Zoledronic Acid Injection (patient information)

Why is this medication prescribed

Zoledronic acid is used to treat high levels of calcium in the blood that may be caused by certain types of cancer. Zoledronic acid is also used along with cancer chemotherapy to treat bone damage caused by multiple myeloma [cancer that begins in the plasma cells (white blood cells that produce substances needed to fight infection)] or by cancer that began in another part of the body but has spread to the bones. Zoledronic acid is not cancer chemotherapy, and it will not slow or stop the spread of cancer. However, it can be used to treat bone disease in patients who have cancer. Zoledronic acid is in a class of medications called bisphosphonates. It works by slowing bone breakdown and decreasing the amount of calcium released from the bones into the blood.

How should this medicine be used

Zoledronic acid comes as a solution (liquid) to infuse (inject slowly) intravenously (into a vein) over at least 15 minutes. It is usually injected by a health care provider in a doctor's office, hospital, or clinic. When zoledronic acid is used to treat high blood levels of calcium caused by cancer it is usually given as a single dose. A second dose may be given at least 7 days after the first dose if blood calcium does not drop to normal levels or remain at normal levels. When zoledronic acid is used to treat bone damage caused by multiple myeloma or cancer that has spread to the bones, it is usually given once every 3-4 weeks.

Your doctor will prescribe a calcium supplement and a multivitamin containing vitamin D to take during your treatment. You should take these supplements every day.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow

Before taking zoledronic acid

tell your doctor and pharmacist if you are allergic to zoledronic acid;other bisphosphonates such as alendronate (Fosamax), etidronate (Didronel), pamidronate (Aredia), risedronate (Actonel), or tiludronate (Skelid); or any other medications.
tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: acetaminophen (Tylenol); amphotericin B (Fungizone); aminoglycoside antibiotics such as amikacin (Amikin), gentamycin (Garamycin), kanamaycin (Kantrex), neomycin (Neo-Rx, Neo-Fradin), netilmycin (Netromycin), paramomycin (Humatin), streptomycin, and tobramycin (Tobi, Nebcin); aspirin and other nonsteroidal anti-inflammatory medications such as ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn); aurothioglucose (Solganal), auranofin (Ridaura); bacitracin; cancer chemotherapy drugs such as carmustine (BCNU), cisplatin (Platinol AQ), cyclophosphamide (Cytoxan, Neosar); daunorubicin (DaunoXome, Cerubidine), doxorubicin (Adriamycin, Rubex), ifosfamide (Ifex), lomustine (CeeNU), and streptozocin (Zanosar); captopril (Capoten); cyclosporine (Neoral, Sandimmune); dapsone (Avlosulfon); foscarnet (Foscavir); gold sodium thiomalate (Myochrysine); loop diuretics ('water pills') such as bumetanide (Bumex), ethacrynic acid (Edecrin), and furosemide (Lasix); methicillin (Staphcillin); nitrates; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); penicillamine (Cuprimine, Depen); pentamidine (NebuPent); primaquine; rifampin (Rifadin, Rimactane); salicylate pain relievers; sulfonamides such as sulfamethoxazole and trimethoprim (Bactrim); thalidomide (Thalomid); and tacrolimus (Prograf). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor if you are being treated wtih radiation therapy and if you have or have ever had heart failure (condition in which the heart cannot pump enough blood to other parts of the body); anemia (condition in which red blood cells cannot bring enought oxygen to the other parts of the body); any condition that stops your blood from clotting normally; problems with your mouth, teeth, or gums; an infection, especially in your mouth; asthma, especially if it is made worse by aspirin; or kidney or liver disease.
tell your doctor if you are pregnant. You should use a reliable method of birth control to prevent pregnancy while you are taking zoledronic acid. If you become pregnant while taking zoledronic acid, call your doctor. Talk to your doctor if you plan to become pregnant at any time in the future because zoledronic acid may remain in your body for years after you stop taking it. Do not breastfeed while you are taking zoledronic acid.
you should know that zoledronic acid may cause serious problems with your jaws, especially if you have dental surgery or treatment while you are taking the medication. A dentist should examine your teeth and perform any needed treatments before you start to take zoledronic acid. Be sure to brush your teeth and clean your mouth properly while you are taking zoledronic acid. Talk to your doctor before having any dental treatments while you are taking this medication.

What special dietary instructions should I follow

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose

If you miss an appointment to receive a zoledronic acid infusion, call your doctor as soon as possible.

Side Effects

Mild side effects

Zoledronic acid may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

redness or swelling in the place where you received your injection
red, swollen, or teary eyes
constipation
upset stomach
vomiting
diarrhea
stomach pain
loss of appetite
weight loss
heartburn
difficulty swallowing
mouth sores
pain anywhere in the body
excessive worry
agitation
difficulty falling asleep or staying asleep
white patches in the mouth
swelling, redness, irritation, burning, or itching of the vagina
white vaginal discharge
hair loss

Severe side effects

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

fever, chills, and other signs of infection
bone, joint, or muscle pain, and other flu-like symptoms
rash
itching
chest pain
coughing
weakness
muscle cramps
fast, pounding, or irregular heartbeat
dizziness
depression
difficulty walking
seizures
confusion
leg swelling
shortness of breath
sudden tightening of muscles
numbness, burning, or tingling in fingers or toes
dry mouth
decreased urination
sunken eyes
sluggishness
headache
pale skin
unusual bruising or bleeding
frequent urination, especially at night
excessive thirst
hallucinations (seeing things or hearing voices that do not exist)
muscle weakness
double vision
difficulty speaking
jaw or mouth pain

Zoledronic acid may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine

Your doctor will store this medication in his or her office and give it to you as needed.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

fever
tingling in hands or feet
weakness
muscle cramps
fast, pounding, or irregular heartbeat
dizziness
depression
difficulty walking
seizures
confusion
shortness of breath
sudden tightening of muscles
numbness, burning, or tingling in fingers or toes
muscle weakness
double vision
difficulty speaking

What other information should I know

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to zoledronic acid.

Brand names

Zometa®

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