• Hypercalcemia of malignancy.
• Multiple myeloma and metastatic bone lesions from solid tumors.
• Paget's disease.
• Treatment of osteoporosis in men.
• Treatment and prevention of osteoporosis in postmenopausal women.
• Treatment and prevention of glucocorticoid-induced osteoporosis in patients expected to be on glucocorticoids for 12 mo.

Contraindicated in:

• Hypersensitivity to zoledronic acid or other bisphosphonates
• Severe renal impairment (CCr <35 mL/min) or acute renal failure
• Hypocalcemia (correct before administering); adequate supplemental calcium and vitamin D required
• OB: Pregnancy.

Use Cautiously in:

• History of aspirin-induced asthma
• Chronic renal impairment
• Chronic renal impairment, concurrent use of diuretics or nephrotoxic drugs, or dehydration (↑ risk of renal impairment; correct deficits prior to use)
• Concurrent use of nephrotoxic drugs
• Invasive dental procedures, cancer, receiving chemotherapy, corticosteroids, or angiogenesis inhibitors, undergoing radiation, poor oral hygiene, periodontal disease, dental disease, anemia, coagulopathy, infection, or poorly fitting dentures (may ↑ risk of osteonecrosis of the jaw [ONJ])
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
• Pedi: Potential for long-term retention in bone in children; use in children only if potential benefit outweighs potential risk
• Geri: ↑risk of renal impairment in older adults.

CV: hypotension, chest pain, leg edema.

Derm: pruritus, rash, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS.

EENT: conjunctivitis.

F and E: hypophosphatemia, hypocalcemia, hypokalemia, hypomagnesemia.

GI: abdominal pain, constipation, diarrhea, nausea, vomiting, dysphagia.

GU: ↓fertility (females), renal impairment/failure.

Hemat: anemia.

MS: musculoskeletal pain, femur fractures, osteonecrosis (primarily ONJ).

Neuro: agitation, anxiety, confusion, insomnia.

Resp: asthma exacerbation.
Misc: fever, flu-like syndrome.

Drug-Drug:

• Concurrent use of loop diuretics, calcitonin, or aminoglycosides↑ risk of hypocalcemia.
• Concurrent use of NSAIDs may ↑ risk of nephrotoxicity.

(Generic available)

• Premixed infusion: 4 mg/100 mL; 5 mg/100 mL;
• Solution for injection: 0.8 mg/mL;

Paget's Disease

• IV (Adults): 5 mg as a single dose (information regarding retreatment unknown).

Treatment of Osteoporosis in Men or Postmenopausal Women or Treatment/Prevention of Glucocorticoid-Induced Osteoporosis

• IV (Adults): 5 mg once yearly.

Prevention of Osteoporosis in Postmenopausal Women

• IV (Adults): 5 mg every 2 yr.

Hypercalcemia of Malignancy

• IV (Adults): 4 mg; may be repeated after 7 days.

Multiple Myeloma or Bone Metastases from Solid Tumors

• IV (Adults): 4 mg every 3–4 wk (has been used for up to 15 mo).

Reclast

• Inhibits bone resorption.
• Inhibits increased osteoclast activity and skeletal calcium release induced by tumors.

• Decreased serum calcium.
• Decreased serum alkaline phosphatase.
• Decreased fractures, radiation/surgery to bone, or spinal cord compression in patients with multiple myeloma or metastatic bone lesions.
• Decreased hip, vertebral, or non-vertebral osteoporosis-related fractures in postmenopausal women.
• Increased bone mass in men, postmenopausal women, and patients on prolonged corticosteroid therapy.

Therapeutic Classification: bone resorption inhibitors, electrolyte modifiers, hypocalcemics

Pharmacologic Classification:

Absorption: IV administration results in complete bioavailability.

Distribution: Concentrated in and binds to bone.

Metabolism/Excretion: Mostly excreted unchanged by the kidneys.

Half-life: 167 hr.

Aclasta, Zometa

(effect on serum calcium)

• Explain the purpose of zoledronic acid to patient. Advise patient to read Medication Guide prior to each administration in case of changes.
• Advise patients of the importance of adequate hydration. Patient should be instructed to drink at least two glasses of water prior to receiving dose.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Advise patient to eat a balanced diet and consult health care professional about the need for supplemental calcium and vitamin D.
• Inform patient that severe musculoskeletal pain may occur within days, mo, or yr after starting zoledronic acid. Symptoms may resolve completely after discontinuation or slow or incomplete resolution may occur. Notify health care professional if severe pain occurs.
• Encourage patient to participate in regular exercise and to modify behaviors that increase the risk of osteoporosis (stop smoking, reduce alcohol consumption).
• Advise patient to notify health care professional if signs and symptoms of ONJ (pain, numbness, swelling of or drainage from the jaw, mouth, or teeth) or hypocalcemia (spasms, twitches, or cramps in muscles; numbness or tingling in fingers, toes, or around mouth) or thigh, hip, or groin pain occur.
• Advise patient to inform health care professional of zoledronic acid therapy prior to dental surgery.
• May cause fetal harm. Advise females of reproductive potential to use effective contraception and avoid breastfeeding during and after therapy. May impair fertility in females.
• Emphasize the importance of lab tests to monitor progress.

zoe-led-DRON-ic AS-id