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zoledronic acid

Trade Name:

Zometa®

Synonym:

Zoledronate

Appearance:

Colourless solution mixed into larger bags of fluids

Monograph Name:

zoledronic acid

Monograph Body:

Drug Monograph

A - Drug Name

zoledronic acid

SYNONYM(S): Zoledronate

COMMON TRADE NAME(S): Zometa®

B - Mechanism of Action and Pharmacokinetics

Zoledronic acid is a bisphosphonate, which inhibits bone resorption via actions on osteoclasts or on osteoclast precursors. It binds to hydroxyapatite and accumulates in bone, thus inhibiting osteoclast migration and maturation. Zoledronic acid inhibits skeletal calcium release induced by tumours, and has a clinically significant impact on mixed and osteoblastic metastases in patients with breast or prostate cancer. Preclinical data suggest that zoledronic acid may have pro-apoptotic or cytostatic properties on cancer cells, or anti-angiogenic effects on endothelial cells.

Absorption

Exposure linearly related to dose. Japanese female patients had higher exposure (47%) than the North American population.

Distribution

Zoledronic acid has a high affinity for calcified tissues i.e. bone. Can be detected in plasma for up to 28 days post-dose.

Cross blood brain barrier?

No information found

PPB

55%

Metabolism

Zoledronic acid does not undergo metabolism and does not affect cytochrome P450 enzymes.

Active metabolites

Inactive metabolites

Elimination

Zoledronic acid is excreted renally as intact drug; the remaining is bound to bone tissue and released slowly into the systemic circulation. Renal clearance correlates with creatinine clearance in patients with mild-moderate renal failure. Body weight, gender, and race do not cause significant variabilities on clearance.

Feces

<3%

Urine

39% (unchanged in 24 hours)

Half-life

Terminal: 146 hours

C - Indications and Status

Health Canada Approvals:

Treatment of tumour-induced hypercalcemia (corrected serum calcium ≥ 3 mmol/L) following adequate saline rehydration. Prior to treatment with zoledronic acid, renal excretion of excess calcium should be promoted by restoring and maintaining adequate fluid balance and urine output.
Treatment of patients with documented bone metastases from solid tumours and patients with osteolytic lesions of multiple myeloma in conjunction with standard care in order to prevent or delay potential complication from the bone lesions.

Other Uses:

Adjuvant Breast Cancer

D - Adverse Effects

Emetogenic Potential:

Not applicable

Extravasation Potential: Irritant

The following table contains adverse effects reported mainly in bone metastases trials in patients with solid tumours, where the incidence is higher than in placebo.

ORGAN SITE	SIDE EFFECT* (%)	ONSET**
Cardiovascular	Arrhythmia (includes atrial fibrillation; rare)	E
	Hypotension (<1%) (rarely severe)	I E
Dermatological	Rash (rare)	I
Gastrointestinal	Diarrhea (24%)	E
	Nausea, vomiting (46%)	E
	Weight loss (16%)	E
General	Edema (21%)	E
	Fatigue (39%)	E
	Flu-like symptoms (acute phase reaction; common)	E
Hematological	Anemia (5%) (↑ from placebo observed)	E
Hypersensitivity	Hypersensitivity (rare)	I
Injection site	Injection site reaction (rare)	I
Metabolic / Endocrine	Abnormal electrolyte(s) (10%) (↓Ca, K, Mg, PO4)	E
Musculoskeletal	Fracture (rare)	D
	Musculoskeletal pain (23%) (including arthritis, may be severe)	E
	Osteonecrosis of jaw (2%) (and other sites)	L
Nervous System	Cognitive disturbance (1%)	E
	Depression (14%)	E
	Dizziness (18%)	E
	Headache (19%)	E
	Paresthesia (15%)	E
Ophthalmic	Conjunctivitis (1-10%)	E
	Eye disorders (blurred vision, uveitis, episcleritis; rare)	E
Renal	Nephrotoxicity (17%)	E
	Other acquired Fanconi syndrome (rare)	E D
Respiratory	Bronchospasm (in ASA sensitive asthmatics; theoretical)	E
	Cough, dyspnea (27%)	E
	Pneumonitis (rare)	E D

* "Incidence" may refer to an absolute value or the higher value from a reported range.
"Rare" may refer to events with < 1% incidence, reported in post-marketing, phase 1 studies,
isolated data or anecdotal reports.

