Aredia (pamidronate disodium)

What Is Aredia? 

AREDIA® is a bisphosphonate medication that prevents bone damage in multiple myeloma patients. Normally, our body has a delicate balance between cells that build bone (osteoblasts) and cells that break down bone (osteoclasts). For myeloma patients, signals sent by cancerous cells stimulate osteoclasts and disrupt this balance causing excess bone breakdown. 

Myeloma patients may experience various bone problems called skeletal-related events, or SREs, including  

• weak bones,
• lytic lesions (holes in the bones),
• and fractures.

In 2010, Lancet Oncology published the findings from a large, randomized, double-blind, phase III clinical trial by the Nordic Myeloma Study Group (NMSG), which compared Aredia given at 30 mg to the standard dose of 90 mg in patients with newly diagnosed multiple myeloma (NDMM). 

Given the toxicities associated with long-term bisphosphonate treatment, the aim of the NMSG study was to establish the lowest effective dose of Aredia. The study validated the efficacy of the reduced dose, concluding that “monthly infusion of Aredia 30 mg should be the recommended dose for prevention of bone disease” in myeloma patients. Ask your doctor if Aredia at 30 mg dose is appropriate for your individual case

Who Is a Candidate for Aredia? 

Aredia is indicated for treating osteolytic lesions in patients with multiple myeloma.

Aredia may not be recommended by your clinician if you have impaired kidney (renal) function or have a known allergy to bisphosphonates. You may also be unable to take Aredia if you are pregnant or breastfeeding.

There are other reasons you may not be a candidate for Aredia. Please see the package insert and discuss Aredia with your doctor for more information.

How Is Aredia Given? 

The typical dose of Aredia is 90 mg, given through an infusion into a vein. The infusion usually lasts 4 hours and is given every 3 to 4 weeks.

Your clinician may recommend taking calcium and Vitamin D supplements while taking Aredia. Your clinician will measure your vitamin D and calcium levels before treatment.

• fatigue,
• weakness (asthenia),
• fever,
• metastases,
• loss of appetite,
• GI side effects (such as nausea, constipation, diarrhea, vomiting, and abdominal pain),
• Muscle pain,
• joint pain/stiffness,
• anxiety,
• headache,
• insomnia,
• coughing,
• shortness of breath,
• pleural effusions,
• sinusitis,
• upper respiratory tract infections,
• urinary tract infections,
• and blood-related changes such as
  • low levels of red blood cells (anemia),
  • low white cells called granulocytes (granulocytopenia),
  • and platelets (thrombocytopenia).²

It is important to know that many side effects in patients taking Aredia also occurred in patients taking a placebo. In addition, many side effects seen in clinical trials are symptoms that can occur because of myeloma. Therefore, these side effects may not be caused by the medication.  

Toxicities associated with this medication are related to dosage, frequency of administration, and duration of infusion.Therefore, your doctor may recommend to reduce your dose and/or frequency of administration, and/or increase the duration of infusion

Aredia may cause severe side effects in some people. In a clinical trial of 392 patients, five patients experienced serious side effects related to Aredia:  

• worsening kidney function (3),
• respiratory distress (1),
• and an allergic reaction (1)³

The kidney toxicity-related concern with the use of Aredia is an excess of a serum protein (albumin) in the urine, known as albuminuria or nephrotic syndrome, that has occurred predominantly if Aredia is given more frequently than monthly or at a dose higher than 90 mg. This side effect is usually reversible with dose and/or schedule adjustments or, in occasional severe cases, by discontinuing Aredia. Very rarely has irreversible damage occurred. Periodic monitoring (e.g., every 3 to 6 months) of urine protein levels with 24-hour urine collection is recommended to prevent any significant kidney damage.

The risk of kidney-related side effects may be increased if you are taking Aredia in combination with thalidomide.⁴ Your clinician will take bloodwork to monitor your creatinine (a measure of your kidney function) before and throughout treatment.  

In addition, your clinician will monitor your blood electrolyte levels (or minerals in your body) as Aredia may cause changes in these levels (for example, low phosphorus, potassium, magnesium, and calcium).

Like other bone-targeting medications, Aredia may cause osteonecrosis of the jaw (ONJ) or opening of areas of the jawbone. You will be advised to have a complete dental exam before starting treatment. ONJ may cause you to feel

• pain,
• numbness,
• unusual drainage,
• or swelling from your jaw, mouth, or teeth.

If you experience any of these symptoms while taking Aredia, it is important to contact your doctor.

For a complete list of side effects, please see the Aredia package insert and consult the additional resources below.

Additional information 

FDA package insert: Aredia

Efficacy of Pamidronate in Reducing Skeletal Events in Patients with Advanced Multiple Myeloma.