Pamidronate is used to treat high levels of calcium in the blood that may be caused by certain types of cancer. Pamidronate is also used along with cancer chemotherapy to treat bone damage caused by multiple myeloma (cancer that begins in the plasma cells [a type of white blood cell that produces substances needed to fight infection]) or by breast cancer that has spread to the bones. Pamidronate is also used to treat Paget's disease (a condition in which the bones are soft and weak and may be deformed, painful, or easily broken). Pamidronate injection is in a class of medications called bisphosphonates. It works by slowing bone breakdown, increasing bone density (thickness) and decreasing the amount of calcium released from the bones into the blood.

Pamidronate injection comes as a solution (liquid) to inject into a vein slowly, over 2 to 24 hours. It is usually injected by a health care provider in a doctor's office, hospital, or clinic. It may be given once every 3 to 4 weeks, once a day for 3 days in a row, or as a single dose that may be repeated after 1 week or longer. The treatment schedule depends on your condition.

Your doctor may recommend a calcium supplement and a multivitamin containing vitamin D to take during your treatment. You should take these supplements every day as directed by your doctor.

Before receiving pamidronate injection,

• tell your doctor and pharmacist if you are allergic to pamidronate injection, alendronate (Fosamax), etidronate (Didronel), risedronate (Actonel), tiludronate (Skelid), zoledronic acid (Zometa), any other medications, or any of the ingredients in pamidronate injection. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: cancer chemotherapy medications; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone);and thalidomide (Thalomid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with pamidronate injection, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• tell your doctor if you are being treated with radiation therapy and if you have or have ever had thyroid surgery, seizures, or liver or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. You should use a reliable method of birth control to prevent pregnancy while you are receiving pamidronate. If you become pregnant while receiving pamidronate, call your doctor immediately. Talk to your doctor if you plan to become pregnant at any time in the future because pamidronate may remain in your body for years after you stop using it.
• you should know that pamidronate may cause serious problems with your jaw, especially if you have dental surgery or treatment while you are taking the medication. A dentist should examine your teeth and perform any needed treatments before you start to receive pamidronate. Be sure to brush your teeth and clean your mouth properly while you are receiving pamidronate. Talk to your doctor before having any dental treatments while you are receiving this medication.
• you should know that pamidronate injection may cause severe bone, muscle, or joint pain. You may begin to feel this pain within days, months, or years after you first receive pamidronate injection. Although this type of pain may begin after you have received pamidronate injection for some time, it is important for you and your doctor to realize that it may be caused by pamidronate. Call your doctor right away if you experience severe pain at any time during your treatment with pamidronate inejction. Your doctor may stop giving you pamidronate injection and your pain may go away after you stop treatment with this medication.

Call your doctor if you miss a dose of pamidronate or an appointment to receive a dose of pamidronate.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• fever
• change in ability to taste food
• sudden tightening of the muscles
• numbness or tingling around the mouth

If you are administering this medication at home, your health care provider will tell you how to store it. Follow these instructions carefully.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

Unless your doctor tells you otherwise, continue your normal diet

Pamidronate injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• redness, swelling, or pain in the injection spot
• stomach pain
• loss of appetite
• constipation
• nausea
• vomiting
• heartburn
• change in ability to taste food
• sores in the mouth
• fever
• headache
• dizziness
• excessive tiredness
• difficulty falling asleep or staying asleep
• coughing
• difficulty urinating or painful urination
• swelling of the hands, arms, feet, ankles, or lower legs

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• painful or swollen gums
• loosening of the teeth
• numbness or heavy feeling in the jaw
• poor healing of the jaw
• vomit that is bloody or looks like coffee grounds
• bloody or black and tarry stools
• shortness of breath
• fast heartbeat
• fainting
• sudden tightening of muscles
• numbness or tingling around the mouth
• eye pain or tearing

Pamidronate injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to pamidronate injection.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Aredia®