** I = immediate (onset in hours to days) E = early (days to weeks)
D = delayed (weeks to months) L = late (months to years)

The most common side effects for zoledronic acid include transient flu-like symptoms, nausea/vomiting, musculoskeletal pain, diarrhea, fatigue, edema, headache, dizziness, renal impairment and cough/dyspnea.

Deterioration of renal function has been noted with zoledronic acid. Factors that may increase the potential of deterioration include pre-existing renal impairment, concomitant use of nephrotoxic drugs, dehydration, prolonged exposure to bisphosphonates, zoledronic acid doses > 4mg, or using an infusion time shorter than the recommendations (in 100mL diluent over 15 minutes). Cases of acquired Fanconi syndrome have been reported and signs include hyperaminoaciduria, glucosuria in the presence of normal serum glucose, phosphate wasting and other clinical features. If this develops, zoledronic acid should be discontinued and the patient treated appropriately.

Hypocalcemia has been reported, and is usually asymptomatic, but may be severe (e.g. tetany, QTc changes) and has a variable onset time. It may be more common in patients with prior thyroid surgery.

An acute phase reaction is common, with symptoms such as fever, fatigue, bone pain and/or arthralgias, myalgias, arthritis, joint swelling and flu-like illness. These reactions usually appear within 3 days after the dose and usually resolve within a few days.

Musculoskeletal pain may occur from days to months after starting treatment and may sometimes be severe. These symptoms recurred in some patients who were re-challenged with the same or different bisphosphonates.

Osteonecrosis of the jaw (ONJ) has been reported, especially in patients also receiving steroids, radiotherapy, anti-angiogenic drugs and chemotherapy who have had invasive dental surgery. Risk may also be increased in those with co-morbid conditions (e.g. anemia, coagulopathies), periodontal and other dental diseases, poorly fitting dentures and smokers. A higher frequency has been reported in advanced breast cancer or multiple myeloma patients. The onset can occur from months to years after the start of bisphosphonate therapy. Patients should be advised to have dental examinations prior to starting therapy and to avoid invasive dental procedures while receiving zoledronic acid. The start of treatment should be delayed in patients with unhealed open soft tissue mouth lesions. In multiple myeloma patients, consider either discontinuing treatment after 2 years for stable responding patients or decreasing frequency to every three months. Cases of osteonecrosis of other anatomical sites, including the femur, hip, humerus, external auditory canal, tibia, ribs, spine, knee, and metatarsal bones have been reported post-market in patients treated with zoledronic acid.

Atypical fractures of the femur (subtrochanteric or diaphyseal) have been reported with bisphosphonate use, primarily in patients receiving long-term treatment. These fractures are often bilateral, occur with minimal or no trauma, with symptoms including thigh or groin pain. Imaging features of stress features may be seen weeks to months before presentation with a completed femoral fracture. Poor healing of these fractures has also been reported.

E - Dosing

Refer to protocol by which patient is being treated. Do not combine with other bisphosphonates. Hypocalcemia must be corrected before administering zoledronic acid. All patients should be adequately hydrated prior to and during treatment with zoledronic acid, but overhydration should be avoided especially in patients with cardiac risk factors.

Doses > 4mg should be avoided, due to the increased risk of nephrotoxicity.

Do not administer to patients with open soft tissue lesions in the mouth.

In patients without hypercalcemia (current or history of), oral calcium 500mg and at least Vitamin D 400 IU daily supplements are recommended.

Adults:

Tumour induced hypercalcemia (TIH)¹:

4mg IV infusion over ≥ 15 minutes following rehydration
May retreat after 7 days if not normocalcemic² and can tolerate hydration (3 to 5 litres per day)

_{¹ Corrected calcium ≥ 3 mmol/L

² Should use corrected calcium levels, calculated using the following formula:

Corrected Calcium (mmol/L) = Measured Calcium (mmol/L) +(0.02 X [40-Measured Albumin (g/L)])}

Bone metastases and Multiple Myeloma:

4mg IV infusion over ≥ 15 minutes every 3 to 4 weeks

Dosage with Toxicity:

Dosage in myelosuppression: No dosage adjustment required

Toxicity	Action
Atypical fractures of the femur	Hold if suspected. Consider discontinuing if confirmed.
Ocular symptoms other than uncomplicated conjunctivitis	Refer to ophthalmologist; consider discontinuing
Osteonecrosis of the jaw, other sites	For ONJ, refer to dentist or dental surgeon; consider hold or discontinue
Severe musculoskeletal pain	Discontinue
Acquired Fanconi syndrome	Discontinue
Increased creatinine: ≥ 44 μmol/L ↑ if normal baseline** OR ≥ 88 μmol/L ↑ if abnormal at baseline OR Serum creatinine > 265 µmol/L (> 400 µmol/L with TIH)	Hold until recovered to within 10% of baseline (see table for dose adjustment for renal impairment at baseline)

**normal baseline creatinine is defined as < 123 μmol/L

Dosage with Hepatic Impairment:

There are no pharmacokinetic data in patients with impaired liver function. Zoledronic acid is not cleared by the liver; therefore, impaired liver function may not affect the pharmacokinetics of zoledronic acid.

