Summary

Commonly reported side effects of pamidronate include: urinary tract infection, cough, dyspepsia, dyspnea, myalgia, abdominal pain, anemia, anxiety, constipation, diarrhea, fatigue, fever, hypervolemia, hypocalcemia, hypokalemia, hypomagnesemia, hypophosphatemia, infusion site reaction, insomnia, nausea, ostealgia, pain, thrombocytopenia, vomiting, and anorexia. Other side effects include: atrial fibrillation, candidiasis, psychosis, syncope, uremia, drowsiness, gastrointestinal hemorrhage, hypertension, hypothyroidism, leukopenia, rales, rhinitis, and tachycardia. Continue reading for a comprehensive list of adverse effects.

Applies to pamidronate: intravenous powder for solution, intravenous solution.

Serious side effects of Pamidronate

Along with its needed effects, pamidronate may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking pamidronate:

More common

• Abdominal or stomach cramps
• black, tarry stools
• bloody in the urine or stools
• blurred vision
• chest pain
• chills
• confusion
• convulsions (seizures)
• decrease in the amount of urine
• dizziness
• drowsiness
• fainting
• fast or irregular heartbeat
• fever
• headache
• increased thirst
• loss of appetite
• muscle pain, cramps, spasms, or twitching
• nausea or vomiting
• nervousness
• noisy, rattling breathing
• numbness or tingling in the hands, feet, or lips
• pinpoint red spots on the skin
• pounding in the ears
• shortness of breath
• slow or fast heartbeat
• swelling of the fingers, hands, feet, or lower legs
• trembling
• troubled breathing at rest
• unusual bleeding or bruising
• unusual tiredness or weakness
• vomiting of blood or material that looks like coffee grounds
• weight gain

Less common

• Cough
• dilated neck veins
• extreme fatigue
• irregular breathing
• lower back or side pain
• painful or difficult urination
• pale skin
• swelling
• ulcers, sores, or white spots in the mouth

Rare

• Decreased vision
• difficulty with swallowing
• eye pain or tenderness
• eye redness
• hives
• itching
• large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
• sensitivity of the eye to light
• skin rash
• sweating
• tearing of the eye
• tightness in the chest

Incidence not known

• Bone, joint, or muscle pain, severe and occasionally incapacitating
• faintness, or lightheadedness when getting up suddenly from a lying or sitting position

Other side effects of Pamidronate

Some side effects of pamidronate may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Acid or sour stomach
• belching
• bladder pain
• bloody or cloudy urine
• body aches or pain
• bone pain
• constipation
• cracks in the skin at the corners of mouth
• diarrhea
• difficult, burning, or painful urination
• difficult or labored breathing
• difficulty moving
• ear congestion
• fear
• frequent urge to urinate
• heartburn
• indigestion
• joint pain
• lack or loss of strength
• lower back or side pain
• muscle aching, cramping, pains, or stiffness
• nasal congestion
• nervousness
• pain and swelling at the injection site
• sensitivity to heat
• shivering
• sneezing
• soreness or redness around the fingernails and toenails
• stomach discomfort, upset, or pain
• sweating
• swollen joints
• trouble sleeping
• weight loss

Less common

• Ammonia-like breath odor
• feeling, seeing, or hearing things that are not there
• feeling that others are watching you or controlling your behavior
• feeling that others can hear your thoughts
• feeling unusually cold
• swelling or inflammation of the mouth
• unusual behavior

For Healthcare Professionals

Applies to pamidronate: intravenous powder for injection, intravenous solution.

General

This drug has been generally well tolerated and many adverse effects that occurred during treatment may have been related to the underlying disease state. Adverse effects have been most often associated with larger (90 mg) doses of pamidronate. The most common adverse effect has been fever, occurring in up to 41% of patients. The fever was generally mild and transient. Onset was typically within the first 48 hours after infusion and resolution was within another 48 hours.^[Ref]

Gastrointestinal

Very common (10% or more): Nausea, vomiting, abdominal pain, diarrhea, constipation, gastritis, dyspepsia^[Ref]

Genitourinary

Very common (10% or more): Urinary tract infection (15%)

Common (1% to 10%): Moniliasis^[Ref]

Metabolic

Very common (10% or more): Hypocalcemia, hypophosphatemia, anorexia, fluid overload

Common (1% to 10%): Hypokalemia, hypomagnesemia

Very rare (less than 0.01%): Hyperkalemia, hypernatremia^[Ref]

