zoledronic acid anhydrous: clinical use

Prescribing considerations

• Confirm adequate hydration while avoiding overhydration in patients at risk of cardiac failure.
• Correct hypocalcaemia before treatment and ensure appropriate calcium and vitamin D support.
• Assess renal function and concurrent nephrotoxic therapy before each administration; withhold treatment if renal function deteriorates in accordance with product information.
• Assess oral health and osteonecrosis-of-the-jaw risk; consider preventive dentistry where risk factors are present.
• Investigate new thigh, hip or groin pain for possible incomplete femoral fracture.

Contraindications and cautions

• Hypersensitivity to zoledronic acid, another bisphosphonate or a formulation excipient
• Breastfeeding

Monitoring

• Serum creatinine and renal function before each administration
• Hydration status
• Serum calcium; consider phosphate and magnesium according to clinical context
• Symptoms and signs of hypocalcaemia
• Oral symptoms, dental status and osteonecrosis-of-the-jaw risk
• New thigh, hip or groin pain

Clinical pharmacology

A nitrogen-containing bisphosphonate with high affinity for mineralised bone that inhibits osteoclast-mediated bone resorption. It is not metabolised, is excreted unchanged by the kidneys, and the fraction retained in bone is released slowly.

Formulation and product differences

• The selected formulation is a clear, colourless concentrate for intravenous infusion and requires dilution.
• Use a calcium-free compatible infusion solution; do not mix with lactated Ringer's solution or other solutions containing calcium or divalent cations.
• Administer as a separate intravenous solution through a separate infusion line.
• It contains mannitol, sodium citrate and water for injections and is essentially sodium-free before dilution.

Solution for infusion

Route: Intravenous

Strengths: 4 mg/5 mL