Dosage with Renal Impairment:

			Starting Dose
Creatinine		Creatinine Clearance (mL/min)	TIH	Other patients
		> 60	4 mg	4 mg
		50 - 60	4 mg	3.5 mg
		40 - 49	4 mg	3.3 mg
		30 - 39	Consider ↓	3 mg
> 265 µmol/L (> 400 µmol/L with TIH)	Or	<30	Do not treat

Dosage in the elderly:

Similar efficacy and safety as compared to younger patients, but use with caution due to cardiac risks or renal function impairment.

Children:

Not recommended for use in children. Bone development was affected in growing animals.

F - Administration Guidelines

Do not infuse over a duration of less than 15 minutes.
All patients should be adequately hydrated prior to and after administration of zoledronic acid, but overhydration should be avoided.
Mix with 100mL solution (D5W or NS) and infuse over ≥ 15 minutes.
Do not mix with calcium or other divalent cation-containing solutions.
Compatible with PVC, glass, polyethylene and polypropylene containers or infusion lines.
Should be administered as a single intravenous solution in a line separate from all other drugs.
Store unopened vials at room temperature.

G - Special Precautions

Contraindications:

Patients who have a hypersensitivity to this drug or any of its components, or other bisphosphonates
Patients with non-corrected hypocalcemia at time of infusion or severe renal failure
Zoledronic acid should not be given together with other bisphosphonates since the combined effects of these agents are unknown.
Patients being treated with Aclasta® should not receive Zometa® concomitantly since they both contain zoledronic acid.
Use of zoledronic acid in patients with severe renal impairment is not recommended.

Other Warnings/Precautions:

The use of zoledronic acid with other nephrotoxins (cisplatin, NSAIDS, aminoglycosides, etc.), doses > 4mg, infusion duration < 15 minutes and previous bisphosphonate use are associated with an increased risk of renal failure.
Use with extreme caution in combination with nephrotoxic agents or with agents which are renally excreted.
Use with caution in patients with cardiac failure, especially in the elderly.
Use with caution in patients with risk factors for ONJ, including patients receiving concomitant chemotherapy or anti-angiogenic agents; patients should be advised to avoid invasive dental procedures while receiving zoledronic acid.
Caution in patients who have had thyroid surgery since they are susceptible to hypocalcemia due to relative hypoparathyroidism.
The risk of hypocalcemia is increased in patients receiving loop diuretics, calcitonin or aminoglycosides.

Other Drug Properties:

Carcinogenicity: Unlikely

Pregnancy and Lactation:

Teratogenicity: Yes

Zoledronic acid is contraindicated for use in pregnancy. Animal studies suggest zoledronic acid may cause fetal harm in pregnant women. Adequate contraception should be used by both sexes during treatment, and for at least 6 months after the last dose.
Excretion into breast milk: Probable

Breastfeeding is contraindicated.
Fertility effects: Documented in animals

H - Interactions

AGENT	EFFECT	MECHANISM	MANAGEMENT
Drugs that can cause hypocalcemia (aminoglycosides, loop diuretics, calcitonin, esp in TIH)	↑ hypocalcemic effect	Additive effect	Caution (monitor calcium and magnesium levels)
Nephrotoxic drugs or drugs that can significantly impact renal function (e.g. selected antineoplastics, NSAIDs, ASA, ACE inhibitors, etc.)	↑ risk of renal dysfunction	Additive effects	Extreme Caution; monitor renal function
Aspirin	↑ incidence bronchospasm (theoretical)	Unknown	Avoid use in ASA sensitive patients
Anti-angiogenic drugs (e.g. sunitinib, bevacizumab)	↑ risk of ONJ	Additive	Caution

I - Recommended Clinical Monitoring

Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Recommended Clinical Monitoring

