BMA Concise Guide to Medicine & Drugs

Zoledronic Acid

Brand names Aclasta, Zometa

Used in the following combined preparations None

QUICK REFERENCE

Drug group Drug for bone disorders and anticancer drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Zoledronic acid is a bisphosphonate, a group of drugs used in the treatment of bone disorders. These drugs work directly on the bones, reducing the rate at which calcium is released from them and thereby making them less liable to fracture. The reduction of calcium release can cause blood calcium levels to fall, which is useful if the level is high (e.g. due to cancer). Zoledronic acid can only be given by infusion into a vein, and has a very long duration of action so that it can be used very infrequently. It is used to treat various bone disorders, including Paget’s disease of the bone and osteoporosis in men and postmenopausal women, particularly those who have had a recent osteoporotic fracture or who are on long-term corticosteroids. Zoledronic acid is also used to prevent bone damage in patients with advanced cancer that has spread to bone.

INFORMATION FOR USERS

The drug is given only under medical supervision and is not for self-administration.

How taken/used Intravenous infusion.

Frequency and timing of doses Advanced cancer involving bone Every 3–4 weeks. Paget’s disease and high blood calcium associated with cancer One-off dose, can be repeated if required. Osteoporosis Once yearly.

Adult dosage range 4–5mg.

Onset of effect Up to 3 months.

Duration of action Up to a year.

Diet advice None. Calcium and/or vitamin D supplements may be prescribed before or after treatment with zoledronic acid.

Storage Not applicable. The drug is not kept in the home.

Missed dose The drug is administered in hospital under medical supervision. If you miss your dose, contact your doctor as soon as possible.

Stopping the drug Discuss with your doctor. Stopping the drug may lead to worsening of the underlying condition.

Exceeding the dose Overdosage is unlikely because the drug is given under close medical supervision. If you think you have received an overdose, tell your doctor as soon as possible.

POSSIBLE ADVERSE EFFECTS

The first dose of zoledronic acid may cause flu-like symptoms, including bone pain, fever, and fatigue; some people also experience gastrointestinal problems, such as nausea and vomiting. These symptoms tend to be milder if further doses are given but you should discuss with your doctor if they are severe or if you also experience palpitations or severe headaches or dizziness. If you develop a rash, itching, facial swelling, tingling, muscle spasms, or pain in the jaw, you should notify your doctor immediately.

INTERACTIONS

None known.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have had a recent hip fracture.

· You have kidney problems.

· You are or may be pregnant or are planning a pregnancy.

· You have had a previous allergic reaction to any bisphosphonate drug.

· You are taking other medicines.

Pregnancy Not recommended. Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding Not recommended. Safety in breast-feeding not established. Discuss with your doctor.

Infants and children Not recommended.

Over 60 No special problems.

Driving and hazardous work No special problems.

Alcohol No special problems.

PROLONGED USE

There have been rare reports of ulceration of the jaw bones in patients given bisphosphonates, including zoledronic acid.

Monitoring Blood tests will be carried out to monitor your calcium levels. Your overall health will also be monitored.