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This is a Buddhist Om Mani Padme Pendant made in Nepal, crafted of Sterling Silver with an embossed finish on the sides to give the pendant an aged look. The phrase Om Mani Padme Hum translates as Hail the Jewel in the Lotus, and that mantra is on the front of the pendant. This type of pendant is often called a Ghau, which means that it is a box that opens up and allows you to put a tiny prayer inside, should you want to.
Aside from the Om Mani prayer on the front, the sides of this pendant are decorated with the double dorge symbol (also known as a vajra in Nepal).