Monitor Type	Monitor Frequency
Renal function tests (serum creatinine and BUN)	Baseline, before each dose and during therapy, as indicated
Comprehensive dental evaluation of both hard and soft tissues; undergo invasive dental procedures, if needed, before starting bisphosphonate treatment	Baseline (before starting treatment) and regular check-ups
Calcium, corrected levels (including serum albumin), electrolytes (including phosphate, magnesium)	baseline, before each dose and during therapy, as indicated
CBC	Baseline and regular
Clinical toxicity assessment for flu-like syndrome, dental, musculoskeletal, signs of acquired Fanconi syndrome, and ocular symptoms	At each visit

Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

Suggested Clinical Monitoring

Monitor Type	Monitor Frequency
Ophthalmology examination	As indicated, with ocular symptoms

J - Supplementary Public Funding

Exceptional Access Program (EAP Website)

zoledronic acid - Treatment of bony metastases in hormone refractory prostate cancer (in those receiving outpatient care who do not meet the criteria of Cancer Care Ontario (CCO)), according to clinical criteria
zoledronic acid - For the prevention of skeletal related events, in patients who have not experienced previous skeletal related events and who have bony metastases secondary to solid tumours, according to clinical criteria
zoledronic acid - For the prevention of skeletal related events, in patients who have not experienced previous skeletal related events and who have bony metastases secondary to breast cancer or multiple myeloma, who are intolerant to pamidronate, according to clinical criteria
zoledronic acid - For the treatment of patients with symptoms due to bony metastases secondary to breast cancer or multiple myeloma who have failed or are intolerant to pamidronate, according to clinical criteria
zoledronic acid - For the treatment of patient with symptoms due to bony metastases secondary to solid tumours (neither breast cancer nor multiple myeloma), considered on a case-by-case basis

K - References

CCO Practice Guideline: The Role of Bisphosphonates in the Management of Skeletal Complications for Patients with Multiple Myeloma

European Public Assessment Reports - Scientific Discussion (Zometa®). European Medicines Agency, 2005.

Lacy MO, Dispenzieri A, Gertz MA, et al. Mayo Clinic Consensus Statement for the Use of Bisphosphonates in Multiple Myeloma. Mayo Clin Proc 2006; 81(8):1047-1053.

McEvoy GK, editor. AHFS Drug Information 2011. Bethesda: American Society of Health-System Pharmacists, p. 3683-7.

Product Monograph: Zometa® (zoledronic acid). Novartis Pharmaceuticals Canada Inc. April 13, 2017.

Wellington K, Goa KL. Zoledronic acid: a review of its use in the management of bone metastases and hypercalcemia of malignancy. Drugs 2003;63(4):417-37.

April 2023 removed NDFP forms

L - Disclaimer

Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.

The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.

Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.

While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.

CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.

Info Sheet Name:

zoledronic acid (patient)

Info Sheet Introduction:

Zoledronic acid may:
- help relieve bone pain and prevent broken bones in some cancers,
- treat too much calcium in the blood caused by certain types of cancer, or
- be used as part of anticancer treatment to prevent breast cancer from coming back.

Info Sheet Date: Thursday, February 8, 2024 Info Sheet body:

Medication Information Sheet

zoledronic acid (ZOE-le-dron-ik AS-id)

This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Zometa®

Appearance:

Colourless solution mixed into larger bags of fluids

What is this medication for?

Zoledronic acid may:
- help relieve bone pain and prevent broken bones in some cancers,
- treat too much calcium in the blood caused by certain types of cancer, or
- be used as part of anticancer treatment to prevent breast cancer from coming back.

What should I do before I have this medication?

Tell your health care team if you have or had significant medical condition(s), especially if you have / had:
- kidney, heart or dental problems,
- asthma plus an allergy to aspirin (ASA),
- take other medications for bone problems,
- have any other allergies,
- have sores in your mouth,
- or if you have any planned dental work.
Tell your dentist that you are on zoledronic acid.

Remember to:

Tell your health care team about all of the other medications you are taking.
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.

How will this medication affect sex, pregnancy and breastfeeding?

The use of this medication in men or women may cause harm to the unborn baby if pregnancy occurs. Let your health care team know if you or your partner is pregnant, becomes pregnant during treatment, or if you are breastfeeding.
If there is ANY chance that you or your partner may become pregnant, you and your partner together must:
- ► Use 2 effective forms of birth control at the same time while taking this drug. Keep using birth control until 6 months after the last dose (general recommendation). Discuss with your healthcare team.
Do not breastfeed while on this treatment.
It is not known if this medication affects fertility (ability to get pregnant).

