zoledronic acid: clinical use

Prescribing considerations

• Assess renal function, hydration, calcium and oral health before treatment.
• Correct hypocalcaemia and review nephrotoxic, hypocalcaemia-inducing and anti-angiogenic medicines.
• Avoid fluid overload in patients at risk of cardiac failure.

Contraindications and cautions

• Hypersensitivity to zoledronic acid, another bisphosphonate or an excipient.
• Breastfeeding.
• The selected product is not recommended for severe renal impairment in advanced malignancy involving bone; severe renal impairment in tumour-induced hypercalcaemia requires individual benefit–risk assessment.

Monitoring

• Serum creatinine before each planned administration.
• Calcium, phosphate and magnesium.
• Hydration status, renal toxicity and dental symptoms.

Clinical pharmacology

A nitrogen-containing bisphosphonate with high affinity for mineralised bone. It inhibits osteoclast-mediated resorption, is not metabolised, is eliminated unchanged through the kidneys and is released slowly from bone.

Formulation and product differences

• The selected product is a clear, colourless concentrate requiring dilution in calcium-free sodium chloride or glucose infusion solution.
• It must use a separate infusion line and must not be mixed with calcium-containing or other divalent-cation solutions.
• It is a single-use preparation; only particle-free, non-discoloured solution should be used.

Solution for infusion

Route: Intravenous

Strengths: 4 mg/5 mL, 5 mg/100 mL