Pamidronate

What is pamidronate?

Pamidronate belongs to a family of medicines called bisphosphonates. Bisphosphonates slow down the rate of bone breakdown. Pamidronate increases bone strength and decreases bone pain. It may also help reduce the chance of fractures in children who have certain types of bone conditions that weaken the bone, such as osteogenesis imperfecta or osteoporosis, or who have fragile bones from other causes, such as long-term steroid treatment.

Pamidronate is also used to treat chronic recurrent multifocal osteomyelitis (CRMO), also sometimes called chronic nonbacterial osteomyelitis (CNO), high blood calcium levels and certain cancers that have spread to the bone.

You may hear pamidronate called by its brand name, Aredia. Pamidronate is given as an infusion through a vein.

Before giving pamidronate to your child

Tell your doctor if your child has:

• reacted badly to pamidronate or any other bisphosphonate in the past
• heart problems: the increased amount of fluid from pamidronate may make this condition worse
• kidney problems: pamidronate may build up in the bloodstream, which may increase the chance of unwanted effects
• any dental problems or any dental procedures planned in the future

Your doctor may ask that your child have a dental examination before starting treatment with pamidronate. This may be required because some patients who have dental infections or periodontal disease (disease affecting surrounding tissues of a tooth) may be at increased risk of problems with their jaw bones following dental procedures (such as tooth extraction) while on treatment with pamidronate.

Your child will need to be taking enough vitamin D and calcium from either their diet or supplements. Your child may need to take extra calcium (either through diet or supplements, such as TUMS) for three days before every infusion, the day of every infusion and three days after every infusion. Please discuss your child's requirements with your health-care provider.

How should you give your child pamidronate?

This medicine is given as an infusion through a vein over four hours. This commonly occurs in the hospital. Children do not need to stay overnight at the hospital. It is usually a full day at the hospital.

Doses of pamidronate are given on a cyclic schedule. Your health-care team will let you know what schedule your child will be on. The first dose is always split into two subsequent days.

What should you do if your child misses a dose of pamidronate?

Call your contact person at the hospital to reschedule the next pamidronate dose.

What are the possible side effects of pamidronate?

Your child may have some side effects while they take pamidronate.

These following side effects are fairly common the first time children receive pamidronate. They usually do not occur with subsequent treatments.

• Flu-like symptoms, for example body aches, feeling tired, chills, fever: if fever occurs, it should resolve in 48 hours. These symptoms often only occur with the first two doses of pamidronate. They usually do not occur with subsequent treatments. Acetaminophen (Tylenol, Tempra) and/or Gravol may help with these symptoms
  
• Headaches
• Sore throat
• Muscle cramps or stiffness
• Upset stomach or throwing up
• Abdominal cramps
• Low calcium levels: pamidronate lowers the amount of calcium in the blood. Symptoms of low calcium include any of the following:
• tingling, pins and needles or numbness around the mouth, fingers or toes
• muscle cramps or spasms

Call your child's doctor or contact nurse as soon as possible during office hours if your child continues to have any of these signs or symptoms:

• lower back or side pain
• dizziness
• skin rash
• itchiness
• redness and swelling at site of infusion
• eye redness or irritation

Most of the following side effects are very uncommon, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to the Emergency Department if your child has any of these side effects:

• shortness of breath or swelling of hands or feet
• black, tarry stools
• confusion or seizures
• blurred vision
• fast or irregular heartbeat
• swelling of the jaw

What safety measures should you take when your child is using pamidronate?

Before your child receives pamidronate, tell your child's doctor about any allergies your child may have and about all the medications your child is taking.

Keep a list of all medications your child is on and show the list to the doctor or pharmacist. Check with your child's doctor or pharmacist before giving your child any other medicines (prescription, non-prescription, herbal or natural products).

This medicine will lower the amount of calcium in the blood. Be sure to follow your child's doctor's instructions regarding calcium and vitamin D intake or supplements while taking pamidronate.

There is a chance that pamidronate may cause birth defects if it is taken at the time of conception or if it is taken during pregnancy. If your child is sexually active, it is best that they use some kind of birth control while receiving pamidronate. Tell the doctor right away if your child may be pregnant.

Before your child has any kind of surgery, including dental surgery, tell the doctor or dentist that your child is taking pamidronate. If possible, your child should not undergo tooth extraction or other dental procedures (excluding regular dental cleaning) while they are being treated with pamidronate.

What other important information should you know about pamidronate?

• Most children will have an improvement in bone pain. Your child's response to pamidronate will be monitored by blood tests and other tests such as bone mineral density scans, which look at the density of your child's bones, and X-rays of your child's spine.
  

At SickKids

Pamidronate is most commonly given in the Medical Day Unit on 4C in the hospital. To book infusions, contact 4C at 416-813-7654 x 206583. The infusions are administered during the week (Monday – Friday).

For urgent issues, please call the fellow on call of the team following your child at 416-813-7500.

Keep pamidronate out of your child’s sight and reach and locked up in a safe place. If your child takes too much pamidronate, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.