How is this medication given?

Zoledronic acid is given by injection into the vein over 15 minutes.

What else do I need to know while on this medication?

Will this medication interact with other medications or natural health products?

This medication can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
Tell your health care team about all of your:
- prescription and over-the-counter (non-prescription) medications and all other drugs, such as cannabis/marijuana (medical or recreational)
- natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
Check with your health care team before starting or stopping any of them.
To prevent lowering of your calcium level while using zoledronic acid, your health care team may tell you to take calcium and vitamin D supplements. Do not take calcium or vitamin D if you have/had high calcium levels in the blood. Talk to your health care team before taking these supplements.

What to DO while on this medication:

Rarely, some people may have jaw, teeth or mouth problems while using zoledronic acid.

DO look for teeth, mouth or jaw problems. You may have pain and swelling, poor healing of mouth sores, unusual discharge from gums, loosening of teeth, and the feeling of numbness or heaviness in the jaw.
DO contact your health care team as soon as possible if you get any of these symptoms.
DO check with your health care team before getting any dental procedures.
DO maintain good dental hygiene and have regular checkups with your dentist, to prevent jaw problems.

What are the side effects of this medication?

The following side effects have been seen in people using zoledronic acid with other chemotherapy drugs, so some of these effects may be caused by chemotherapy.

You may not have all of the side effects below. You may have side effects that are not listed.

Side effects and what to do	When to contact doctor?
Common Side Effects (25 to 49 out of 100 people)

Nausea and vomiting

(Usually mild)

May occur in hours to days after your treatment.

If you have nausea or vomiting:

Take anti-nausea medication(s) as prescribed to you by your doctor.
Drink clear liquids and have small meals. Get fresh air and rest.
Do not eat spicy, fried foods or foods with a strong smell.
Limit caffeine (e.g. coffee, tea) and alcohol.
Contact your health care team if the prescribed anti-nausea medications are not helping to control your nausea and vomiting.

Also see Nausea & Vomiting pamphlet for more information.

Contact your health care team if no improvement or if severe

Fatigue (tiredness)

Be active and aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days.
Check with your health care team before starting any new exercise.
Pace yourself, do not rush. Put off less important activities. Rest when you need to.
Eat well and stay hydrated by drinking at least 6 to 8 glasses of water or other liquids every day (unless your doctor told you to drink more or less).
Avoid driving or using machinery if you are feeling tired

See our Fatigue pamphlet for more information.

Contact your health care team if no improvement or if severe

Cough; Feeling short of breath

(May be severe)

You may have cough and feel short of breath without any signs of infection, such as a sore throat or a stuffed nose.

If you have severe chest pain, shortness of breath or are coughing up blood you should seek emergency medical help straight away.

Contact your health care team if no improvement or if severe

Side effects and what to do	When to contact doctor?
Less Common Side Effects (10 to 24 out of 100 people)

Diarrhea

May happen days to weeks after you get your treatment.

To help prevent diarrhea :

Drink lots of clear liquids. Drink small amounts at a time.
Avoid foods or drinks with artificial sweetener (e.g. chewing gum, “diet” drinks), coffee and alcohol.
Eat many small meals and snacks instead of 2 or 3 large meals.

If you have diarrhea:

Take anti-diarrhea medication if your health care team prescribed it.

See the Diarrhea pamphlet for more information.

Contact your health care team if no improvement or if severe

Headache; mild joint, muscle pain

(May be severe)

Take your pain medication as prescribed by your doctor.
You can take acetaminophen (Tylenol®) tablets as needed for mild aches and pains. Ask your doctor or pharmacist about the right dose for you.
Talk to your doctor or pharmacist first before taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin. These medication may increase bleeding risk.
Rest often and try light exercise as it may help.

Contact your health care team if no improvement or if severe

Mild swelling in arms and legs; puffiness

To help prevent swelling :

Eat a low-salt diet.
Avoid tight fitting clothing.

If you have swelling in your legs, keep your feet up when sitting.

Contact your health care team if no improvement or if severe

Dizziness

You may feel light headed.
Lay down if this happens.
Get up and move slowly once you feel better.
Do not drive a motor vehicle or use machinery if you feel dizzy.

