Disodium pamidronate

Disodium pamidronate is a type of bisphosphonate. You might have it as part of your treatment for a number of different types of cancer.

How disodium pamidronate works

Disodium pamidronate is a treatment for cancers that break down bone cells or have spread to the bones. It sticks to the bone and helps to reduce bone loss.

It also lowers high levels of calcium in the blood (hypercalcaemia), which can happen in secondary bone cancer. Secondary bone cancer is when a cancer has spread to the bones from where it started.

How you have disodium pamidronate

You have disodium pamidronate as a drip into your bloodstream (intravenously).

You have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

When you have disodium pamidronate

You can have disodium pamidronate as a one off treatment to reduce calcium levels in your blood. Or you can have it every 3 to 4 weeks as a regular treatment to prevent or reduce bone damage.

Each treatment lasts from one to several hours depending on the dose.

Tests

You have blood tests before starting treatment and during your treatment. They check your blood calcium levels. You might also need to do urine samples for testing and have tests to check how well your heart and kidneys are working.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse
Early treatment can help manage side effects better.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Flu like symptoms

For about 24 to 48 hours after treatment, you might have flu like symptoms including a high temperature (fever), chills and a headache. 

Low levels of calcium and phosphate in the blood

Low calcium levels in the blood can cause painful muscle spasms, cramps or muscle twitching. You might also get numbness or tingling in your feet, hands or around your mouth.

Tell your doctor or nurse if you experience these side effects.

Low levels of phosphate can cause muscle weakness and confusion.

You have blood tests to check the levels of calcium and phosphate, as well as other substances such as potassium and magnesium.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

  • redness, swelling, pain or leaking at your drip site – tell your nurse straight away if you have this
  • feeling breathless and looking pale
  • low levels of magnesium and potassium which you have regular blood tests for - let your doctor or nurse know if you have cramping in your arm or leg muscles, tingling or numbness, palpitations (feeling your heart beat irregularly), or if you feel faint
  • low platelets levels in your blood can cause nosebleeds, bruising or bleeding gums
  • headaches
  • difficulty sleeping
  • drowsiness - don’t drive or operate machinery if you have this
  • bowel changes such as constipation or diarrhoea
  • feeling sick or being sick
  • loss of appetite
  • eye problems such as conjunctivitis - itching and redness of the eye
  • skin rash
  • changes in the way your kidneys work
  • pain in different parts of the body such as the stomach, bones, joints and muscle
  • high blood pressure

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

  • allergic reaction which includes a rash, shortness of breath, redness or swelling of the face, feeling hot, dizziness or a sudden need to pass urine
  • kidney failure with can cause breathlessness and swelling in different parts of the body
  • fluid build-up may cause swelling in your arms, hands, ankles, legs, face and other parts of the body
  • feeling tired
  • seizures (fits)
  • feeling dizzy
  • mood changes which include feeling agitated
  • inflammation of the eye causing eyes to get red or sore
  • low blood pressure which can cause feeling light headed, faint or weak
  • lung problems such as difficulty breathing and coughing
  • stomach problems such as indigestion and cramps
  • liver changes that are usually mild and unlikely to cause symptoms – you will have regular blood tests to check for any changes in the way your liver is working
  • itchy skin
  • damage to jaw bone if you have disodium pamidronate for longer than a year - have regular dental check ups

Jaw problems

Damage to the bones (for example in the jaw or thigh) is a rare but serious side effect. Contact your medical team if you have any of the following:

  • ear pain
  • discharge from your ear
  • an ear infection
  • pain in the mouth, teeth or jaw
  • loosening of a tooth
  • pain or weakness in your hip, thigh or groin

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Dental treatment

You should avoid any invasive dental treatment while you are having this treatment. You can have fillings and routine cleaning.

Talk to your specialist if you need dental treatment about whether you should stop your bisphosphonates beforehand. But don't stop taking them without talking to your doctor first.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Related links