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This information is about a drug called pamidronate that can be used when cancer has spread to the bones.
If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
Pamidronate belongs to a group of drugs called bisphosphonates. Bisphosphonates are commonly used to treat bone thinning (osteoporosis). In certain situations bisphosphonates can help protect your bones against some of the effects of secondary bone cancer, such as pain and weakness.
Secondary bone cancer occurs when the original cancer (the primary) spreads to form a secondary cancer (metastasis) in the bone.
Pamidronate is often given alongside other cancer treatments. As well as being used in some types of secondary bone cancer, it has been shown to be effective in people with myeloma (a cancer of the plasma cell). It is also used to reduce a raised calcium level in the blood.
In secondary bone cancer, calcium (which helps to strengthen the bones) can be lost from the damaged bone and can seep into the bloodstream. When the level of calcium in the blood is raised, this is known as hypercalcaemia and can cause symptoms such as feeling or being sick (nausea or vomiting), tiredness, irritability and sometimes confusion. Pamidronate can help to reduce high levels of calcium.
Secondary cancer in the bones may cause them to become weakened, and in some situations they may break or fracture. Pamidronate can help to re-strengthen the bone and reduce the risk of fractures.
Cancer can affect the bones in different ways, and pamidronate is not helpful for all cancers that affect the bones. Your doctor or specialist nurse can tell you if pamidronate would be helpful for you.
In normal bone, two types of cell (osteoclasts and osteoblasts) work together constantly to shape, rebuild and strengthen existing bone:
Myeloma and some secondary bone cancers can produce chemicals that make the osteoclasts work harder. This means that more bone is destroyed than rebuilt, and leads to weakening of the affected bone. This can cause pain and means that the bone can fracture or break more easily.
Pamidronate targets areas of bone where the osteoclast activity is high. It helps to bring the balance of osteoclast and osteoblast activity back to normal. This can reduce pain and help to strengthen the bone. It also means that less calcium will be lost from the bones.
Pamidronate is given by a drip (infusion) into the vein through a fine tube called a cannula. It can usually be given in the outpatient department at the hospital. The infusion is given over several hours every 3–4 weeks.
If you are having pamidronate to reduce pain, or to strengthen your bones, then you may need to take it for as long as it seems to be working for you.
Pamidronate to lower calcium levels is usually given in a single 'one-off' dose. It can also be given over 2–4 days as multiple infusions.
Each person’s reaction to any medication is different. Most people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is having pamidronate and may be different if you are having more than one drug.
We have outlined the most common side effects. However, we have not included those that are rare and therefore extremely unlikely to affect you. If you notice any effects that are not listed here, please discuss them with your doctor or nurse.
Increased pain Sometimes pain in the affected bone can temporarily become worse when you first take pamidronate. If this happens, your doctor can prescribe pain-relieving drugs for you until this side effect wears off.
Flu-like symptoms including a high temperature, chills, muscle and joint pains can sometimes occur. Let your doctor know if these effects are troublesome. It may be helpful to take mild painkillers.
Drop in calcium levels below normal This is rare and usually only temporary. Your doctor will carry out regular blood tests to monitor the level of calcium in your blood.
Feeling sick (nausea) or being sick (vomiting) This can be prevented with antisickness (anti-emetic) medication. Tell your doctor if the sickness is not well controlled.
Abdominal (tummy) pain, constipation or diarrhoea This can usually be easily controlled with medicine, but let your doctor know if it is severe or if it continues.
Change in kidney function Sometimes pamidronate can affect how the kidneys work. This does not usually cause any symptoms and the effects are generally mild. Your doctor will monitor how well your kidneys are working during your treatment by doing regular blood tests.
Headaches Some people have headaches with pamidronate, but this is not common. It is important to drink plenty of fluids. Let your doctor know if you are getting headaches, as medication can be prescribed.
Jaw problems (osteonecrosis) This is a very rare side effect of pamidronate. It means healthy bone dies off in a way that is not normal. This tends to happen more commonly in people who have had teeth removed or undergone dental procedures while taking pamidronate. It can result in poor healing of the gums or loosening of teeth. If possible, dental treatment should be avoided while taking pamidronate. It is important to let your dentist know that you are taking pamidronate. Also let your doctor know if you need dental treatment while taking pamidronate.
This section has been compiled using information from a number of reliable sources, including:
For further references, please see general bibliography.
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