Zoledronic Acid (zoledronate)

What is Zoledronic Acid

Zoledronic acid (also known as zoledronate) is an intravenous (IV), heterocyclic, nitrogen-containing bisphosphonate; it is considered a third-generation bisphosphonate. Zoledronic acid is a potent inhibitor of bone resorption, making it useful in a variety of skeletal-related conditions, including hypercalcemia of malignancy, multiple myeloma, bone metastases due to solid tumors, Paget’s disease, and the treatment and prevention of osteoporosis.

Brand Names

  • Reclast
  • Zometa

Indications

  • bone metastases
  • breast cancer
  • hypercalcemia
  • multiple myeloma
  • osteoporosis
  • osteoporosis prophylaxis
  • Paget’s disease

For the treatment of hypercalcemia of malignancy (i.e., albumin-corrected serum calcium 12 mg/dL or higher)

Side Effects

  1. abdominal pain
  2. agitation
  3. alopecia
  4. anaphylactoid reactions
  5. anemia
  6. angioedema
  7. anorexia
  8. anxiety
  9. arrhythmia exacerbation
  10. arthralgia
  11. asthenia
  12. atrial fibrillation
  13. azotemia
  14. back pain
  15. blurred vision
  16. bone fractures
  17. bone pain
  18. bradycardia
  19. bronchospasm
  20. chest pain (unspecified)
  21. chills
  22. confusion
  23. conjunctivitis
  24. constipation
  25. cough
  26. dehydration
  27. depression
  28. diarrhea
  29. dizziness
  30. dysgeusia
  31. dyspepsia
  32. dysphagia
  33. dyspnea
  34. erythema
  35. Fanconi syndrome
  36. fatigue
  37. fever
  38. flank pain
  39. flushing
  40. headache
  41. hematuria
  42. hyperesthesia
  43. hyperhidrosis
  44. hyperkalemia
  45. hypermagnesemia
  46. hypernatremia
  47. hypertension
  48. hyperthermia
  49. hypocalcemia
  50. hypoesthesia
  51. hypokalemia
  52. hypomagnesemia
  53. hypophosphatemia
  54. hypotension
  55. infection
  56. infertility
  57. influenza
  58. injection site reaction
  59. insomnia
  60. iritis
  61. lethargy
  62. malaise
  63. muscle cramps
  64. musculoskeletal pain
  65. myalgia
  66. nausea
  67. neutropenia
  68. ocular inflammation
  69. ocular pain
  70. osteonecrosis
  71. palpitations
  72. pancytopenia
  73. paresthesias
  74. peripheral edema
  75. pharyngitis
  76. proteinuria
  77. pruritus
  78. rash
  79. renal failure (unspecified)
  80. renal tubular necrosis
  81. seizures
  82. Stevens-Johnson syndrome
  83. stomatitis
  84. teratogenesis
  85. tetany
  86. thrombocytopenia
  87. toxic epidermal necrolysis
  88. tremor
  89. urticaria
  90. uveitis
  91. vertigo
  92. vomiting
  93. weight gain
  94. weight loss
  95. xerostomia

Monitoring Parameters

  • CBC with differential
  • serum 25(OH)hydroxyvitamin D concentrations
  • serum alkaline phosphatase
  • serum calcium
  • serum creatinine/BUN
  • serum electrolytes
  • serum magnesium
  • serum phosphate

Contraindications

  • anemia
  • asthma
  • breast-feeding
  • cardiac arrhythmias
  • chemotherapy
  • children
  • coagulopathy
  • contraception requirements
  • corticosteroid therapy
  • dehydration
  • dental disease
  • dental work
  • diabetes mellitus
  • diarrhea
  • electrolyte imbalance
  • ensure correct formulation selection
  • fever
  • geriatric
  • history of angioedema
  • hypertension
  • hypocalcemia
  • hypomagnesemia
  • hypophosphatemia
  • hypovolemia
  • infants
  • infection
  • infertility
  • multiple myeloma
  • phosphonate hypersensitivity
  • pregnancy
  • pregnancy testing
  • renal disease
  • renal failure
  • renal impairment
  • reproductive risk
  • seizures
  • vomiting

Interactions

  • Acetaminophen; Aspirin, ASA; Caffeine
  • Aluminum Hydroxide
  • Aluminum Hydroxide; Magnesium Carbonate
  • Aluminum Hydroxide; Magnesium Hydroxide
  • Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
  • Aluminum Hydroxide; Magnesium Trisilicate
  • Amikacin
  • Aminoglycosides
  • Amlodipine; Celecoxib
  • Aprotinin
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Bumetanide
  • Calcium
  • Calcium Acetate
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Calcium Chloride
  • Calcium Gluconate
  • Calcium; Vitamin D
  • Capreomycin
  • Celecoxib
  • Chromium
  • Cidofovir
  • Colistimethate, Colistin, Polymyxin E
  • Cyclosporine
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Entecavir
  • Esomeprazole; Naproxen
  • Ethacrynic Acid
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Flurbiprofen
  • Furosemide
  • Gallium Ga 68 Dotatate
  • Gentamicin
  • Hetastarch; Dextrose; Electrolytes
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydrocodone; Ibuprofen
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Immune Globulin IV, IVIG, IGIV
  • Indomethacin
  • Inotersen
  • Iohexol
  • Iopamidol
  • Iopromide
  • Ioversol
  • Iron
  • Iron Salts
  • Isosulfan Blue
  • Kanamycin
  • Ketoprofen
  • Ketorolac
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lansoprazole; Naproxen
  • Lanthanum Carbonate
  • Loop diuretics
  • Mannitol
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Non-Ionic Contrast Media
  • Nonsteroidal antiinflammatory drugs
  • Omeprazole; Sodium Bicarbonate
  • Oxaprozin
  • Paromomycin
  • Piroxicam
  • Plazomicin
  • Polymyxin B
  • Polymyxins
  • Polysaccharide-Iron Complex
  • Rofecoxib
  • Sodium Bicarbonate
  • Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
  • Streptomycin
  • Sulindac
  • Tacrolimus
  • Telavancin
  • Telbivudine
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Thalidomide
  • Tobramycin
  • Tolmetin
  • Torsemide
  • Valdecoxib
  • Vancomycin
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