Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041

Uses For This Medication

  • Zoledronic acid is used to treat hypercalcemia (high blood levels of calcium) that may occur in patients with certain types of cancer.
  • Zoledronic acid is also used to treat patients whose cancer has spread to their bones, as well as patients with multiple myeloma, a cancer that starts in the bone marrow. Zoledronic acid is not a chemotherapy medication and is usually used along with other cancer treatments, such as radiation therapy, chemotherapy, or hormone therapy.
  • This medication may also be given for other conditions as determined by your doctor.

How This Medication Works

Zoledronic acid is used to treat hypercalcemia, which occurs when cancer cells break down bone and release calcium into the bloodstream. The spread of cancer cells from the primary tumor (the place the cancer starts) to the bones (bone metastasis) is a common complication of many cancers, especially prostate cancer, breast cancer, and lung cancer. Zoledronic acid belongs to a class of medications called bisphosphonates, which target cancer cells that have invaded the bone and prevent them from breaking down and weakening the bone. In addition, zoledronic acid prevents abnormal bone formation which occurs when cancer cells invade the bone. These new areas of abnormal bone are weak, can break easily, and can cause pain for many patients. Because zoledronic acid stops cancer cells from breaking down bone, less calcium from the bones goes into the blood stream and blood levels of calcium are prevented from getting too high (hypercalcemia).  

Benefits Of This Medication

Zoledronic acid reduces bone pain, slows down bone damage caused by cancer, lowers the risk of bone fractures, and reduces hypercalcemia.   Who Should Not Take This Medication You should not take this medication if you:
  • Are allergic to zoledronic acid or any of its components 
  • Are allergic to any other bisphosphonates such as pamidronate (Aredia®), alendronate (Fosamax®) or risedronate (Actonel®) 

Precautions To Be Aware Of Before Taking This Medication

Organ related precautions

Rarely, this medication can cause changes in the ability of your kidneys to work normally, especially if higher doses of zoledronic acid are used or if it is administered too quickly. In addition, this medication is cleared from the body by the kidneys. In patients with severe kidney problems, zoledronic acid may not be cleared from the body as well. This can lead to high levels of this medication in the body and a greater chance of side effects. Your doctor or healthcare provider will check your kidneys regularly, usually through blood tests, while you are on this medication to make sure that your kidneys are working properly. If you have any kidney problems before starting this medication, make sure that you tell your doctor or healthcare provider so that he or she can watch you carefully for possible problems or side effects.

Miscellaneous precautions

  • Osteonecrosis of the jaw has been reported in patients on this medication. Osteonecrosis of the jaw occurs when blood flow to the jaw is reduced and the jaw bone dies. This condition can cause severe jaw pain. Many of the patients who developed this problem were receiving chemotherapy and corticosteroids (such as dexamethasone) in addition to zoledronic acid. In addition, many of these patients had undergone invasive or surgical dental work (such as a pulled tooth). If you have dental problems now or have had them in the past, you should discuss this with your doctor or healthcare provider so that he or she can determine whether you should have a dental exam before starting zoledronic acid. While receiving this therapy patients should avoid invasive dental procedures if possible. If you need to have any dental work done while on this medication, you should talk with your doctor or healthcare provider first.
  • Some bisphosphonates have caused bronchospasm (symptoms include cough, wheezing, chest tightness) in patients with asthma who are sensitive to aspirin. This condition has not been reported in patients taking zoledronic acid. However, if you have asthma and have problems when you take aspirin, you should let your doctor or healthcare provider know before receiving zoledronic acid.

Patient specific precautions

  • It is not known if this medication is safe and effective in children. Due to the long-term changes in bone structure this drug should only be used in children if the potential benefit outweighs the potential risk.

Pregnancy and breastfeeding precautions

  • This medication may cause fetal harm. When taking this medication, you should use effective birth control to prevent pregnancy. Tell your doctor or healthcare provider right away if you or your spouse/partner becomes pregnant.
  • It is not known whether this medication is found or excreted in breast milk. Since many medications are excreted in breast milk and because this medication can cause serious harmful reactions in infants, breastfeeding should be avoided.

Medication And Food Interactions

Before using this medication, tell your doctor or healthcare provider of all prescription or over-the- counter products you are taking, including dietary supplements or vitamins, herbal medicines and homeopathic remedies. Do not start or stop any medication without your doctor or healthcare provider’s approval. Possible interactions can occur with zoledronic acid and the following medications:
  • Diuretics (a.k.a. water pills) such as furosemide (Lasix®)
  • Aminoglycoside antibiotics such as gentamicin or tobramycin
  • Medications that can cause kidney problems
  • Thalidomide (Thalomid®)

Side Effects

  • All medications can cause side effects. However, not all patients will experience these side effects. In addition, other side effects not listed can also occur in some patients. You should call your doctor or healthcare provider if you have any questions or concerns while you are on this medication.
  • You should contact your doctor or healthcare provider if you experience any side effect(s) which persist, worsen, are serious in nature, or are worrisome to you.
  • Side effects can occur when zoledronic acid is given alone or together with other chemotherapy medications. The side effects listed below are those reported in patients who were treated with zoledronic acid alone.

More common side effects

  • Pain in the bone [may be relieved by acetaminophen (Tylenol) or ibuprofen (Advil)]
  • Nausea, vomiting, constipation, diarrhea
  • Fever
  • Tiredness (fatigue)
  • Decreased red blood cell count
  • Flu-like symptoms, chills, arthralgias, myalgias

Less common side effects

  • Stomach pain, indigestion, loss of appetite, weight loss
  • Muscle pain, joint pain, back pain
  • Chills, flu-like symptoms
  • Low potassium and/or low calcium levels in the blood
  • Headache, dizziness, difficulty sleeping
  • Shortness of breath, cough
  • Hypertension (high blood pressure)
  • Slow heart rate
  • Hypotension (low blood pressure)

Rare side effects

This is not a complete list of the rare side effects reported with zoledronic acid. For a complete list, please talk with your doctor or healthcare provider about reviewing a copy of the package insert. 
  • Kidney problems (see Precautions To Be Aware Of Before Taking This Medication)
  • Osteonecrosis of the jaw (see Precautions To Be Aware Of Before Taking This Medication)
  • Weight gain
  • Elevated potassium and sodium levels
  How To Take This Medication
  • This medication is typically given by injection into a vein (IV) over 15 minutes or more by a healthcare professional.
  • Before receiving zoledronic acid, you may be given IV fluids and medications to hydrate you and help your kidneys to flush the zoledronic acid through your body quickly.
  • Unless your doctor tells you otherwise, you should drink 2-3 quarts of fluid a day to help protect your kidneys from this medicine.
  • While you are receiving zoledronic acid, it is important you follow your doctor or healthcare provider’s instructions for taking vitamin D and calcium supplements. Usually, patients are instructed to take 500mg of calcium and a multivitamin containing 400IU of Vitamin D daily.
  • In the unlikely event of an overdose of this medication contact your doctor, your local poison control center at 1-800-222-1222, or emergency services immediately.
  Proper Storage
  • It is unlikely that you will need to store this medication. However, in the event that you do, the unopened containers should be stored at controlled room temperature.
  • Keep this medication out of the reach of children or pets.
  • Ask your doctor or healthcare provider how to dispose of any medication that you no longer use.