Zoledronic Acid

Zoledronic acid injection is indicated for treatment and prevention of postmenopausal osteoporosis, treatment to increase bone mass in men with osteoporosis, treatment and prevention of glucocorticoid-induced osteoporosis, and treatment of Paget's disease of bone in men and women. Optimal duration of use has not been determined. For patients at low-risk for fracture, consider drug discontinuation after 3 to 5 years of use.

Most common adverse reactions (greater than 10%): pyrexia, myalgia, headache, arthralgia, pain in extremity. Other important reactions: flu-like illness, nausea, vomiting, diarrhea, eye inflammation. Acute phase reaction symptoms typically occur within first 3 days and usually resolve within 3 days but may take 7-14 days. Renal impairment including acute renal failure has been reported. Hypocalcemia, osteonecrosis of jaw, atypical fractures, and severe musculoskeletal pain reported.

Discontinue zoledronic acid injection when pregnancy is recognized. Animal studies showed increases in fetal skeletal, visceral, and external malformations starting at 2 times the recommended dose. Bisphosphonates incorporated into bone matrix over years; potential risk of fetal harm if woman becomes pregnant after completing bisphosphonate therapy. Female fertility may be impaired based on animal studies.

Patients receiving Zometa should not receive zoledronic acid injection. Hypocalcemia may worsen during treatment; adequate calcium and vitamin D supplementation required. Renal impairment: single dose should not exceed 5 mg; infusion duration no less than 15 minutes. Monitor creatinine clearance before each dose. Osteonecrosis of the jaw has been reported; routine oral examination required prior to treatment. Atypical fractures including femoral fractures reported. Severe bone, joint, and muscle pain may occur. Contraindicated in patients with hypocalcemia, creatinine clearance less than 35 mL/min, or known hypersensitivity.