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Overview: Zoledronic acid is used for osteoporosis, Paget’s disease, and to manage high calcium levels or bone problems due to cancer. It is in a class of medicines known as bisphosphonates, and is available in an injectable form given by a healthcare provider. Common side effects include flu-like symptoms (such as fever or chills), headache, and bone, muscle, or joint pain. Although rare, serious side effects may include severe jawbone problems and unusual thigh bone fractures.

Uses

What is zoledronic acid used for?

Zoledronic acid is commonly used for the following conditions.

  • Treatment and prevention of osteoporosis after menopause. Osteoporosis is a condition where your bones become thin and weak and may break more easily.
  • Treatment and prevention of osteoporosis caused by a medicine known as a corticosteroid
  • Treatment of osteoporosis in men
  • Treatment of Paget's disease, which is a condition where your body’s natural bone-building process is disrupted, causing your bones to become weak and misshapen. 
  • High calcium levels (hypercalcemia) from certain types of cancer
  • Treatment of bone problems from multiple myeloma, which is a type of blood cancer, or from cancer that has spread to the bone (bone metastases)

Zoledronic acid may also be used for other conditions as determined by your healthcare provider.

How does zoledronic acid work (mechanism of action)?

Zoledronic acid slows the natural breakdown of your bones and reduces the amount of calcium released into your blood. This helps bones stay stronger, reducing the risk of broken bones, and lowers calcium levels. 

How is zoledronic acid supplied (dosage forms)?

Brands and other names

  • Reclast 
  • Zometa

Dosage forms and strengths

Zoledronic acid is available in an injectable form that is given by a healthcare provider.

How should I store zoledronic acid?

Zoledronic acid is usually given by a healthcare provider in a hospital or clinic. You will not store it at home.

Side Effects

What are the most common side effects of zoledronic acid?

The most common side effects of zoledronic acid are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Fever, chills, or feeling like you have the flu
  • Headache
  • Bone, muscle, or joint pain (see below)
  • Arm or leg pain
  • Infection in the nose or throat, sore throat, or common cold symptoms
  • Nausea or vomiting
  • Constipation or diarrhea
  • Tiredness
  • Low red blood cell levels (anemia)
  • Trouble breathing

There may be other side effects of zoledronic acid that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of zoledronic acid?

While less common, the most serious side effects of zoledronic acid are described below, along with what to do if they happen.

Severe Allergic Reactions. Zoledronic acid may cause allergic reactions, which can be serious. Get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Low Calcium Level (Hypocalcemia). Zoledronic acid may cause low calcium levels, which can be serious. Low calcium levels can cause a rare but dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium, or who take some medicines for other heart rhythm problems. Tell your healthcare provider if you have any of the following symptoms. 

  • Changes in your heart rate or rhythm, such as a fast or skipping heartbeat
  • Fainting
  • Numbness, tingling, or burning sensation in your arms, feet, or face (paresthesia)
  • Muscle pain or spasms
  • Seizures

Severe Jawbone Problems (Osteonecrosis). Zoledronic acid can rarely cause severe jawbone problems, also called osteonecrosis of the jaw. In this condition, your jawbone may get damaged due to reduced blood flow. You may be at higher risk if you are undergoing certain dental procedures (such as a tooth extraction or dental implants), have poor oral health, or have cancer or certain other conditions. You may be told to see a dentist before starting zoledronic acid and to practice good mouth care. Call your healthcare provider right away if you have any of the following symptoms of jaw osteonecrosis.

  • Jaw pain or discomfort
  • Mouth sores
  • Loose teeth

Unusual Thigh Bone Fractures. Zoledronic acid may cause an increased risk for fractures in your thigh bone, even with a light force. Call your healthcare provider if you have new or unusual pain in your thigh, hip, or groin.

Bone, Muscle, or Joint Pain. Zoledronic acid may cause severe pain in the bones, joints, or muscles (musculoskeletal pain). The pain can be severe enough that it could be hard to do your normal activities. Call your healthcare provider right away if you have severe pain while you are using zoledronic acid.

