Zoledronic Acid Injection

Uses Of Zoledronic Acid

Zoledronic acid is a bisphosphonate that slows bone breakdown, increases bone density, and decreases the amount of calcium bones release into the blood. It is used to treat a number of conditions involving osteoporosis, bone disease, and cancer-related bone damage. Zoledronic acid (Reclast) can prevent or treat osteoporosis in post-menopausal women and in men, as well as in men and women taking glucocorticoids (a corticosteroid medication known to trigger osteoporosis). Is also used to treat Paget’s disease of bone, which causes soft, weak bones that may be deformed or painful and are easily broken. Zoledronic acid (Zometa), on the other hand, can help correct high blood calcium due to cancer. Used alongside cancer chemotherapy, it may treat bone damage caused by multiple myeloma (a cancer that begins in white blood cells) or by other cancers that have spread to the bones. Please note that Zoledronic acid (Zometa) is not chemotherapy, and thus does not slow or stop the spread of cancer.

Side Effects Of Zoledronic Acid

Consult your doctor if the following symptoms are severe or persist:

  • agitation, anxiety, or depression
  • constipation
  • decreased appetite
  • diarrhea
  • difficulty falling or staying asleep
  • fever, chills, cough, or other signs of infection
  • hair loss
  • heartburn
  • mouth sores
  • nausea, stomach pains, and/or vomiting
  • numbness/tingling around the mouth
  • numbness/tingling in fingers or toes
  • red, swollen, itchy, or teary eyes
  • swelling, pain, or itching around the injection site
  • swelling, redness, irritation, or itching of the vagina
  • swollen eyes
  • weight loss
  • white patches in the mouth
  • white vaginal discharge

Some side effects can be serious. Immediately contact your physician if you experience the following:

  • difficulty breathing or swallowing
  • irregular heartbeat
  • itching; rash/hives
  • loosening of the teeth
  • loss of voice
  • muscle spasms or cramps
  • numbness or heavy feeling in the jaw
  • painful or swollen gums
  • sores in the mouth or the jaw that do not heal
  • swollen face, eyes, lips, throat, or tongue
  • swollen hands, arms, feet, ankles, or lower legs
  • unusual bruising or bleeding
  • upper chest pain
  • Osteoporosis treatment with a bisphosphonate medication such as zoledronic acid injection may increase your risk of thigh bone(s) breakage. You may experience a dull, aching pain in your hips, groin, or thighs for several weeks or months before the bone(s) break, which may occur with falling or other trauma to the bones. Talk to your doctor about the risks of receiving zoledronic acid injections.

Warnings & Precautions

Before receiving zoledronic acid injection:

  • tell your doctor and pharmacist if you are allergic to any medication (including zoledronic acid) or to any of the ingredients in zoledronic acid injections. (Your pharmacist can provide a Medication Guide containing a list of the ingredients.)
  • zoledronic acid injections are prescribed under the brand names Zometa and Reclast. You should use only one at a time.
  • tell your doctor and pharmacist if you are taking any medication (prescription and over-the-counter) and/or supplements, as many medications interact with zoledronic acid. It is important to mention the following: aminoglycoside antibiotics [e.g., amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), neomycin (Neo-Rx, Neo-Fradin), paromomycin (Humatin), streptomycin, tobramycin (Tobi, Nebcin)]; nonsteroidal anti-inflammatory drugs (NSAIDs) [e.g., aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn)]; cancer chemotherapy medications; digoxin (Lanoxin, in Digitek); diuretics (‘water pills’) [e.g., bumetanide (Bumex), ethacrynic acid (Edecrin), furosemide (Lasix)]; and oral steroids [e.g., dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone)].
  • tell your doctor if you have or have had kidney disease, which may cause your doctor not to prescribe zoledronic acid injections; if you have any signs of dehydration (e.g., dry mouth, dark urine, decreased sweating, dry skin); recently have had diarrhea, vomiting, fever, infection, or excessive sweating; or if you have been unable to drink enough fluids. Your doctor will wait until you are no longer dehydrated to give you an injection. In addition, your doctor will likely check your blood calcium levels to ensure they are high enough to begin treatment.
  • tell your doctor if you have been treated with zoledronic acid or other bisphosphonates (e.g., Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, Zometa) before; if you have had surgery on your parathyroid gland or thyroid gland; or if you have had surgery to remove sections of your small intestine.
  • tell your doctor if you have or have had heart failure; anemia; a condition that prevents normal blood clotting; low blood calcium, magnesium, or potassium; a condition that prevents your body from properly absorbing nutrients from food; problems with your mouth, teeth, or gums; any infection, especially in the mouth; asthma or wheezing (especially if the condition worsens when taking aspirin; or parathyroid or liver disease.
  • tell your doctor if you plan to become pregnant, are pregnant, or are breast-feeding. Be sure to use a reliable method of birth control to prevent pregnancy while receiving injections. If you do become pregnant, call your doctor immediately as zoledronic acid may harm the fetus. Zoledronic acid may remain in the body long after treatment ceases, so talk to your doctor if you plan to become pregnant at any time in the future.
  • you should know that zoledronic acid injection may cause severe bone, muscle, or joint pain days to months after your first injection. Call your doctor immediately if you experience severe pain at any time during treatment. Your doctor may stop your zoledronic acid injections, which may in turn stop the pain.
  • you should know that zoledronic acid may cause osteonecrosis of the jaw (ONJ, a serious condition affecting the jaw bone), especially if you receive dental treatment or surgery while taking this medication. Have your dentist perform any needed treatments, including cleaning, before you begin injections and brush your teeth regularly once zoledronic acid treatment starts.

Dosage Of Zoledronic Acid

Zoledronic acid is a solution that is injected into a vein for at least 15 minutes. Injections usually take place at a doctor’s office, hospital, or clinic. When zoledronic acid injection is used to treat high blood calcium levels due to cancer it is usually given as a single dose. A second dose may be required a week or more after the first dose if blood calcium does not fall to or remain at normal levels. If used to treat bone damage caused by multiple myeloma or cancer that has spread to the bones it is usually given once every 3 to 4 weeks. If zoledronic acid injection is used to treat or prevent osteoporosis, on the other hand, it is usually given only once a year (or once every 2 years for post-menopausal women). Treatment of Paget’s disease of bone is also usually given as a single dose, though additional doses may be necessary in the future.

Drink at least 2 glasses of water a few hours before you receive a zoledronic acid injection.

Your doctor may recommend you take a calcium supplement and a multivitamin containing vitamin D during your treatment.

During the first few days after a zoledronic acid injection, you may experience a reaction that involves flu-like symptoms, fever, headache, chills, and bone, joint, or muscle pain. These symptoms may last up to 14 days. Your doctor recommend you to take an over-the-counter pain reliever/fever reducer after you receive an injection to help prevent these symptoms.

You should continue receiving zoledronic acid injections to prevent or treat osteoporosis as prescribed even if you are feeling well. Do not stop treatment without your doctor’s consent.


Keep all appointments with your doctor and laboratory services provider, as certain tests will be prescribed to check your body’s response to zoledronic acid.