Why is this medication prescribed?

Pamidronate Injection is prescribed primarily for the treatment of conditions that involve abnormal bone resorption, such as:

• Hypercalcemia of Malignancy (HCM): This condition occurs when cancer causes elevated levels of calcium in the blood. Pamidronate helps lower calcium levels by inhibiting bone resorption.
• Paget’s Disease of Bone: A disorder that results in the abnormal breakdown and formation of bone, leading to bone pain, deformities, and fractures. Pamidronate helps regulate bone remodeling.
• Osteolytic Bone Lesions in Multiple Myeloma: Pamidronate is used to manage bone lesions caused by multiple myeloma, a type of blood cancer, to reduce pain and prevent fractures.
• Osteolytic Bone Metastases of Breast Cancer: It is also prescribed for patients with breast cancer that has spread to the bones, helping to manage pain and reduce the risk of fractures.

Pamidronate works by inhibiting osteoclasts, the cells responsible for breaking down bone tissue, thereby slowing bone loss and stabilizing bone structure.

How should this medicine be used?

Pamidronate Injection is used primarily to treat high levels of calcium in the blood (hypercalcemia) that may occur with certain types of cancer. It is also used to treat bone damage caused by cancer (e.g., multiple myeloma, breast cancer) and to manage Paget’s disease of bone.

How to Use Pamidronate Injection:

• Administration: Pamidronate is administered by slow intravenous infusion. The infusion usually lasts between 2 to 24 hours, depending on the dosage and the condition being treated. It must be given under the supervision of a healthcare professional.
• Dosage: The dosage and duration of the treatment are determined by the condition being treated, the patient’s overall health, and their response to the treatment. For hypercalcemia, a single dose may range from 30 mg to 90 mg, often repeated as needed. For bone metastases or multiple myeloma, a typical dose is 90 mg every 3 to 4 weeks.
• Precautions: Pamidronate can affect kidney function, so kidney function should be monitored before and during treatment. It’s important to be well-hydrated before receiving this medication to minimize kidney strain. Patients may need calcium and vitamin D supplements to prevent low calcium levels in the blood.
• Side Effects: Common side effects include fever, fatigue, nausea, vomiting, and bone pain. Serious side effects can include kidney problems, low blood calcium levels (hypocalcemia), and jaw bone problems (osteonecrosis of the jaw).
• Monitoring: Regular blood tests to monitor calcium levels, kidney function, and other electrolytes. Bone density may be monitored in long-term use.

Always follow your healthcare provider’s instructions when using Pamidronate Injection, and report any unusual symptoms or side effects immediately.

Other uses for this medicine

• Osteoporosis: Although not the primary indication, Pamidronate can sometimes be used off-label to treat osteoporosis, especially in cases where other treatments have failed or are not suitable.
• Bone Pain: It may be used to relieve bone pain associated with metastatic bone disease.
• Complex Regional Pain Syndrome (CRPS): Pamidronate has been explored in some cases for treating severe pain in CRPS.

What special precautions should I follow?

Special Precautions to Follow When Using Pamidronate Injection:

• Kidney Function: Your healthcare provider will likely check your kidney function with blood tests before starting treatment. Regular monitoring of kidney function is essential because Pamidronate can cause or worsen kidney problems. Dosage adjustments may be necessary based on kidney function.
• Hydration: It’s important to drink plenty of fluids before receiving Pamidronate, especially if you’re being treated for hypercalcemia. This helps protect your kidneys.
• Calcium and Vitamin D Levels: Pamidronate can cause low calcium levels (hypocalcemia), so your doctor may recommend taking calcium and vitamin D supplements. Symptoms of low calcium include muscle cramps, tingling, or numbness, and should be reported immediately.
• Dental Check: Have a dental check-up before starting treatment. Good oral hygiene and regular dental visits are important.
• Avoid Invasive Dental Procedures: Inform your dentist if you’re on Pamidronate before any dental procedures, as invasive dental work might increase the risk of ONJ.
• Pregnancy and Breastfeeding: Pamidronate should not be used during pregnancy unless absolutely necessary, as it may harm the fetus. It’s not recommended to breastfeed while using Pamidronate, as it’s unknown if it passes into breast milk.
• Allergic Reactions: If you have any known allergies, especially to bisphosphonates, inform your healthcare provider. Signs of an allergic reaction include rash, itching, swelling (especially of the face, tongue, and throat), severe dizziness, or difficulty breathing. Seek immediate medical attention if these occur.
• Bone, Joint, or Muscle Pain: Some patients may experience severe bone, joint, or muscle pain. If you experience these symptoms, inform your doctor immediately.
• Infusion-Related Reactions: You may experience fever, chills, or flu-like symptoms after the infusion, especially after the first dose. These symptoms typically resolve on their own but should be reported.

Following these precautions helps to minimize risks and ensures the best possible outcome from the treatment. Always discuss any concerns or symptoms with your healthcare provider.

What special dietary instructions should I follow?

• Avoid High-Calcium Foods Before Treatment: If you’re being treated for hypercalcemia, your healthcare provider may advise you to avoid high-calcium foods before the infusion to prevent further elevation of calcium levels.
• No Other Specific Dietary Restrictions: Apart from calcium and vitamin D considerations, there are no other specific dietary restrictions while on Pamidronate unless otherwise directed by your healthcare provider.

What should I do if I forget a dose?

