Zoledronic Acid

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Molecule Description

Zoledronic Acid is used to treat bone loss and decrease the risk of fractures in certain groups of patients. It belongs to a class of medicines called ‘Bisphosphonates.’

Uses

Treatment of thinning of bone or bone loss (osteoporosis) in adult men and postmenopausal women (age-related termination of menstrual periods)
In patients who are at increased risk for fracture or had a recent hip fracture. This includes patients being treated with or without glucocorticoids (a class of medicines that suppress the immune response, e.g. Methylprednisolone, Dexamethasone, etc.)
Treatment of Paget’s disease of the bone in adults (a bone disorder more common in white adults, in which the bone becomes weakened and bent)

Contraindications

When should one not use Zoledronic Acid

Hypersensitivity to Zoledronic Acid or any of the components of the medicine or other Bisphosphonates
Severe kidney diseases
Low blood calcium levels (hypocalcemia)

Side effects

Common side effects of this drug are:

Abnormal heart rhythms (common, but inform the doctor promptly), especially seen in postmenopausal women
Increased sensitivity to light, swollen, red and painful eyes with itching (uncommon)
A serious condition called osteonecrosis of the jaw can occur with the use of Zoledronic acid – symptoms include pain in the jaw or the mouth, mouth sores, loose tooth, heaviness or numb feeling of the jaw, any discharge from the mouth. This is a serious condition and usually occurs after a dental procedure in people who have or taking treatment for cancer. Even otherwise, caution is advised and you are advised to consult the doctor promptly, also if you notice the slightest of symptoms
Allergic reaction like - fever, chills, rash, hives, breathing difficulty, swelling over your face, lips, throat
Fainting, slow breathing; fast breathing or heartbeats, headache, chest pain
Fever, swollen glands, chills, flu-like symptoms, cold, sudden weakness
Sore skin, easy bruising, bleeding, itching, numbness, muscle weakness and pain
Problems with urination indicating kidney problem- little, no urine, painful, difficult urination
Skin reaction- fever, swelling on face and tongue, sore throat, burning skin and eyes, purple and red rash on the skin which later starts peeling and scaling
Nausea, vomiting, diarrhea, constipation
Back pain, joint and muscle pain, weakness
Dizziness, drowsiness, tiredness
Loss of appetite, weight loss, stomach pain
Sore throat, cough

Precautions and Warnings

Pregnancy

Not enough data is available. Zoledronic Acid should not be used during pregnancy as it has the potential to harm the unborn baby

Breast Feeding

Sufficient data is lacking and it is not known with certainty if Zoledronic Acid is secreted in breast milk. It is best advised to avoid this medicine in breastfeeding women.

Driving

This medicine may cause problems with your vision or dizziness. Exercise caution if you experience any such side effects.

Alcohol

Alcohol may not directly interact with Zoledronic Acid but may increase the risk for fractures. It is advised to minimize alcohol consumption (to occasional drinking) while taking this medicine. Avoid alcohol for at least two weeks before and after treatment.

Other General Warnings

Talk to your doctor if

Inform the doctor if any of the following applies to you:
Taking any other treatment containing Zoledronic Acid
Surgery of parathyroid glands (specialized tissue in the neck that control calcium levels in the body) or intestines
Kidney problems
If you cannot take daily calcium supplements, you have cancer or you are taking medicines that suppress immune response (Corticosteroids – Prednisolone, Dexamethasone)

Mode of Action

How Does It Work?

Zoledronic Acid works by attaching to bone minerals, preventing them from break down. This will reduce bone loss and decreases the risk of fractures. When this is combined with calcium or vitamin D intake, the bone can be strengthened.

Interactions

Interactions with other medicines

Use the following medicines with caution:
Any medicines that can cause kidney damage - Diuretics or water pills (Spironolactone, Triamterene, etc.), Aminoglycoside antibiotics (Amikacin, Gentamicin, Neomycin, etc.), pain killers (Ibuprofen, Diclofenac), etc.
Other forms of Bisphosphonates
Medicines that suppress immune response (Corticosteroids – Prednisolone, Dexamethasone)
Do not mix Zoledronic acid with IV fluids containing calcium (Ringer’s solution, parenteral nutrition)
Inform your doctor about all other medicines, supplements or herbs you are taking

Interactions with food items

Zoledronic Acid infusion can be taken before or after food.

Dietary Restrictions

Drink plenty of fluids, starting at least a week before and up to 2 weeks after the treatment. You can have your regular diet on the day of surgery.

Dosage

Overdose

An overdose is unlikely as healthcare professionals will give you the medicine as an injection. Excess Zoledronic Acid may cause muscle weakness, stiffness and aches, low calcium levels and may increase the risk of fractures. Consult your doctor in case of such symptoms. Calcium supplementation usually helps with these symptoms.

Missed a Dose

Zoledronic Acid is usually taken once a year under medical supervision. If you miss a dose, call the doctor and take the missed dose as soon as you can.

Frequently Asked Questions (FAQs)

Bisphosphonates are substances that are naturally made in the body and they primarily strengthen the bone (increase the density of the bone). They do this mainly by preventing the breakdown of the bone. Hence, calcium and Vitamin D supplementation is necessary while taking Bisphosphonates, as these can help the substance of the bone to regrowOsteoporosis is thinning of bone due to the death of bone cells which is usually age-related. For such patients, when Bisphosphonates are given, they penetrate the bone and stop the bone cells from dying. In normal conditions, our bone strength is a balance between bone loss and bone growthIn old aged people and certain diseases (like cancers), there is only bone loss, but the bone does not grow which leads to thinning of the bone and increases the risk of fracturesBisphosphonates are phosphates which prevent bone loss. In these conditions and with calcium and Vitamin D supplementation, bone strength can be restoredBisphosphonate injections are usually safe but they are not given in all patients with bone loss. They are generally reserved for patients who cannot tolerate the tablets or those at high risk for fracturesBisphosphonates are also used to treat certain types of cancer

The frequency of administration of Zoledronic Acid varies depending on the condition of the patients. For some diseases, it is given once a year, and for some others as a single doseRetreatment may be necessary, but in any case, the usual frequency is once in a year. So, there is no problem of overdose or missed doseAdequate calcium and Vitamin D supplementation is necessary to derive maximum benefit from Zoledronic Acid. Calcium can be taken in the form of tablets every day, but injections may be required for Vitamin DZoledronic Acid is given as a slow intravenous drip (through the veins), for a period not less than 15 minutesQuit smoking, maintain good oral health, have regular dental check-ups and inform the doctor if you have any cancers or previously treated with BisphosphonatesZoledronic Acid should not be used in patients with severe kidney disease or those less than 18 years of ageNever self-administer this medicine. Zoledronic Acid must always be taken under medical supervision