Zoledronic Acid (Generic Name)

Other Names: Zometa®

About This Drug

Zoledronic acid is used to treat high levels of calcium in the blood (hypercalcemia), which affects patients with certain types of cancer. It also is used to treat multiple myeloma (tumors formed by bone marrow cells) and/or bone lesions associated with the spread of cancer (bone metastases).  This drug is given in the vein (IV).

Possible Side Effects (More Common)

  • Fever
  • Back and joint pain
  • Nausea and throwing up (vomiting)
  • Lower abdominal pain
  • This drug may affect how your kidneys work. Your kidney function will be checked as needed. 
  • Changes in bowel movements. Some patients have diarrhea, while others have constipation.
  • Trouble breathing
  • Feeling dizzy or lightheaded
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
  • Feeling nervous or anxious
  • Trouble sleeping
  • Confusion
  • Cough
  • Anemia. You may feel very tired.
  • Electrolyte changes.  Your blood will be checked for electrolyte changes as needed.
  • Swelling of hands, feet, or legs
  • Tiredness
  • Hair loss. You may notice hair getting thin. Some patients lose their hair. Your hair often grows back when treatment is done.

Possible Side Effects (Less Common)

  • Osteonecrosis (oss-tee-oh-ne-KRO-sis) of the jaw. This is a breakdown of the jaw bone. It is a bad but rare health problem.  Possible symptoms are:
    • Pain, swelling, or infection of the gums
    • Loose teeth
    • Poor healing of the gums
    • Numbness or the feeling that your jaw is heavy

Treating Side Effects

  • Drink 6-8 cups of fluids each day unless your doctor has told you to limit your fluid intake due to some other health problem. A cup is 8 ounces of fluid. If you throw up or have loose bowel movements you should drink more fluids so that you do not become dehydrated (lack water in the body due to losing too much fluid).
  • Ask your doctor or nurse about medicines that are available to help stop or lessen constipation.
  • If you are not able to move your bowels, check with your doctor or nurse before you use enemas, laxatives, or suppositories.
  • Ask your doctor or nurse about medicine to help stop or lessen nausea, vomiting, diarrhea, and/or back and joint pain.
  • Let your doctor or nurse know if you are having trouble sleeping or if you feel very nervous.
  • Tell your cancer doctor if you have any problems with your teeth or jaw before you start this drug. It is important that your dentist knows that you are on this drug. Give your dentist and your cancer doctor each other’s name and phone number so they may call each other if they have any questions.
  • Mouth care is very important. Your mouth care should consist of routine, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of 1/2 teaspoon of salt in 8 ounces of water or ½ teaspoon of baking soda in 8 ounces of water. This should be done at least after each meal and at bedtime.
  • Use a mirror to check your teeth and gums daily for any changes, such as sores or bleeding gums. If you notice a change, tell your cancer doctor right away.
  • If you have mouth sores, avoid mouthwash that has alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.

Special Instructions

  • It is very important you discuss dental work with your cancer doctor before you have it done. This includes pulling of teeth, insertion of dental implants, and special gum treatments.
  • Tell your cancer doctor if you have any problems with your teeth or jaw before you start this drug. It is important that your dentist knows that you are on this drug. Give your dentist and your cancer doctor each other’s name and phone number so they may call each other if they have any questions.

Food and Drug Interactions

There are no known interactions of zoledronic acid with food. This drug may interact with other medicines. Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.

When to Call the Doctor

Call your doctor or nurse right away if you have any of these symptoms:

  • Fever of 100.5 F (38 C) or higher
  • Chills
  • Easy bleeding or bruising
  • Wheezing or trouble breathing
  • Rash or itching
  • Feeling dizzy or lightheaded
  • Feeling that your heart is beating in a fast or not normal way (palpitations)
  • Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or lightheadedness
  • Blurred vision or other changes in eyesight
  • Pain when passing urine; blood in urine
  • Pain in your lower back or side
  • Feeling confused or agitated
  • Nausea that stops you from eating or drinking
  • Throwing up more than 3 times a day
  • Chest pain or symptoms of a heart attack. Most heart attacks involve pain in the center of the chest that lasts more than a few minutes. The pain may go away and come back. It can feel like pressure, squeezing, fullness, or pain. Sometimes pain is felt in one or both arms, the back, neck, jaw, or stomach. If any of these symptoms last 2 minutes, call 911.
  • Symptoms of a stroke such as sudden numbness or weakness of your face, arm, or leg, mostly on one side of your body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, feeling dizzy, loss of balance or coordination; or sudden, bad headache with no known cause.  If you have any of these symptoms for 2 minutes, call 911. 
  • Signs of liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin

Call your doctor or nurse as soon as possible if you have any of these symptoms:

  • Change in hearing, ringing in the ears
  • Decreased urine
  • Unusual thirst or passing urine often
  • Pain in your mouth or throat that makes it hard to eat or drink
  • Nausea that is not relieved by prescribed medicines
  • Rash that is not relieved by prescribed medicines
  • Heavy menstrual period that lasts longer than normal
  • Numbness, tingling, decreased feeling or weakness in fingers, toes, arms, or legs
  • Trouble walking or changes in the way you walk, feeling clumsy when buttoning clothes, opening jars, or other routine hand motions
  • Swelling of legs, ankles, or feet
  • Weight gain of 5 pounds in one week (fluid retention)
  • Lasting loss of appetite or rapid weight loss of five pounds in a week
  • Fatigue that interferes with your daily activities
  • Headache that does not go away
  • Painful, red, or swollen areas on your hands or feet.
  • No bowel movement for 3 days or you feel uncomfortable
  • Extreme weakness that interferes with normal activities

Reproduction Concerns

  • Pregnancy warning: This drug may have harmful effects on the unborn baby, so effective methods of birth control should be used by both men and women during your cancer treatment and for at least 3 months after treatment.
  • Genetic counseling is available for you to talk about the effects of this drug therapy on future pregnancies. Also, a genetic counselor can look at the possible risk of problems in the unborn baby due to this medicine if an exposure happens during pregnancy.
  • Breast feeding warning: Women should not breast feed during treatment because this drug could enter the breast milk and badly harm a breast feeding baby.

Revised November 2014

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