Aredia (pamidronate)

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Your doctor has recommended a treatment called Aredia which is used to protect the bones and blood stream from the effects of cancer.

How do cancer cells effect the bones? It is possible in some patients for cancer cells to spread from its original site, for example the breast, to the bones. They then grow into small tumours which release chemicals which upset the normal balance between bone formation (osteoblast cells)  and bone reabsorption (osteoclast cells).

These chemicals stimulate osteoclasts to excessively reabsorb bone, release of calcium into the blood stream, reduced bone density, leading to holes in the bones and weakness. Weak bones lead to bone pain and fracture. A high calcium (Hypercalcaemia) can cause a number of troublesome symptoms including; Dry mouth, thirst & dehydration due to passing of excessive urine, constipation, nausea & vomiting, severe tiredness, muscle weakness, low mood leading to depression.

How does Aredia work?   Aredia contains disodium pamidronate a member of a group of drugs called bisphosphonates. Aredia blocks the function of the cells which reabsorb bone  (osteoclasts) but does not effect the cells which strengthen bone (osteoblasts). Clinical trials have shown that inhibiting bone reabsorption corrects and prevents the release of too much calcium into the blood stream, reduces bone pain, reduces the occurrence of fractures and maintains or improves general well being.

Who takes Aredia?   Mainly patients who have a cancer which has spread to the bones. Most often these are with breast cancer but it is sometimes recommended for patients with other types of cancer including prostate, lung and myeloma. It is most often given to patients where the cancer in the bone has caused pain or signs of weakness.  It is particularly recommended if the level of calcium in the blood stream is raised.

New studies are underway and some have already suggested that disodium pamidronate may also be of use in women who are risk of developing disease in the bone but do not have any evidence of it on any scans at the present time (see having a bone scan). Some of these studies with other bisphosphonates (Bonefos & Loron) have suggested that they have prevented the spread of cancer to the bones.

How should Aredia be given? For bone disease with a normal blood calcium -mixed with saline (sterile water with salt) and infused over 1-2 hours usually as an outpatient. It is then repeated every 3-4 weeks. For bone disease with a raised calcium - Treatment may be initially given as an inpatient preceded by steroids and fluids for a number of days before hand. Thereafter, in many cases the infusion is repeated as an outpatient  every 3-4 weeks. Alternatively, patients can be maintained on oral medication.

Side effects
Aredia is generally well tolerated but occasional side effects can occur. These are mentioned below but it is rarely possible to develop side effects not mentioned here. If in doubt ask!

These symptoms are caused by a mild allergic reaction. They can usually be corrected next time by a small dose of intravenous steroids (e.g. Dexamethasone 4mg iv) given with the pamidronate.

Patients who have moderate to severe renal failure should only take Aredia only under strict supervision.

 

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