From the Guidelines
Pamidronate commonly causes several side effects, including flu-like symptoms, gastrointestinal disturbances, injection site reactions, electrolyte abnormalities, bone, joint, and muscle pain, and ocular complications. The most frequent side effects of pamidronate include:
- Flu-like symptoms (fever, chills, muscle aches, and fatigue) that typically occur within the first three days after infusion and usually resolve within 24-48 hours 1
- Gastrointestinal disturbances such as nausea, vomiting, diarrhea, and abdominal pain 1
- Injection site reactions including pain, redness, and swelling at the infusion site 1
- Electrolyte abnormalities, particularly hypocalcemia (low calcium), hypophosphatemia (low phosphate), and hypomagnesemia (low magnesium) can occur, which is why monitoring blood levels is important during treatment 1
- Bone, joint, and muscle pain are frequently reported and may be managed with over-the-counter pain relievers 1
- Some patients develop ocular complications like conjunctivitis, uveitis, or scleritis 1 More serious but less common side effects include:
- Osteonecrosis of the jaw (particularly in patients undergoing dental procedures) 1
- Atypical femur fractures with long-term use 1
- Rarely, kidney problems 1 Patients should stay well-hydrated before and after treatment, take calcium and vitamin D supplements as directed, maintain good oral hygiene, and report any persistent or severe symptoms to their healthcare provider promptly.
From the FDA Drug Label
Adverse experiences considered to be related to trial drug, which occurred in at least 5% of patients with Paget’s disease treated with 90 mg of pamidronate disodium in two U. S. clinical trials, were fever, nausea, back pain, and bone pain At least 10% of all pamidronate disodium-treated patients with Paget’s disease also experienced the following adverse experiences during clinical trials: Cardiovascular : Hypertension Musculoskeletal : Arthrosis, bone pain Nervous system : Headache Commonly Reported Adverse Experiences in Three U. S. Controlled Clinical Trials Pamidronate Disodium 90 mg over 4 hours N=205 General % Asthenia 16.1 Fatigue 31.7 Fever 38.5 Pain 13.2 Digestive system Anorexia 17.1 Constipation 28.3 Diarrhea 26.8 Dyspepsia 17.6 Nausea 35.6 Pain Abdominal 19.5 Vomiting 16.6 Hemic and Lymphatic Anemia 47.8 Granulocytopenia 20.5 Thrombocytopenia 16.6 Musculoskeletal System Arthralgias 10.7 Myalgia 25.4 Skeletal Pain 61 CNS Anxiety 7.8 Headache 24.4 Insomnia 17.1 Respiratory System Coughing 26.3 Dyspnea 22.2
The common side effects of pamidronate include:
- General:
- Asthenia (16.1%)
- Fatigue (31.7%)
- Fever (38.5%)
- Pain (13.2%)
- Digestive system:
- Anorexia (17.1%)
- Constipation (28.3%)
- Diarrhea (26.8%)
- Dyspepsia (17.6%)
- Nausea (35.6%)
- Pain Abdominal (19.5%)
- Vomiting (16.6%)
- Hemic and Lymphatic:
- Anemia (47.8%)
- Granulocytopenia (20.5%)
- Thrombocytopenia (16.6%)
- Musculoskeletal System:
- Arthralgias (10.7%)
- Myalgia (25.4%)
- Skeletal Pain (61%)
- CNS:
- Anxiety (7.8%)
- Headache (24.4%)
- Insomnia (17.1%)
- Respiratory System:
- Coughing (26.3%)
- Dyspnea (22.2%) 2
From the Research
Common Side Effects of Pamidronate
The common side effects of pamidronate include:
- Transient febrile reactions, sometimes accompanied by myalgias and lymphopenia, which occur commonly after the first infusion of pamidronate 3
- Transient neutropenia 3
- Mild thrombophlebitis 3
- Asymptomatic hypocalcaemia 3
- Ocular complications (uveitis and scleritis), although rare 3
- Flu-like syndrome after pamidronate infusion, reported in 41% of patients 4
- Renal deterioration, although this is not always directly related to pamidronate administration 5, 6
Less Common Side Effects
Less common side effects of pamidronate include:
- Severe hypocalcemia, reported in only 1 case out of 31 patients 5
- Systemic ill effects, which were not observed in most studies 5, 6
- Nephrotoxicity, which has been described after pamidronate administration in animals, but is not commonly reported in humans 5, 6
Special Considerations
Pamidronate is generally well-tolerated in patients with renal failure and hypercalcemia 7, 5, and can be safely administered to patients with end-stage renal disease on dialysis 7. However, caution should be exercised when administering pamidronate to patients with pre-existing renal impairment 6.