• Missed Appointment: If you miss an appointment for your Pamidronate injection, contact your healthcare provider as soon as possible to reschedule. It’s important to keep your treatment schedule on track.
• Do Not Double Dose: Do not double up on doses to make up for a missed one. Follow your healthcare provider’s instructions regarding the next dose.
• Consult Your Doctor: If you forget a dose, discuss with your doctor the best course of action. They may adjust your treatment schedule accordingly.

What side effects can this medication cause?

Pamidronate Injection can cause a range of side effects, some common and mild, while others may be more serious. It’s important to be aware of these potential side effects and report any unusual symptoms to your healthcare provider.

Common Side Effects:

• Fever: A mild fever may occur, especially after the first dose. This is usually temporary.
• Flu-like Symptoms: You may experience symptoms like fatigue, chills, muscle aches, and general discomfort, particularly after the initial infusion.
• Nausea and Vomiting: Some patients report nausea or vomiting after receiving Pamidronate.
• Bone, Joint, or Muscle Pain: Pain in the bones, joints, or muscles is a relatively common side effect, particularly in the days following an infusion.
• Headache: Headaches can occur, though they are typically mild.
• Low Calcium Levels (Hypocalcemia): Pamidronate can lower calcium levels in your blood, leading to symptoms like tingling or numbness, muscle cramps, or spasms.

Serious Side Effects:

• Kidney Problems: Pamidronate can cause or worsen kidney issues, including kidney failure in severe cases. Symptoms to watch for include changes in urine output, swelling in the legs or feet, and fatigue.
• Osteonecrosis of the Jaw (ONJ): This is a rare but serious condition where the jawbone begins to weaken and die. It can lead to pain, swelling, and infection of the jaw. It’s more likely to occur in patients undergoing dental procedures or with poor oral hygiene.
• Allergic Reactions: Severe allergic reactions are rare but possible. Symptoms include rash, itching, swelling (especially of the face, tongue, or throat), severe dizziness, or difficulty breathing. Immediate medical attention is required if these occur.
• Eye Problems: In rare cases, Pamidronate may cause inflammation in the eyes, leading to pain, redness, sensitivity to light, or blurred vision. Report any eye symptoms to your doctor.
• Heart Problems: Pamidronate may rarely cause irregular heart rhythms or low blood pressure during or after the infusion. If you experience dizziness, fainting, or heart palpitations, seek medical attention.
• Severe Bone, Joint, or Muscle Pain: While mild pain is common, severe or debilitating pain is less common and should be reported immediately.
• Infusion Reactions: Some patients may experience reactions at the site of infusion, such as redness, swelling, or pain. Systemic reactions like difficulty breathing, chest pain, or rapid heartbeat require immediate medical attention.
• Laboratory Monitoring: Regular blood tests are often required to monitor calcium levels, kidney function, and other parameters during treatment.
• Long-Term Use: The risk of some side effects, particularly ONJ and kidney issues, may increase with long-term use.

If you experience any side effects, whether mild or severe, it’s important to inform your healthcare provider. They may adjust your dosage or provide supportive care to manage these effects.

What should I know about storage and disposal of this medication?

Storage and Disposal of Pamidronate Injection:

• Storage:
  • Store Pamidronate Injection at room temperature, typically between 20°C to 25°C (68°F to 77°F).
  • Keep the medication in its original packaging to protect it from light and moisture. Do not freeze.
  • Store it out of reach of children and pets.
• Disposal:
  • Do not dispose of Pamidronate in household trash or flush it down the toilet.
  • Return any unused or expired medication to a pharmacy or follow local regulations for drug disposal. Some areas have drug take-back programs.

In case of emergency/overdose

• Signs of Overdose: Symptoms of overdose may include severe hypocalcemia (very low calcium levels), which can cause muscle cramps, tingling, numbness, seizures, or irregular heartbeats. Severe kidney issues, confusion, and fainting are also possible.
• Emergency Contact: If you suspect an overdose, call emergency services (911 in the U.S.) or go to the nearest emergency room immediately.
• Poison Control: Contact your local poison control center for further guidance.
• Information to Provide: Be ready to provide information such as the dosage taken, the time of the overdose, and any symptoms being experienced. This will help healthcare professionals manage the situation effectively.

What other information should I know?

• Regular Monitoring: Keep all follow-up appointments with your healthcare provider. Regular monitoring of kidney function, calcium levels, and other relevant parameters is crucial during treatment with Pamidronate.
• Medication Interactions: Always inform your healthcare provider about all medications you are taking, including prescription drugs, over-the-counter medications, and supplements. Pamidronate can interact with other drugs, especially those affecting kidney function or calcium levels.
• Medical History: Provide your doctor with a full medical history, particularly if you have kidney disease, dental issues, or any conditions affecting calcium metabolism.
• Pregnancy and Breastfeeding: If you are pregnant, planning to become pregnant, or breastfeeding, discuss the risks and benefits of Pamidronate with your healthcare provider.
• Side Effects: Promptly report any side effects, especially symptoms of low calcium (tingling, muscle cramps), kidney issues (swelling, fatigue), or jaw pain.
• Avoid Invasive Dental Procedures: Avoid invasive dental procedures while receiving Pamidronate unless absolutely necessary, due to the risk of osteonecrosis of the jaw (ONJ).
• Medical ID: Consider carrying a medical ID or a card that indicates you are receiving Pamidronate, particularly if you have a history of severe allergic reactions or are at risk of significant side effects.
• Lifestyle Considerations: Ensure adequate fluid intake, especially before infusions. Follow your doctor’s advice on calcium and vitamin D supplementation to help maintain appropriate blood levels.

By staying informed and following your healthcare provider’s recommendations, you can safely and effectively manage your treatment with Pamidronate Injection.