ZOMETA – ZOLEDRONIC ACID

Adult: IV Hypercalcaemia of malignancy 4 mg as a single dose infusion. May repeat 1 wk later if needed. Advanced bone malignancies 4 mg infusion 3-4 wkly. Paget’s disease of bone 5 mg as a single dose infusion. Postmenopausal osteoporosis 5 mg as a single dose infusion, once yrly Hypercalcaemia

Electrolyte disturbances (e.g. hypocalcaemia); GI disturbances; dizziness; hypersensitivity reactions; blood disorders e.g. anaemia; weight loss; dyspnoea; iritis; uveitis; conjunctivitis; influenza-like symptoms; myalgia; arthralgia; fever; rigors; renal impairment; taste disturbance; dry mouth; stomatitis; chest pain; cough; CNS effects; pruritus; rash; sweating; asthenia; peripheral oedema; hypertension; bradycardia.

Cardiac disease (avoid fluid overload). Renal impairment. Monitor serum electrolytes, calcium, phosphate and magnesium. Assess renal function before each dose. Withhold treatment if there is worsening of renal function (increase of 44 micromoles/l in patients with normal baseline creatinine or increase in 88 micromoles/l in those with abnormal baseline creatinine); restart treatment at precious dose when creatinine return to within 10% of baseline. Ensure adequate hydration throughout therapy and maintain urinary output of 2 L/day. Increased risk of renal impairment with small infusion volume and rapid infusion. Increased risk of bronchoconstriction in aspirin-sensitive patients. Consider dental examination with appropriate corrective action before initiating treatment in patients at risk of osteomyelitis and osteonecrosis of the jaws (e.g. infection, anaemia, pre-existing viral disease, trauma, coagulation disorders). Hard and soft tissue oral assessment to be carried out every 3-4 mth and avoid invasive dental procedures while on treatment.

Pregnancy; lactation; children.

Increased risk of hypocalcaemia with aminoglycosides and loop diuretics. Increased risk renal dysfunction with nephrotoxic agents.