Kidney Damage. Kidney damage can happen when using zoledronic acid. This can sometimes lead to a hospital stay or the need for dialysis. You may be at higher risk for this if you have kidney problems, are dehydrated, are 65 or older, or if you take certain medicines. Drink plenty of water before each dose of zoledronic acid to stay hydrated. Your healthcare provider may also give you intravenous (IV) fluids. Tell your healthcare provider right away if you have any of the following symptoms of kidney damage.

  • Reduced need to pee
  • Swelling in your feet, ankles, or legs
  • Weakness or unusual tiredness
  • Difficulty catching your breath or chest pain/pressure
  • Confusion
  • Nausea
  • Seizures

Warnings & Precautions

Who should not use zoledronic acid?

Allergies to Ingredients. People who are allergic to any of the following should not use zoledronic acid.

  • Zoledronic acid
  • Zometa
  • Reclast
  • Any of the ingredients in the specific product dispensed

Your healthcare provider can tell you all of the ingredients in the specific zoledronic acid products they stock.

Kidney Problems. Zoledronic acid should not be used if your kidneys are not working as well as they should be or if you are on dialysis. If there is a concern about the health of your kidneys, your healthcare provider may do tests to determine if they are working well enough to use this medicine.

Low Calcium Level (Hypocalcemia). Zoledronic acid can cause low calcium levels. It should not be used if you have low calcium levels.

What should I know about zoledronic acid before using it?

Zoledronic acid is usually given by a healthcare provider in a hospital or clinic. 

It is important to be well hydrated before receiving zoledronic acid. Drink plenty of water. Your healthcare provider may order bloodwork to be sure you are not dehydrated before giving you a dose of zoledronic acid.

Your healthcare provider may tell you to take calcium and vitamin D supplements while using zoledronic acid.

Your healthcare provider may recommend that you have a dental exam before starting and while using zoledronic acid.

Talk with your healthcare provider about how long you should use zoledronic acid.

If you can become pregnant, your healthcare provider may check to be sure you are not pregnant prior to giving you zoledronic acid. 

Zoledronic acid may make it hard to get pregnant. Talk to your healthcare provider if you have any concerns about this.

What should I tell my healthcare provider before using zoledronic acid?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if zoledronic acid is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following. 

  • Parathyroid or thyroid surgery
  • Asthma or wheezing after taking aspirin
  • Malabsorption syndrome, which is a problem absorbing nutrients
  • Surgery involving your intestines

Other Medicines and Supplements. Zoledronic acid may interact with other medicines and supplements. Before using zoledronic acid, tell your healthcare provider about any prescription or OTC medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Planned Dental Surgery. Tell your healthcare provider if you are planning to undergo any dental treatments, such as tooth extraction or dental implant surgery, while using zoledronic acid. Certain dental procedures may increase the risk of osteonecrosis of the jaw.

Pregnancy. Zoledronic acid may cause harm to an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. If you become pregnant, contact your healthcare provider right away. 

Breastfeeding. It is not known if zoledronic acid passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should stop breastfeeding or stop zoledronic acid.

Interactions

Does zoledronic acid interact with foods or drinks?

There are no known interactions between zoledronic acid and foods or drinks.

It is unknown if drinking alcohol will affect zoledronic acid, but drinking alcohol can increase your risk for dehydration. It is important to be well hydrated before each dose of zoledronic acid.

Does zoledronic acid interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using zoledronic acid.

  • Any other bisphosphonate, such as alendronate (Binosto, Fosamax), risedronate (Actonel, Atelvia), ibandronate, or another zoledronic acid product, which is a medicine commonly used for osteoporosis
  • Any aminoglycoside antibiotic, such as amikacin or gentamicin, which is given by injection to treat infections
  • Calcitonin, which is a medicine used for osteoporosis
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
  • A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, and others, which is in many prescription and OTC products for pain, swelling, and fever

This may not be a complete list of medicines that can interact with zoledronic acid. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much zoledronic acid?

Zoledronic acid is usually given by a healthcare provider. If you have any side effects, report them to your healthcare provider. If you or someone else has used too much zoledronic acid, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of zoledronic acid?

Zoledronic acid is usually given by a healthcare provider in a hospital or clinic. If you miss an appointment to get your zoledronic acid dose, call your healthcare provider to make another appointment as soon as possible.