Zoldix

Indications

Zoledronic Acid is a bone-strengthening medicine given by drip into a vein. It is used to:

• Treat high blood calcium caused by cancer.
• Prevent fractures and other bone problems in people with multiple myeloma or cancer that has spread to the bones.
• Treat osteoporosis (thin, weak bones) in women after menopause and in men, including osteoporosis caused by long-term steroid use.
• Treat Paget's disease of bone.

How It Works

Bone is constantly broken down and rebuilt. Zoledronic Acid slows down the cells that break bone down (osteoclasts). This makes bones stronger, lowers the risk of fractures and reduces the release of calcium from bone into the blood.

Dosage and Administration

Zoledronic Acid is given by a doctor or nurse as an infusion (drip) into a vein over at least 15 minutes, as prescribed. For osteoporosis it is usually given once a year; for cancer-related bone disease it is usually given every 3 to 4 weeks. The dose and timing depend on the condition and kidney function. Drink enough water before the infusion, as advised. Your doctor may also prescribe calcium and vitamin D supplements.

Interactions

• Aminoglycoside antibiotics (such as Gentamicin) and loop diuretics (such as Furosemide) can lower calcium further.
• Medicines that can harm the kidneys, such as NSAID painkillers, increase the risk of kidney problems.
• Do not use with other bisphosphonates at the same time.

Contraindications

• Low blood calcium that has not been corrected.
• Severe kidney impairment (for the osteoporosis dose).
• Pregnancy and breastfeeding.
• Allergy to zoledronic acid or other bisphosphonates.

Side Effects

Common: flu-like symptoms (fever, chills, muscle and joint aches, headache) for 1 to 3 days after the infusion, especially the first one; nausea, tiredness, bone pain and low calcium or phosphate. Less common: kidney problems and eye inflammation. Rare: jaw bone damage (osteonecrosis of the jaw) and unusual thigh bone fractures.

Get urgent medical help if you have numbness or tingling around the mouth or in the fingers, muscle cramps or spasms, a painful red eye or changes in vision, jaw pain, loose teeth or a sore in the mouth that will not heal, new pain in the thigh, hip or groin, much less urine than usual, or signs of a serious allergic reaction.

Pregnancy and Lactation

Must not be used during pregnancy or breastfeeding. Women who could become pregnant should use reliable contraception during treatment.

Precautions and Warnings

• Kidney function is checked before each dose.
• Have a dental check-up before starting, keep good mouth hygiene and tell your dentist you are receiving this medicine.
• Low calcium and vitamin D should be corrected before treatment.
• Tell your doctor about asthma triggered by aspirin and any heart rhythm problems.

Overdose

Overdose is unlikely because it is given in hospital. Too much can cause low calcium, phosphate and magnesium and kidney problems; these are treated by the medical team.

Therapeutic Class

Bisphosphonate (bone resorption inhibitor).

Storage

Unopened vials and bags: store below 30°C, away from light. Once prepared, the solution is handled by hospital staff according to the product instructions (usually used straight away or kept at 2 to 8°C for a short time). Keep out of reach of children.