What is pamidronate?

Pamidronate belongs to a group of drugs called bisphosphonates. It can be used to treat:

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 and constantly renew themselves. This helps bones keep their strength and shape.

Inside the bones, there are 2 types of bone cell:

  • osteoclasts, which break down and remove old bone
  • osteoblasts, which 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 in-creased 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 and can break more easily.

Bones contain calcium, which gives them strength. A bone affected by secondary cancer or mye-loma may lose calcium from the bones into the blood. A raised level of calcium in the blood is called hypercalcaemia. This may cause you to have symptoms including:

  • feeling sick (nausea)
  • vomiting
  • tiredness
  • irritability
  • confusion.

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 the “Less common side effects” section below.

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

This treatment may make your eyes feel sore, red and itchy (conjunctivitis). If you have red or sore eyes, your doctor can prescribe eye drops to help treat this. Your pharmacist can tell you how to use the eye drops.

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

This treatment can cause a rash. Tell your doctor if this happens. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

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.

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 and in people who have gum disease or 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 specialist and dentist straight away if you 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

Sometimes pain in muscles or bones gets worse for a short time when you start taking zoledronic acid. If this happens, your doctor can prescribe painkillers for you until it gets better.

Rarely, people on this treatment 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. 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

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 they can talk to them for advice.

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: 

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

  • 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

Reviewed: 01 September 2022
|
Next review: 01 March 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

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.