When This Medicine Should Not Be Used:
You should not receive this medicine if you have had an allergic reaction to pamidronate or to similar medicines such as alendronate, etidronate, risedronate, tiludronate, Actonel®, Didronel®, Fosamax®, or Skelid®. You should not receive this medicine if you are pregnant.

How to Use This Medicine:
Injectable

• Your doctor will prescribe your dose and schedule. This medicine is given through a needle placed in a vein.
• A nurse or other health provider will give you this medicine.
• Your doctor may also give you vitamins containing Vitamin D and calcium. Tell your doctor if you are unable to take these supplements.
• Drink extra fluids so you will urinate more often and help prevent kidney problems. However, it is very important to not drink too much liquid. Talk to your doctor about the right amount of liquids for you.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are receiving cancer medicines or radiation treatments. Tell your doctor if you are using thalidomide (Thalomid®), medicine to treat an infection (such as amikacin, gentamicin, streptomycin, tobramycin, Garamycin®, TOBI®), or a steroid medicine (such as hydrocortisone, methylprednisolone, prednisolone, prednisone). Tell your doctor if you also use a pain or arthritis medicine or NSAID such as aspirin, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®.

Warnings While Using This Medicine:

• It is not safe to take this medicine during pregnancy. It could harm an unborn baby. Tell your doctor right away if you become pregnant.
• Make sure your doctor knows if you are breastfeeding, or if you have kidney disease, heart disease, parathyroid problems, or a history of thyroid surgery. Tell your doctor if you have anemia, cancer, dehydration, a mineral imbalance, or a history of problems with your mouth or teeth (such as gum disease or dentures). Make sure your doctor knows if you have been treated with a bisphosphonate medicine in the past.
• You may need a dental exam before you start to use this medicine. Tell your doctor if you develop pain, swelling, or numbness in your teeth or jaw.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. Try to avoid major dental work, such as dental surgery, while you are being treated with this medicine.
• Tell your doctor if you develop severe bone, joint, or muscle pain.
• This medicine may increase your risk for fractures of the thigh bone. Check with your doctor right away if you have a dull or aching pain in the thighs, groin, or hips.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blood in the urine, lower back pain, side pain, or sharp back pain just below the ribs
• Confusion, mental changes, unusual tiredness or weakness, muscle spasms or stiffness
• Decrease in how much or how often you urinate, burning or painful urination
• Dry mouth, increased thirst, muscle cramps, nausea, vomiting
• Fast, slow, pounding, or uneven heartbeat
• Pain or other problems with your teeth or jaw
• Seizures
• Severe bone, joint, or muscle pain
• Swelling in your hands, ankles, or feet
• Trouble breathing
• Unusual bleeding, bruising, or weakness

If you notice these less serious side effects, talk with your doctor:

• Fever, chills, cough, runny or stuffy nose, sore throat
• Mild nausea, vomiting, constipation, loss of appetite, stomach pain or upset
• Pain, redness, swelling, or a lump under your skin where the needle is placed

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088