| name | Zoledronic acid |
| classification | Nitrogen-containing bisphosphonate |
| pharmacokinetics | High bone affinity, prolonged terminal half-life (weeks to months). Primarily excreted renally. Significant accumulation in bone tissue. |
| suggested dosage | | adult male | Typically a single dose of 5 mg intravenously annually for osteoporosis prevention/treatment, 5 mg annually for postmenopausal osteoporosis. May be different for other indications (such as Paget's disease). Consult with a physician for appropriate dosing. |
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| additional dosage notes | Dosage needs adjustment in patients with renal impairment. Consider creatinine clearance. |
| indications | | 1 | Postmenopausal osteoporosis | | 2 | Osteoporosis in men | | 3 | Paget's disease of bone | | 4 | Multiple myeloma | | 5 | Hypercalcemia of malignancy |
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| safety in pregnancy | Category C. Potential risk to the developing fetus is unknown. Should not be used during pregnancy unless the potential benefit outweighs the risk. Should not be used during breastfeeding. |
| safety in breastfeeding | Not recommended. Excreted in breast milk. Risk to infant is unknown. Discontinue drug if breastfeeding is desired. |
| side effects | | 1 | Injection site reactions (e.g., pain, redness, swelling) | | 2 | Headache | | 3 | Fever | | 4 | Myalgia (muscle pain) | | 5 | Arthralgia (joint pain) | | 6 | Pharyngitis (sore throat) | | 7 | Gastrointestinal problems (e.g., nausea, vomiting, diarrhea) | | 8 | Renal adverse effects (possible, especially with high doses and/or impaired renal function) | | 9 | Atrial fibrillation risk, although controversial | | 10 | Hypocalcemia |
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| alternatives | |
| contraindications | | 1 | Known hypersensitivity to bisphosphonates | | 2 | Severe renal impairment | | 3 | Hypocalcemia (uncontrolled) | | 4 | Inability to remain upright for at least 30 minutes after administration |
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| interactions | | 1 | Antacids (reduce absorption) | | 2 | Other drugs that affect renal function | | 3 | Concurrent use of certain other medications may increase the risk of side effects (check drug interactions) |
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| warnings and precautions | | 1 | Monitor renal function during treatment. Measure creatinine clearance. | | 2 | Assess for pre-existing dental issues (osteonecrosis of the jaw) | | 3 | Esophageal erosions in those taking oral bisphosphonates, especially with poor adherence to administration instructions (e.g., taking with a full glass of water and remaining upright for 30 minutes) | | 4 | Risk of atypical femur fractures may be elevated in patients with long-term use, especially at high doses | | 5 | Monitor for signs and symptoms of hypocalcemia. Correct hypocalcemia before starting therapy if needed. |
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| additional information | Consult a physician for appropriate diagnosis and individualized dosing schedule, particularly in cases of co-morbidities or other medications. A detailed patient history is critical. |
