Pamidronate injection (patient information)

# About your treatment
Your doctor has ordered pamidronate to help treat your illness. The medication will be added to an intravenous fluid that will drip through a needle or catheter into your vein. You will receive your dose of pamidronate as an infusion (slow injection) that may last 2-24 hours. You may receive an infusion of pamidronate once every 3-4 weeks, once a day for 3 days in a row, or as a single dose that may be repeated after 1 week or longer. The treatment schedule depends on your condition.
Pamidronate is used to treat high levels of calcium in the blood that may be caused by certain types of cancer. Pamidronate is also used along with cancer chemotherapy to treat bone damage caused by multiple myeloma (cancer that begins in the plasma cells ) or by cancer that began in another part of the body but has spread to the bones. Pamidronate is also used to treat Paget's disease (a condition in which healthy bones are broken down and replaced by abnormally thick but weak bones). Pamidronate helps prevent bone breakdown and bone fractures. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Your health care provider (doctor, nurse, or pharmacist) may measure the effectiveness and side effects of your treatment using laboratory tests and physical examinations. It is important to keep all appointments with your doctor. The length of treatment depends on your condition and on how you respond to the medication.

# Precautions
Before administering pamidronate
- tell your doctor and pharmacist if you are allergic to pamidronate, alendronate (Fosamax), etidronate (Didronel), risedronate (Actonel), tiludronate (Skelid), zoledronic acid (Zometa), any other medications, or any of the ingredients in pamidronate infusion. Ask your health care provider for a list of the ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take. Be sure to mention any of the following: amphotericin B (Fungizone); antibiotics such as amikacin (Amikin),bacitracin; dapsone (Avlosulfon);foscarnet (Foscavir); ganciclovir (Cytovene); gentamicin (Garamycin), kanamaycin (Kantrex),methicillin (Staphcillin);neomycin (Neo-Rx, Neo-Fradin), netilmycin (Netromycin), paramomycin (Humatin), pentamidine (NebuPent); polymyxin (Aerosporin);rifampin (Rifadin, Rimactane);sulfonamides such as sulfamethoxazole and trimethoprim (Bactrim);streptomycin, tobramycin (Tobi, Nebcin),and valganciclovir (Valcyte); aspirin and other nonsteroidal anti-inflammatory medications such as ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn); aurothioglucose (Solganal); auranofin (Ridaura); cancer chemotherapy medications captopril (Capoten); cyclophosphamide (Cytoxan, Neosar); cyclosporine (Neoral, Sandimmune); gold sodium thiomalate (Myochrysine); lidocaine (Xylocaine, others); certain medications to treat or prevent malaria; nitrates; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); penicillamine (Cuprimine, Depen); salicylate pain relievers;and tacrolimus (Prograf).
- tell your doctor if you have or have ever had an infection of the mouth or bones, gum disease or other problems with your teeth or mouth, or kidney or liver disease.
- tell your doctor if you are pregnant or are breast-feeding. Use a reliable method of birth control during your treatment with pamidronate. If you become pregnant while using pamidronate, call your doctor. Pamidronate may harm the fetus. Also talk to your doctor if you plan to become pregnant at any time in the future because pamidronate may remain in your body for years after you stop using it.
- if you are having surgery, tell the doctor that you are using pamidronate.
- you should know that pamidronate may cause serious problems with your jaw, especially if you have dental surgery or treatment while you are using the medication. A dentist should examine your teeth and perform any needed treatments before you start to use pamidronate. Be sure to brush your teeth and clean your mouth properly while you are using pamidronate. Talk to your doctor before having any dental treatments while you are using this medication. Call your doctor if you have any of the following symptoms: jaw pain; pain, swelling, or infection of the gums; sores or cuts on the gums that do not heal; loosening of teeth; numbness or a feeling of heaviness in the jaw; drainage of fluid from the gum or jaw; or seeing any exposed bone in your mouth.
- You should make sure your diet contains enough calcium and vitamins. You should discuss this with your health care provider.

# Administering your medication
Before you administer pamidronate, look at the solution closely. It should be clear and free of floating material. Gently squeeze the bag or observe the solution container to make sure there are no leaks. Do not use the solution if it is discolored or if it contains particles. Use a new solution, but show the damaged one to your health care provider.
It is important that you use your medication exactly as directed. Do not stop your therapy on your own for any reason. Do not administer it more often or for longer periods than your doctor tells you. Do not change your dosing schedule without talking to your health care provider. Your health care provider may tell you to stop your infusion if you have a mechanical problem (such as blockage in the tubing, needle, or catheter); if you have to stop an infusion, call your health care provider immediately so your therapy can continue.

# Side effects

## Mild side effects
Pamidronate may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- bone, joint, or muscle pain
- slight fever
- loss of appetite
- upset stomach
- vomiting
- stomach pain
- constipation
- heartburn
- weakness
- dizziness
- headache
- increased sweating

## Severe side effects
If you experience any of the following symptoms, or those mentioned in the PRECAUTIONS section, call your health care provider immediately:
- seizures
- eye pain, swelling, itching, or redness
- blurred vision or changes in vision
- sensitivity to light
- fast or irregular heartbeat
- fainting
- sore throat, high fever, chills, cough, or other signs of infection
- unusual bruising or bleeding
- black and tarry stools
- red blood in stools
- bloody vomit
- vomiting material that looks like coffee grounds
- shortness of breath or fast breathing
- chest pain
- numbness or tingling in the arms, legs, lips, tongue, or the area around the mouth
- muscle cramps, spasms, or sudden muscle tightening
- depression
- personality changes
- difficult, frequent, or painful urination
- swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
- difficulty swallowing
- hoarseness
- hives
- rash
- itching
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storing your medication
Store your medication only as directed. Make sure you understand how to store your medication properly. Do not use the solution after the expiration date and time written on the label of the medication. Keep your supplies in a clean, dry place when you are not using them, and keep all medications and supplies out of the reach of children. Your health care provider will tell you how to throw away used needles, syringes, tubing, and containers to avoid accidental injury.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- fever
- dizziness or lightheadedness
- blurred vision
- fainting
- changes in the way food tastes

# Signs of infection
If you are receiving pamidronate in your vein or under your skin, you need to know the symptoms of a catheter-related infection (an infection where the needle enters your vein or skin). If you experience any of these symptoms near your intravenous catheter, tell your health care provider as soon as possible:
- tenderness
- warmth
- irritation
- hardness or bump
- drainage
- redness
- swelling
- pain

# Brand names
- Aredia

# Other names
- ADP Sodium
- AHPrBP Sodium