Cancer cells from some tumors (most commonly breast, prostate and lung cancers) can spread to the bone, which is called bone metastasis. Multiple myeloma is a type of cancer affecting plasma cells, which are found in the bone marrow, and thus directly involves bone. In both of these situations the cancer cells cause breakdown or wearing away of the normal bone. In turn, affected bones become more fragile; they may be painful and can even break due to the damage from the cancer cells. Pamidronate is a type of drug called a bisphosphonate, which is used to slow the destruction of bone caused by cancer cells.
How to Take Pamidronate
Pamidronate is given directly into a vein as an infusion, over 15 minutes. Your dose, and how often you receive it, will be determined by your provider. Your healthcare provider may want you to take calcium and vitamin D supplements to help with your bone health. Talk with your team about what doses are right for you. You should drink plenty of fluids while taking this medication. Try to drink 8-10 glasses of non-alcoholic, non-caffeinated liquids a day.
Possible Side Effects of Pamidronate
There are a number of things you can do to manage the side effects of pamidronate. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Osteonecrosis of the Jaw
Osteonecrosis of the jaw (ONJ) is a rare side effect, however, it is important that you know about it and take steps to protect your dental health. The maxilla (upper jaw bone) and mandible (lower jaw bone) are normally covered by gum tissue. In the case of ONJ, this tissue is gone and the bone is exposed. Typical symptoms associated with ONJ are: pain, swelling or infection of the gums, loosening of the teeth, exposed bone (often at the site of a previous tooth extraction). Some patients may report numbness or tingling in the jaw or a "heavy" feeling jaw. ONJ may have no symptoms for weeks or months and may only be recognized by the presence of exposed bone. ONJ most often occurs soon after a dental procedure, though not always. Stop treatment with pamidronate at least 3 weeks prior to any dental procedures.
Changes in Laboratory Values
Pamidronate can cause imbalances in the electrolytes calcium, magnesium and phosphorus. This medication can also affect the kidneys, causing a rise in serum creatinine (a laboratory value that measures kidney function). Your healthcare team will periodically check these levels with blood tests and may give you supplemental electrolytes, if needed.
Bone, Joint and Muscle pain
Pamidronate can cause bone, joint and/or muscle pain that can be severe. This can occur from 1 day to several months after starting the medication. Report these symptoms to your provider, who can advise you on strategies to relieve the pain. Pain in the hip, thigh and groin can be caused by an atypical femur fracture. Notify your provider immediately of any new pain in this area.
Fever, Body Aches
More than half of the people receiving this medication experience fever and chills after the first infusion, which may be accompanied by muscle aches (also called myalgias). Anti-inflammatory medications, such as ibuprofen (Motrin) and naproxen (Aleve) may be used to relieve these side effects. Ask your healthcare team if you are able to take these medications if side effects occur. Many patients do not have these side effects after subsequent infusions.
There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.
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