What is Pamidronate Disodium?

Pamidronate injection is used to treat hypercalcemia (too much calcium in the blood) that may occur in patients with some types of cancer. It is also used to treat Paget's disease of bone, multiple myeloma (tumors formed by the cells of the bone marrow), and certain types of bone metastases (the spread of cancer to the bones).

This medicine is to be administered only by or under the supervision of your doctor.

A nurse or other trained health professional will give you this medicine. This medicine is given through a needle placed in a vein.

Your doctor may also give you vitamins containing Vitamin D and calcium. Tell your doctor if you are unable to take these supplements.

Drink extra fluids so you will pass more urine while you are using this medicine. This will keep your kidneys working well and help prevent kidney problems. However, it is also important to not drink too much liquid. Talk to your doctor about the right amount of liquids for you.

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For injection dosage form:
  • For treating hypercalcemia (too much calcium in the blood):
    • Adults—60 to 90 milligrams (mg) in a solution to be injected over 2 to 24 hours into a vein. If your doctor decides that you need additional doses, you will receive the medicine again after at least 7 days have passed.
    • Children—Use and dose must be determined by your doctor .
  • For treating Paget's disease of bone:
    • Adults—30 mg in a solution to be injected over 4 hours into a vein, for 3 consecutive days. Your doctor will decide if you need more than 3 doses.
    • Children—Use and dose must be determined by your doctor .
  • For treating multiple myeloma:
    • Adults—90 mg in a solution to be injected over 4 hours into a vein once per month. Your doctor will decide how long this treatment should continue.
    • Children—Use and dose must be determined by your doctor .
  • For treating bone metastases:
    • Adults—90 mg in a solution to be injected over 2 hours into a vein once every 3 to 4 weeks. Your doctor will decide how long this treatment should continue.
    • Children—Use and dose must be determined by your doctor .

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Appropriate studies have not been performed on the relationship of age to the effects of pamidronate injection in the pediatric population. Safety and efficacy have not been established.

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of pamidronate injection in the elderly. However, elderly patients are more likely to have age-related kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving pamidronate injection.

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Anemia or
• Dehydration or
• Heart disease or
• Kidney disease or
• Leukopenia (low number of white blood cells) or
• Mineral imbalance (e.g., low calcium, magnesium, phosphorus, or potassium in the blood) or
• Thrombocytopenia (low number of platelets)—Use with caution. May make these conditions worse.

• Cancer, history of or
• Dental or tooth problems or
• Dental procedures or
• Poor oral hygiene or
• Surgery (e.g., dental surgery)—May increase risk for severe jaw problems.

• Parathyroid disease (e.g., hypoparathyroidism) or
• Thyroid surgery, history of—These conditions may increase your risk of having hypocalcemia (low levels of calcium in the blood).

It is important that your doctor check your progress at regular visits after you have received pamidronate injection. If your condition has improved, your progress must still be checked. The results of laboratory tests or the occurrence of certain symptoms will tell your doctor if your condition is coming back and a second treatment is needed.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

For patients using this medicine for hypercalcemia (too much calcium in the blood):

• Your doctor may want you to follow a low-calcium diet. If you have any questions about this, check with your doctor.

Your doctor will need to know if you have a history of problems with your mouth or teeth (e.g., gum disease). Make sure your doctor knows if you have been treated with a bisphosphonate medicine, such as alendronate (Fosamax®), etidronate (Didronel®), pamidronate (Aredia®), risedronate (Actonel®), or tiludronate (Skelid®) in the past.

You may need to have a dental exam before you start using this medicine.

It is important that you check with your doctor before having any dental procedures or surgeries done while you are receiving pamidronate. Tell your doctor right away if you have jaw tightness, swelling, numbing, or pain or a loose tooth. This could be symptoms of a severe problem of your jaw.

Make sure you tell your doctor about any new medical problems, especially with your teeth or jaws. Tell your doctor right away if you have severe bone, joint, or muscle pain after receiving this medicine.

This medicine may increase your risk of developing fractures of the thigh bone. This may be more common if you use it for a long time. Check with your doctor right away if you have a dull or aching pain in the thighs, groin, or hips.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.