Pamidronate = Aredia®

Like Zometa®, it can cause acute phase response (APR), which involves
flu-like symptoms for a few days. It's interesting to see that the medic
knew about APR, but apparently did not know how to avoid it. And it is
avoidable through use of a low initial dosage infused over a longer
time. Later dosages can them be administered at the usual dosages and
for the usual infusion periods.

Myalgia (muscle pain) is a possible though rare side effect (SE). See
the Aredia® SEs on Rx List at:
http://www.rxlist.com/cgi/generic/aredia_ad.htm

It seems to me that this requires medical attention.

I hope not hospice but hospital.

Why suffer because of concern about "what they'll do in terms of drugs?"
He has a known problem for which he refuses to seek treatment because of
what the medics *might* do to relieve it. That's how it looks from here,
and it seems illogical. He can have a consultation, then decide whether
to follow whatever advice he is given. He's still in control.

Good luck.

Regards,

Steve J

Have you Googled it? One prompt hit included this discussion of
biphosphanates for bone pain:
http://www.cancerhelp.org.uk/help/default.asp?page=5271 .

Or is some of his pain esophageal? After all, biphosphanates such as
Fosamax are generally precluded if the patient has esophageal problems
such as a hiatal hernia (and I'd bet an ulcerated esophagus qualifies).

The various medical websites list several side effects of
biphosphanates, including esophageal irritation, stomach ache, diarrhea,
jaw bone destruction, muscle and bone discomfort,

From http://www.rxcarecanada.com/Bisphosphonates.asp we see that

Contraindications: All bisphosphonates are contraindicated in patients
with hypersensitivity to any bisphosphonate. Alendronate is
contraindicated in patients with abnormalities of the esophagus that
delay emptying, such as stricture or achalasia, in patients who cannot
stand or sit upright for at least 30 minutes and in patients with
creatinine clearance <0.58 mL/s. Clodronate is contraindicated in
patients with serum creatinine >440 µmol/L or severe inflammation of the
gastrointestinal tract. Etidronate is contraindicated in patients with
clinically overt osteomalacia, until appropriate treatment has been
initiated for it. Risedronate is contraindicated in patients with
hypocalcemia.

Warnings: Bisphosphonates may cause upper gastrointestinal disorders
such as dysphagia, esophagitis, esophageal ulcer and gastric ulcer.
[That's been discussed numerous times in this forum as a contraindicator
of bone restoring meds; I'm surprised his doctors would prescribe it to
a man with ulcerated esophagus, but what do I know?] Esophageal injury
has been more commonly associated with aminobisphosphonates such as
alendronate. There appears to be a higher risk of esophageal injury if
the patient does not remain upright following the dose. It is
recommended that patients take bisphosphonates on an empty stomach with
a full glass of water and remain in an upright position for at least 30
minutes after a dose.

Because bisphosphonates are excreted renally, caution and appropriate
monitoring are advised for patients with renal failure (see
Contraindications).

In the treatment of Paget's disease with etidronate, it can take months
to realize the maximum benefit of therapy. Caution is advised regarding
treatment beyond the recommended duration of therapy, because of the
potential for impaired mineralization of new bone. A drug-free interval
is recommended between courses of treatment for Paget's disease (see
Dosage).

Precautions: Gastrointestinal: To minimize the risk of upper
gastrointestinal irritation or injury, bisphosphonates should be taken
on an empty stomach with a full glass of plain water. They should not be
taken with food, calcium, other medications, or any beverage other than
water. Patients should remain in an upright position (sitting or
standing) for 30 minutes after a dose. Manufacturers' recommendations
vary for the different agents with respect to the time of day and how
long before a meal they should be taken (see Dosage).

Dosing instructions should be clearly explained and reinforced. Patients
should be advised to stop taking the bisphosphonate and consult their
physician if symptoms of esophageal injury develop, such as such as
difficulty swallowing, retrosternal pain or new or worsening heartburn.

Caution is advised for patients with a history of gastrointestinal
disorders, especially delayed esophageal transit time. Alendronate is
contraindicated in patients with delayed esophageal emptying.

Bone Metabolism: Hypocalcemia and other disturbances of bone and mineral
metabolism should be effectively treated prior to bisphosphonate
therapy. Because mild decreases in serum calcium and phosphorus have
been observed with some bisphosphonates, maintaining adequate intake of
calcium and vitamin D is recommended. Calcium interferes with the
absorption of the bisphosphonate and should be taken at a different
time. In the case of cyclic etidronate therapy, calcium and vitamin D
supplements are not recommended during the 14-day etidronate phase (see
Dosage, Table II). For information on recommended intake of calcium and
vitamin D, see the Calcium Salts: Oral and Vitamin D general monographs
in the White pages and Osteoporosis and the Older Adult in the Clin-Info
section.

And so it goes. You'll find scores to hundreds of useful sites by
Googling various key words such as biphosphanate side effects, both
answering and raising many related questions.

I.P.

Kevin

My experience is with Zometa which is similar to Aredia. I am
surprised that his doctor did not provide countermeasures to minimize
the pain.

With Zometa, the following helps some patients:

1- reducing the normal dosage to half for the first infusion - for
Zometa it is 2 mg instead of 4 mg.

2- extending the time span for the infusion to double or triple the
normal time  - for Zometa it is slowing down the infusion rate to take
60 minutes.

3- Having the patient drink a lot of water before and after the
infusion - and as long as the pain persists.

4- Take adequate calcium and vitamin D daily at supper and at bedtime
- Dr Strum recommends Jarrow's BONE-UP of 3 caps at a time (500 mg
calcium plus )

7- The doctor should run a blood test to check electrolytes especially
potassium as it may also require supplementation.

These are the countermeasures that have helped me but remember each
patient is different so it is important to work with a VERY
knowledgeable and caring doctor.

Best wishes ... Lud

These