Indications
Zoledronic Acid is a bone-strengthening medicine given by intravenous infusion. It is used for osteoporosis in women after the menopause and in men, including osteoporosis caused by long-term steroid use, and to lower the risk of further fractures after a hip fracture. It is also used for Paget’s disease of bone, for high blood calcium caused by cancer, and to prevent bone complications (such as fractures and bone pain) in people with multiple myeloma or cancer that has spread to the bones.
How It Works
Zoledronic Acid belongs to a group called bisphosphonates. It binds strongly to bone and slows down osteoclasts, the cells that break down bone. This reduces bone loss, helps bone density increase and lowers the amount of calcium released from bone into the blood.
Dosage and Administration
It is given by a doctor or nurse as a slow drip into a vein over at least 15 minutes. The dose and how often it is given are decided by the doctor: for osteoporosis it is usually given once a year, while for cancer-related bone disease it may be given every 3 to 4 weeks. The dose is adjusted for kidney function. Drink plenty of water before and after the infusion. Calcium and vitamin D supplements are usually advised.
Interactions
Use with care with other medicines that can harm the kidneys, such as Gentamicin and other aminoglycosides, NSAIDs or diuretics, and with medicines that lower calcium such as Calcitonin. It should not be given with other products containing Zoledronic Acid or other bisphosphonates. Tell your doctor about cancer medicines such as Thalidomide or anti-angiogenic drugs, which may increase jaw problems.
Contraindications
- Allergy to Zoledronic Acid or other bisphosphonates.
- Low blood calcium (hypocalcaemia) that has not been corrected.
- Severe kidney impairment (for the osteoporosis dose).
- Pregnancy and breastfeeding.
Side Effects
Flu-like symptoms such as fever, muscle and joint aches, headache and tiredness are common within 3 days of the first infusion and usually settle. Other effects include nausea, bone pain, low calcium, low phosphate and changes in kidney function. Rarely it can cause eye inflammation, osteonecrosis of the jaw (poor healing of the jaw bone) and unusual thigh bone fractures.
Get urgent medical help if you have muscle cramps, tingling or numbness around the mouth or fingers, a painful red eye or vision changes, signs of allergy such as swelling and difficulty breathing, passing much less urine, or new pain in the hip, groin or thigh.
Pregnancy and Lactation
Do not use during pregnancy; it may harm the developing baby’s bones. Women who could become pregnant should use effective contraception. Do not breastfeed while receiving it.
Precautions and Warnings
Kidney function and blood calcium are checked before each dose. Have a dental check before starting and keep good oral hygiene; tell your dentist you receive this medicine before any tooth extraction. Report any jaw pain, loose teeth or ear pain. Atrial fibrillation (irregular heartbeat) has been reported.
Overdose
Overdose is unlikely because it is given in hospital. Too much may cause low calcium, low phosphate and low magnesium, which are treated with supplements under medical care.
Therapeutic Class
Bisphosphonate (bone resorption inhibitor).
Storage
Hospital medicine: store as directed on the pack, usually below 30°C. After opening or dilution, use promptly or keep at 2 to 8°C for the time stated on the pack. Keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.