A bisphosphonate given by drip
Pamidronate
A bisphosphonate given as a slow drip by a healthcare team for high calcium, Paget's disease of bone and bone problems in cancer.
What is Pamidronate?
Pamidronate is a bisphosphonate medicine given as a slow drip (infusion) into a vein by a healthcare team. It is used to treat a high blood calcium level, Paget's disease of bone and bone problems caused by some cancers. It can cause a temporary flu-like reaction, and the team will check your kidneys and calcium and advise on dental care.
Education and reference only. This is a plain-language guide to Pamidronate — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Pamidronate is a bisphosphonate, a type of medicine that acts on bone. Unlike the bisphosphonate tablets people take for osteoporosis, pamidronate is given as a slow drip into a vein in hospital or a clinic. It is used to lower a high blood calcium level, to treat Paget's disease of bone, and to reduce bone complications and pain in conditions such as myeloma and cancer that has spread to bone. Because it is given by infusion, it is always administered by a healthcare team.
How it works
Pamidronate sticks to bone and damps down the activity of osteoclasts — the cells that break bone down. By slowing this breakdown, it reduces the release of calcium from bone into the blood (which lowers a high calcium level), calms the overactive bone turnover of Paget's disease, and helps protect bone that is being weakened by cancer. The effect builds and lasts well beyond the time of the drip itself.
Practical use
How to take Pamidronate
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given as a slow drip (infusion) into a vein by a healthcare team, not taken at home.
- Drink plenty of fluid before and after treatment unless you are told otherwise, to protect the kidneys.
- Expect to have blood tests around treatment to check kidney function and calcium.
- Have a dental check-up and tell the team about any dental problems before starting if possible.
- A calcium and vitamin D supplement may be advised by your team to keep calcium steady.
- Report any thigh, groin or jaw pain, or mouth problems, to your team.
Weighing it up
Advantages & disadvantages of Pamidronate
Advantages
- An effective way to bring down a dangerously high blood calcium level.
- Reduces bone pain and complications such as fractures in cancer affecting bone.
- Calms the overactive bone turnover of Paget's disease.
- Given by infusion, so it does not rely on remembering daily tablets.
Disadvantages
- Must be given by a healthcare team as a drip, so it means attending hospital or a clinic.
- Often causes a temporary flu-like reaction after the first infusion.
- Carries a small risk of osteonecrosis of the jaw, so dental care and checks are needed.
- Needs kidney function and calcium to be monitored, and is used with caution in kidney problems.
Practical use
Good to know
It is given as a slow drip by a healthcare team, never taken at home. A flu-like reaction — aches, mild fever and tiredness — is common in the day or two after the first infusion and usually settles. Staying well hydrated is important, and the team checks kidney function and calcium levels around treatment. Good dental care matters: tell the team about any dental problems, as there is a small risk of osteonecrosis of the jaw (ONJ).
Who should not take it / use with caution
- People with significantly reduced kidney function, where it is used with great caution or avoided.
- People with a low blood calcium level that has not been corrected.
- People with current dental infection or a planned dental procedure may need this addressed first because of the jaw risk.
- Caution in pregnancy and breastfeeding — it is generally avoided unless essential.
Monitoring
- Kidney function checked before and around each infusion.
- Blood calcium and other minerals checked, as calcium can fall after treatment.
- Dental review and watching for any jaw, mouth, thigh or groin symptoms.
Side effects
- A flu-like reaction (aches, mild fever, tiredness) in the day or two after the drip.
- A temporary fall in blood calcium, sometimes with tingling or muscle cramps.
- Bone, joint or muscle aches.
- Reactions where the drip goes in, and occasionally eye inflammation.
- Rarely, osteonecrosis of the jaw or, with long-term use, unusual thigh-bone fractures.
Key interactions
- Other medicines that can harm the kidneys increase the risk to kidney function.
- Other medicines that lower calcium can add to a fall in blood calcium.
- Certain cancer treatments may add to the risk of jaw osteonecrosis.
- Tell the team about all your medicines so risks can be weighed before each infusion.
Available as: Intravenous infusion (a slow drip into a vein).
Answers
Pamidronate: frequently asked questions
How is pamidronate given?
It is given as a slow drip (infusion) into a vein by a healthcare team, in hospital or a clinic — it is not a medicine you take at home.
Why do I feel flu-like after the drip?
A flu-like reaction with aches, mild fever and tiredness is common in the day or two after the first infusion. It usually settles on its own.
Why is dental care important?
There is a small risk of osteonecrosis of the jaw. Having a dental check, keeping your mouth healthy and reporting any jaw or mouth problems helps reduce this risk.
Why are my kidneys and calcium checked?
Pamidronate can affect kidney function and can lower blood calcium, so the team checks these around treatment and may advise a calcium and vitamin D supplement.
What is pamidronate used for?
It is used for a high blood calcium level, Paget's disease of bone, and bone problems caused by some cancers such as myeloma and cancer that has spread to bone.
The wider class
About Bisphosphonates
Pamidronate belongs to the bisphosphonates class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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