Pamidronate

Bones are living tissue. They have a blood and nerve supply to keep them healthy. Bones are constantly being renewed. This helps maintain their strength and shape.

Inside the bones, there are 2 types of bone cell:

• Osteoclasts break down and remove old bone.
• Osteoblasts build new bone.

When we are children and young adults, our bones keep getting thicker and stronger. But as we get older, osteoclasts begin to remove more bone than osteoblasts make. This means our bones slowly become thinner (less dense). In some people, too much bone is lost and they have an increased risk of bone fractures.

Myeloma and some secondary bone cancers make chemicals that cause osteoclasts to destroy more bone. This means that more bone is destroyed than rebuilt. The affected bone becomes weak and painful. They can break more easily.

Bones contain calcium, which gives them strength. A bone affected by secondary cancer or myeloma may lose calcium from the bones into the blood. A raised level of calcium in the blood is called hypercalcaemia. This may cause the following symptoms:

• feeling sick (nausea)
• feeling thirsty
• tiredness or feeling drowsy
• feeling irritable
• feeling confused
• constipation and tummy pain.

You will be given pamidronate in the outpatient department at the hospital. You will have blood tests before starting treatment and during treatment. These check several things, including:

• how your kidneys are working
• your calcium levels.

Your urine may also be checked.

Pamidronate is given by a drip (infusion) into a vein. The infusion may be given over between 90 minutes and 4 hours. Your doctor or nurse will tell you how long your treatment will take. It is usually given every 3 to 4 weeks.

We explain the most common side effects of this treatment here. We also include some that are less common. 

You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.

Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

• drugs to help control some side effects 
• advice about managing side effects. 

It is important to take any drugs exactly as explained. This means they will be more likely to work for you.

Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Rarely, some people have an allergic reaction while having this treatment. Signs of a reaction can include:

• feeling hot or flushed
• shivering
• itching
• a skin rash
• feeling dizzy or sick
• a headache
• feeling breathless or wheezy
• swelling of your face or mouth
• pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, they can treat it quickly.

Sometimes a reaction happens a few hours after treatment. If you develop any of these signs or feel unwell after you get home, contact the hospital straight away on the 24-hour number.

This treatment can cause pain:

• at the place where the drip (infusion) is given 
• along the vein. 

If you feel pain, tell your nurse straight away. They can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.

Sometimes pain in the affected bone gets worse for a short time when you start taking this treatment. If this happens, your doctor can prescribe painkillers to help.

You may feel sick or be sick (vomit) during treatment. This is usually mild. Your doctor can prescribe anti-sickness tablets to help.

Take the drugs exactly as your nurse or pharmacist tells you to. It is easier to prevent sickness than treat it after it has started.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

Tell your doctor if you have diarrhoea or constipation. They can give you medicine to help with this. Try to drink at least 2 litres (3½ pints) of fluids each day.

This treatment can reduce the number of white cells in your blood. These cells fight infection. If you have any signs of an infection, tell your doctor, nurse or pharmacist. These signs include:

• a cough
• a sore throat
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

Contact the hospital straight away on the 24-hour number if you have any of these symptoms:

• a temperature above 37.5°C 
• a temperature below 36°C
• you feel unwell, even with a normal temperature.

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

This treatment can affect your blood pressure. It can cause high blood pressure and sometimes low blood pressure. Tell your doctor if you:

• have problems with your blood pressure
• have headaches
• feel dizzy.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

This treatment can affect how the kidneys work. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your kidneys are working. Contact the hospital on the 24-hour number if you:

• have blood in your urine (pee) 
• are passing less urine or peeing less often than usual.

Drinking fluids helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.

Rarely, this treatment can affect the jawbone. Healthy bone in the jaw becomes damaged and dies. This is called osteonecrosis of the jaw (ONJ). It can cause:

• pain
• loosening of the teeth
• problems with the way the gums heal.

The risk of jaw problems is higher after some types of dental treatment. It is also higher in people who smoke, have gum disease or have dentures that do not fit well.

It is important to avoid having any dental treatment that could affect your jawbone when you are having bisphosphonates. This includes having a tooth or root removed or dental implants put in. You can still have fillings, gum treatments or a scale and polish.

To reduce your risk of developing jaw problems, your doctor will advise you to:

• have a full dental check-up before starting treatment
• look after your teeth and gums during treatment (ask your dentist for advice)
• tell your dentist you are taking a bisphosphonate before having any dental treatment.

Tell your cancer doctor and dentist straight away if at any time you develop:

• pain
• swelling or redness in your gums
• numbness or heaviness in your jaw
• loose teeth.

Rarely, people taking clodronate develop a break (fracture) in their thigh bone without any obvious cause. Sometimes both thigh bones are affected.

If you have any pain in the thigh, hip or groin, tell your doctor and mention that you are taking bisphosphonates. They can arrange tests to check the thigh bones for any signs of weakness or fracture.

You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor, nurse or pharmacist. They can give you painkillers and advice. They can also tell you if any of the painkillers you usually take are suitable. 

Tell them if the pain does not get better. Having warm baths and resting regularly may help. 

Very rarely, bones in the outer ear may be affected by this treatment. Always tell your doctor if you have any:

• ear pain
• discharge from your ear
• ear infections.

You should also let them know if you notice any other changes in your ears or hearing.

You may have a higher risk of having a fit (seizure). But this is rare. This may be caused by high levels of calcium from the cancer and from having treatment. If this happens, call 999 straight away.