Contact your health care team if no improvement or if severe

Kidney problems

(May be severe)

You may have lower back pain, swelling, pee less than usual and have unusual weight gain.
Your doctor may monitor for proteins in your pee. You may have blood in your pee.
This may be sign of a serious kidney or bladder infection.
In rare cases, you may pee more than usual and lose protein, sugar and other substances in your pee. You may feel weak and/or have bone pain. See your doctor right away.

To prevent bladder or kidney problems, drink lots of water or other liquids. Drink at least 6 to 8 cups (2 L) of liquids per day on treatment days, unless you have been told otherwise.

Get emergency medical help right away

Weight Loss, Low appetite

You may not feel like eating or you may lose weight.
Try to eat foods that you like and eat small meals throughout the day.
You may need to take meal supplements to help keep your weight up.
Talk to your health care team if you have a low appetite.
See our Loss of appetite pamphlet for more information.

Contact your health care team if no improvement or if severe

Tingling, numb fingers and toes

May slowly get better after your treatment ends.
Contact your health care team if you have trouble doing up buttons, writing, picking up small objects, have pain or trouble moving.

Contact your health care team if no improvement or if severe

Depression

Everyone feels sad sometimes and having cancer can cause you to feel down. Depression is when these feelings last for weeks or months.

To help prevent depression :

Eating well and exercising may give you more energy and help you feel better. Always check with your health care team before starting a new exercise program to make sure it is safe for you.
Get support from your family, friends, community and health care team.

Contact your health care team if no improvement or if severe

Salt imbalances

It may cause muscle twitching, severe weakness or cramping, confusion and irregular heartbeat.

Get emergency medical help right away

Flu-like symptoms

You may have fever, chills and muscle pain without any signs of infection, such as a sore throat, cough or skin rash.
It may happen at any time after you receive your treatment and it usually goes away as your body gets used to the medication.
Contact your health care team if these feelings bother you.
Check your temperature to make sure you don’t have a fever. If you do not have a fever, you may take acetaminophen (Tylenol®) tablets to help you feel better. Ask your health care team for the correct dose for you. If you do have a fever, speak to your health care team or go to the nearest emergency room.

Contact your health care team if no improvement or if severe

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

severe bone pain
irregular heartbeat or low blood pressure
blurred vision or changes to your vision
signs of an allergic reaction: fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness

Who do I contact if I have questions or need help?

My cancer health care provider is: ______________________________________________

During the day I should contact:________________________________________________

Evenings, weekends and holidays:______________________________________________

Other Notes:

____________________________________________________________________________

December 2023 Updated information sheet

For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

Info Sheet (English):

zoledronic acid patient.pdf Info Sheet (French):

acide zoldronique pour le patient.pdf Monograph:

zoledronic acid.pdf Funding Program: Exceptional Access Program Funding Instance:

zoledronic acid - Treatment of bony metastases in hormone refractory prostate cancer (in those receiving outpatient care who do not meet the criteria of Cancer Care Ontario (CCO)), according to clinical criteria
zoledronic acid - For the prevention of skeletal related events, in patients who have not experienced previous skeletal related events and who have bony metastases secondary to solid tumours, according to clinical criteria
zoledronic acid - For the prevention of skeletal related events, in patients who have not experienced previous skeletal related events and who have bony metastases secondary to breast cancer or multiple myeloma, who are intolerant to pamidronate, according to clinical criteria
zoledronic acid - For the treatment of patients with symptoms due to bony metastases secondary to breast cancer or multiple myeloma who have failed or are intolerant to pamidronate, according to clinical criteria
zoledronic acid - For the treatment of patient with symptoms due to bony metastases secondary to solid tumours (neither breast cancer nor multiple myeloma), considered on a case-by-case basis

Phonetic Spelling:

ZOE-le-dron-ik AS-id

Cancer Type: Breast Central Nervous System Endocrine Gastrointestinal Anus Colorectal Esophagus Gastric / Stomach Hepatobiliary / Liver / Bile Duct Pancreas Small bowel and appendix Genitourinary Prostate Renal cell / Kidney Gynecologic Head and Neck Hematologic Multiple Myeloma Lung Non-Small Cell Small Cell Sarcoma GIST Skin Unknown Primary Type of Content: Drug Monograph Status: Null Info Sheet Status: Null Global Date: Tuesday, April 25, 2023 Universal Date: 2024-02-08 00:00:00 AddThis: Title URL: zoledronicacid Drug Display Status: Active Revision Summary:
Patient Info Sheet FR: Updated/revised information sheet (Fiche d’information mise à jour/révisée)