Aredia (Disodium pamidronate)
How does it work?
Aredia infusion contains the active ingredient disodium pamidronate, which is a type of medicine called a bisphosphonate. These agents are used in a variety of metabolic bone disorders.
Bone is not a static structure. There is a continual turnover of bone in the body; bone is formed by cells called osteoblasts, and is broken down by cells called osteoclasts. These cells continously deposit and remove calcium and phophorous, stored in a protein network that makes up the structure of the bone.
Biphosphonates work by preventing the osteoclasts from breaking down bone. They do this by binding very tightly to the bone and preventing the calcium from being removed.
This action of pamidronate gives it a number of uses. For example, in Paget's disease of the bone there is excessive breakdown of bone by the osteoclasts, and the normal bone marrow is replaced with fibrous tissue. This causes the bones to become weak and brittle and prone to fracture. Pamidronate stops the bone breakdown and so helps keep the bones strong.
Cancer of the bone marrow and cancers that have spread to the bone from other sites, eg the breast, can also cause excessive bone breakdown. This causes areas of bone weakness and pain. Pamidronate binds to the bone and prevents it being broken down in these situations too.
Bone is broken down by the osteoclasts removing calcium from the bone structure. The calcium then seeps into the blood, so bone cancer can also result in high levels of calcium in the blood. This can cause symptoms such as feeling sick, tiredness and confusion. As pamidronate prevents the calcium being removed from bone, it can also be used to treat high levels of calcium in the blood that are the result of tumours.
Pamidronate is given via a drip into a vein (intravenous infusion).
What is it used for?
- Bone damage and bone pain due to bone marrow cancer (multiple myeloma) or breast cancer that has spread to the bone.
- High levels of calcium in the blood (hypercalcaemia) caused by tumours.
- Bone disease called Paget's disease, in which there is excessive breakdown of bone, causing the bones to become weak and prone to breaking.
- Your doctor may need to take a blood test to assess your kidney function before each dose of this medicine is given. Your doctor will also want to check that you are not dehydrated. You should talk to your doctor about how much you should drink while you are being treated, because it is important that you don't get dehydrated.
- This medicine might make you feel sleepy or dizzy following the infusion. If affected, you should avoid potentially hazardous activities such as driving or operating machinary until this wears off.
- As pamidronate can lower the level of calcium in the blood, your doctor may want you to take calcium and vitamin D supplements while you are being treated with this medicine. This is recommended for people who are at risk of calcium or vitamin D deficiency, for example through malabsorption or lack of exposure to sunlight. Follow the instructions given by your doctor.
- While receiving treatment with this medicine you will need regular blood tests to monitor the levels of calcium, phosphate and other electrolytes in your blood.
- The class of medicines that disodium pamidronate belongs to (bisphosphonates) has been associated with a rare condition called osteonecrosis of the jaw. The majority of cases of this condition have been in cancer patients treated with bisphosphonates by injection into a vein, and many of these people were also having treatment with chemotherapy or corticosteroids. However, the risk may also be increased by poor oral hygiene, dental problems such as gum disease or poorly fitting dentures, teeth extractions, oral surgery and smoking. For this reason, you should have a dental examination and, if necessary, appropriate preventive dentistry, before you start treatment with this medicine. Discuss this with your doctor. It is important to look after your mouth and teeth as much as possible while you are having treatment. You should have regular check-ups with your dentist and get advice straight away if you have any problems with your mouth or teeth. When you see a dentist during treatment, make sure they know you are being treated with this medicine. Invasive dental procedures such as tooth extraction or surgery should be avoided if possible.
- Some people being treated with bisphosphonates (mainly people having long-term treatment for osteoporosis) have experienced an unusual fracture of their thigh bone. For this reason it is important to let your doctor know if you get any pain in your thighs, hips or groin while you are having treatment with this medicine. These symptoms could be an early indication of a possible fracture.
Use with caution in
- Decreased kidney function.
- Severely decreased liver function.
- Heart disease, particularly in elderly people.
- People who have had surgery on their thyroid gland.
- People being treated with diuretic medicines.
Not to be used in
- People who are allergic to other bisphosphonate medicines.
- The manufacturer has not studied this medicine in children. It is not recommended for children.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This safety of this medicine for use during pregnancy has not been established. It could be harmful to a developing baby and for this reason it should not be used in pregnant women. Seek further medical advice from your doctor.
- It is not known if this medicine passes into breast milk. Mothers who need treatment with this medicine should not breastfeed their infants. Seek further medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Very common (affect more than 1 in 10 people)
- Flu-like symptoms.
- Feeling unwell.
- Low level of calcium or phosphate in the blood (hypocalcaemia or hypophosphataemia).
Common (affect between 1 in 10 and 1 in 100 people)
- Pain, redness, swelling or hardening of the skin at the site of infusion.
- Temporary bone pain.
- Pain in the muscles or joints.
- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain.
- Inflammation of the stomach (gastritis).
- Loss of appetite.
- Difficulty sleeping (insomnia).
- Inflammation of the membrane covering the eyeball (conjunctivitis).
- Increased blood pressure.
- Low level of calcium in the blood (hypocalcaemia) that causes symptoms such as pins and needles or muscle spasms/twitches/cramps. Tell your doctor if you experience symptoms like these.
- Low level of potassium or magnesium in the blood (hypokalaemia or hypomagnesaemia).
- Decreased numbers of red blood cells (anaemia), white blood cells (lymphocytopenia) or platelets (thrombocytopenia) in the blood.
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Feeling lethargic.
- Feeling agitated.
- Inflammation of the middle layer of the eyeball (uveitis).
- Decreased blood pressure.
- Muscle cramps.
- Acute kidney failure.
Very rare (affect less than 1 in 10,000 people)
- Flare-ups of cold sores or shingles.
- Increased level of potassium or sodium in the blood.
- Heart failure.
- Worsening of kidney disease.
- Blood in the urine.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while receiving treatment with this one, to make sure that the combination is safe.
The manufacturer recommends that this medicine is NOT used in combination with other bisphosphonate medicines.
There may an increased chance of the amount of calcium in the blood falling too low if aminoglycoside antibiotics such as gentamicin are used in combination with this medicine.
There may be an increased risk of side effects on the kidneys if this medicine is used in combination with other medicines that can affect the kidneys, for example thalidomide, aminoglycoside antibiotics and anti-inflammatory painkillers called NSAIDs (for example ibuprofen, diclofenac or indometacin. You should ask your doctor or pharmacist for advice before taking this type of painkiller.
Other medicines containing the same active ingredient
Disodium pamidronate infusion is also available without a brand name, ie as the generic medicine.