroying more bone cells than are created. This can weaken the bone, cause pain, or increase the amount of calcium in the blood.  Pamidronate can slow the action of osteoclasts, allowing the bone to recover. It also helps to lower raised calcium levels in the blood.

Pamidronate is given as an intravenous drip every 3–4 weeks, or sometimes as a single dose. There are some side effects associated with pamidronate. Not everyone having the treatment will have all the side effects. Any changes should be discussed with your doctor or nurse.

Pamidronate (Aredia®)

Pamidronate belongs to a group of drugs called bisphosphonates. Bisphosphonates are commonly used to treat bone thinning (osteoporosis). In certain situations, they can help protect your bones against some of the effects of secondary bone cancer, such as pain and weakness. Secondary bone cancer occurs when cells from the original (primary) cancer spreads to form a new tumour (secondary cancer or metastasis) in the bone.

Pamidronate is often given alongside other cancer treatments. As well as being used in some types of secondary bone cancer, it has been shown to be effective in people with myeloma, a cancer of the plasma cells in the blood. It is also used to lower a raised calcium level in the blood.

The effect of cancer on the bones

In secondary bone cancer, calcium, which helps strengthen the bones, can be lost from the damaged bone and seep into the bloodstream. A raised level of calcium in the blood is known as hypercalcaemia. This can cause symptoms such as feeling or being sick (nausea or vomiting), tiredness, irritability and sometimes confusion. Pamidronate can help reduce high levels of calcium.

Secondary cancer in the bones may make them weak, and in some situations they may fracture or break. Pamidronate can help to re-strengthen the bone and reduce the risk of fractures.

Cancer can affect the bones in different ways, and pamidronate is not helpful for all cancers that affect the bones. Your doctor or specialist nurse can tell you if it would be helpful for you.

How pamidronate works

In normal bone, two types of cell called osteoclasts and osteoblasts work together constantly to shape, rebuild and strengthen existing bone:

  • osteoclasts destroy old bone,
  • osteoblasts build new bone.

Myeloma and some secondary bone cancers can produce chemicals that make the osteoclasts work harder. This means that more bone is destroyed than rebuilt, which leads to weakening of the affected bone. This can cause pain and means that the bone can fracture or break more easily.

Pamidronate targets areas of bone where the osteoclast activity is high. It helps bring the balance of osteoclast and osteoblast activity back to normal by reducing the activity of the osteoclasts. This can reduce pain and help strengthen the bone. It also means that less calcium will be lost from the bones.

How pamidronate is given

Pamidronate is given by a drip (infusion) into a vein through a fine tube called a cannula. It can usually be given in the outpatient department at the hospital. The infusion is given over several hours every 3-4 weeks.

How long pamidronate is given for

If you are having pamidronate to reduce pain, or strengthen your bones, then you may need to take it for as long as it seems to be working.

Pamidronate to lower calcium levels is usually given in a single 'one-off' dose. This dose can also be given over 2-4 days as multiple infusions.

Possible side effects of pamidronate

Some people have very few side effects while others may experience more. The side effects described below won't affect everyone who is having pamidronate and may be different if you're having more than one drug.

We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed below, discuss them with your doctor or nurse.

Increased pain

Sometimes pain in the affected bone can temporarily become worse when you first take pamidronate. If this happens, your doctor can prescribe painkillers until this side effect wears off.

Flu-like symptoms

These include a high temperature, chills, and pains in your muscles or joints. Let your doctor know if these effects are troublesome. It may be helpful to take mild painkillers.

Pamidronate (Aredia®)

Tingling sensations in lips or tongue

This can happen if the calcium levelin the blood drops below normal. This is rare and usually only temporary. Your doctor will carry out regular blood tests to monitor the level of calcium in your blood.

Feeling sick (nausea) or being sick (vomiting)

This is usually mild and can be controlled with anti-sickness (anti-emetic) tablets.

Abdominal (tummy) pain, constipation or diarrhoea

This can usually be controlled with medicine, but let your doctor know if it is severe or continues.

Pain or redness at the injection site or painful veins

Let your doctor or nurse know if you have these problems.

Red or sore eyes

Your doctor can prescribe eye drops to ease this.

Change in kidney function

Sometimes pamidronate can affect how the kidneys work. This does not usually cause any symptoms and the effects are generally mild. Your doctor will monitor how well your kidneys are working during your treatment by doing regular blood tests.


This is not common, but it's important to let your doctor know if you are getting headaches. They will advise you about what medicines to take. It's also important to drink plenty of fluids.

Jaw problems (osteonecrosis)

A rare side effect of pamidronate is a condition called osteonecrosis of the jaw. This is when healthy bone tissue in the jaw becomes damaged and dies. Gum disease, problems with your dentures and some dental treatments, such as having a tooth removed, can increase the risk of this. So before you start taking the drug you'll be advised to have a full dental check-up.

During treatment with bisphosphonates, it's very important to look after your teeth by brushing them regularly and having routine dental check-ups. Always let your dentist know that you're taking bisphosphonates. Some of the symptoms of osteonecrosis can include pain, swelling, redness of the gums, loose teeth or a feeling of numbness or heaviness in your jaw. Tell your cancer specialist and dentist straight away if you have any of these symptoms.

Additional information

Non-cancer admission

If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you’re having treatment with bisphosphonates. You should tell them the name of your cancer specialist so that they can ask for advice.

Emergency contacts

It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home.

Back to Bisphosphonates

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