Presentation of hypocalcemia may be delayed. In one case report, the patient presented with fingertip paresthesias and a serum calcium of 6.8 mEq/L (7.8 mEq/mL, corrected) 13 days after a single infusion of pamidronate.^[Ref]

Musculoskeletal

Very common (10% or more): Arthrosis

Common (1% to 10%): Transient bone pain, arthralgia, myalgia, generalized pain

Uncommon (0.1% to 1%): Muscle cramps, osteonecrosis

Postmarketing reports: Atypical subtrochanteric and diaphyseal femoral fractures^[Ref]

Other

Very common (10% or more): Fever and influenza-like symptoms sometimes accompanied by malaise, rigor, fatigue, flushes, asthenia

Very rare (less than 0.01%): Reactivation of Herpes simplex, reactivation of Herpes zoster^[Ref]

Respiratory

Very rare (less than 0.01%): Acute respiratory distress syndrome, interstitial lung disease

Postmarketing reports: Adult respiratory distress syndrome (ARDS), interstitial lung disease (ILD)^[Ref]

Cardiovascular

Common (1% to 10%): Atrial fibrillation, hypertension

Uncommon (0.1% to 1%): Hypotension

Very rare (less than 0.01%): Left ventricular failure (dyspnea, pulmonary edema), congestive heart failure (edema) due to fluid overload^[Ref]

Dermatologic

Common (1% to 10%): Rash

Uncommon (0.1% to 1%): Pruritus^[Ref]

Hematologic

Leukopenia was generally mild and transient. In one study, granulocytopenia occurred in 4.2% of patients but completely resolved after discontinuation of pamidronate therapy. Patients with anemia, leukopenia, or thrombocytopenia prior to initiation of pamidronate should be carefully monitored during the first 2 weeks of therapy.^[Ref]

Common (1% to 10%): Anemia, thrombocytopenia, lymphocytopenia, leukopenia^[Ref]

Local

Common (1% to 10%): Reactions at the infusion site (pain, redness, swelling, induration, phlebitis, thrombophlebitis)^[Ref]

Nervous system

Common (1% to 10%): Symptomatic hypocalcemia (tetany, paresthesia), headache

Uncommon (0.1% to 1%): Seizures, lethargy, dizziness

Very rare (less than 0.01%): Confusion^[Ref]

Ocular

Uveitis generally occurs within 24 to 48 hours after administration of pamidronate. The uveitis may be bilateral, and reversible, partial 3rd and 4th nerve palsies have been reported with the uveitis. Recurrences have occurred with rechallenge of the drug. Therapy with pamidronate should be discontinued if uveitis occurs. Although severe cases have been reported, most symptoms have resolved on discontinuation of pamidronate with minimal or no intervention.

A nonspecific conjunctivitis has been reported with pamidronate use. The conjunctivitis may consist of any or all of the following symptoms: conjunctival hyperemia, irritation, epiphora, discharge, and blurred vision. These symptoms may appear within the first 6 to 48 hours after administration of the drug and generally resolve within a few days after drug discontinuation.^[Ref]

Common (1% to 10%): Conjunctivitis

Uncommon (0.1% to 1%): Uveitis (iritis, iridocyclitis)

Very rare (less than 0.01%): Scleritis, episcleritis, xanthopsia

Frequency not reported: Optic neuritis

Postmarketing reports: Orbital inflammation^[Ref]

Psychiatric

Common (1% to 10%): Insomnia

Uncommon (0.1% to 1%): Agitation

Very rare (less than 0.01%): Visual hallucinations^[Ref]

Renal

Common (1% to 10%): Increase in serum creatinine

Uncommon (0.1% to 1%): Increase in serum urea, acute renal failure

Rare (0.01% to 0.1%): Focal segmental glomerulosclerosis including the collapsing variant, nephrotic syndrome

Very rare (less than 0.01%): Deterioration of pre-existing renal disease, hematuria, renal tubular disorder, tubulointerstitial nephritis, glomerulonephropathy^[Ref]

Endocrine

Uncommon (0.1% to 1%): Hypothyroidism in patients receiving doses of 90 mg^[Ref]

Hepatic

Uncommon (0.1% to 1%): Abnormal liver function test^[Ref]

Hypersensitivity

Uncommon (0.1% to 1%): Allergic reactions including anaphylactoid reactions, bronchospasm/dyspnea, Quincke's (angioneurotic) edema

Very rare (less than 0.01%): Anaphylactic shock^[Ref]