Pamidronate, Injection

________________________________________________________________________

KEY POINTS

• This medicine is given by injection to treat high levels of calcium in the blood, Paget’s disease of bone, or bone damage caused by certain types of cancer.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause severe jaw problems, thigh fractures, or other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

________________________________________________________________________

What are other names for this medicine?

Type of medicine: bisphosphonate; antihypercalcemic

Generic and brand names: pamidronate, injection

What is this medicine used for?

This medicine is given by injection to treat:

• Hypercalcemia (too much calcium in the blood) caused by some types of cancer
• Paget's disease of the bone
• Bone damage caused by certain types of cancer such as breast cancer or multiple myeloma

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• Kidney disease
• A seizure disorder
• Heart problems
• Thyroid surgery
• Trouble absorbing minerals in your stomach or intestines (malabsorption syndrome)

Tell your provider the date of your last dental exam and if you are scheduled for dental surgery. You may be at risk of a disease called osteonecrosis of the jaw if you have dental surgery while taking this medicine.

Females of childbearing age: This medicine is not usually given to pregnant women because it can harm the baby. If you are pregnant, tell your healthcare provider. Do not become pregnant during treatment with this medicine. If you become pregnant, contact your healthcare provider right away. Do not breast-feed while you are receiving this medicine.

How do I use it?

This medicine is given as a single dose by IV infusion (slow drip through a tube into a vein) over a period of 2 to 24 hours. Your healthcare provider will determine how often you will receive this medicine.

Follow your healthcare provider's instructions about diet and taking vitamin supplements, especially calcium and vitamin D.

What should I watch out for?

This medicine may increase your risk for a rare, but severe thigh bone fracture. Contact your healthcare provider right away if you have any new or unusual thigh or hip pain. Talk with your healthcare provider about this.

This medicine may increase severe muscle, joint, or bone pain or may cause pain more often. The increased pain may be temporary and may stop during treatment. You may have pain when you first start taking this medicine or several months later. If the pain continues or gets worse, contact your healthcare provider.

This medicine may cause a rare, but serious disease called osteonecrosis of the jaw. You may be at an increased risk for this problem if you have any dental problems or dental surgery, have cancer, anemia, or blood clotting problems, or you are receiving chemotherapy or corticosteroids (such as prednisone). Talk with your healthcare provider about this. You should brush your teeth and clean your mouth properly while taking this medicine. If you have any jaw pain, swelling, numbness, or loose teeth, contact your healthcare provider right away.

You will need to have lab tests regularly to see how this medicine affects you. Keep all appointments for these tests.

You may have a mild fever 1 or 2 days after the infusion. If the fever continues or becomes severe, contact your healthcare provider.

This medicine may make you drowsy or lightheaded. Be careful in everyday activities, and do not drive or operate machinery unless you are fully alert.

You may have some redness, swelling, or pain at the spot where the injection was given. If these continue or become worse, contact your healthcare provider.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you have received this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Blood in bowel movements or black tarry bowel movements; burning or pain with urination; decreased urination; confusion; muscle or joint pain; tingling in lips, tongue, fingers or feet; fast or irregular heartbeat; lightheadedness or fainting; seizures; swelling in hands, ankles or feet, or any unexplained swelling; unusual bruising or bleeding; jaw pain, swelling, numbness, or loose teeth; new or unusual thigh, groin, or hip pain; eye pain or vision problems.

Other: Nausea, vomiting, constipation, loss of appetite, tiredness, fever, stomach pain, runny nose, increased sweating, redness or swelling at injection site.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Antibiotics such as amikacin, gentamicin, and tobramycin
• Aspirin and other salicylates
• Medicines to block or prevent stomach acid such as cimetidine (Tagamet), esomeprazole (Nexium), famotidine (Pepcid), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and ranitidine (Zantac)
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as diclofenac (Cambia, Voltaren, Zipsor), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Phosphate supplements
• Thalidomide (Thalomid)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

---

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.