Zoledronic Acid Injection (patient information)

# Why is this medication prescribed
Zoledronic acid is used to treat high levels of calcium in the blood that may be caused by certain types of cancer. Zoledronic acid is also used along with cancer chemotherapy to treat bone damage caused by multiple myeloma  or by cancer that began in another part of the body but has spread to the bones. Zoledronic acid is not cancer chemotherapy, and it will not slow or stop the spread of cancer. However, it can be used to treat bone disease in patients who have cancer. Zoledronic acid is in a class of medications called bisphosphonates. It works by slowing bone breakdown and decreasing the amount of calcium released from the bones into the blood.

# How should this medicine be used
Zoledronic acid comes as a solution (liquid) to infuse (inject slowly) intravenously (into a vein) over at least 15 minutes. It is usually injected by a health care provider in a doctor's office, hospital, or clinic. When zoledronic acid is used to treat high blood levels of calcium caused by cancer it is usually given as a single dose. A second dose may be given at least 7 days after the first dose if blood calcium does not drop to normal levels or remain at normal levels. When zoledronic acid is used to treat bone damage caused by multiple myeloma or cancer that has spread to the bones, it is usually given once every 3-4 weeks.
Your doctor will prescribe a calcium supplement and a multivitamin containing vitamin D to take during your treatment. You should take these supplements every day.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow
Before taking zoledronic acid
- tell your doctor and pharmacist if you are allergic to zoledronic acid;other bisphosphonates such as alendronate (Fosamax), etidronate (Didronel), pamidronate (Aredia), risedronate (Actonel), or tiludronate (Skelid); or any other medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: acetaminophen (Tylenol); amphotericin B (Fungizone); aminoglycoside antibiotics such as amikacin (Amikin), gentamycin (Garamycin), kanamaycin (Kantrex), neomycin (Neo-Rx, Neo-Fradin), netilmycin (Netromycin), paramomycin (Humatin), streptomycin, and tobramycin (Tobi, Nebcin); aspirin and other nonsteroidal anti-inflammatory medications such as ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn); aurothioglucose (Solganal), auranofin (Ridaura); bacitracin; cancer chemotherapy drugs such as carmustine (BCNU), cisplatin (Platinol AQ), cyclophosphamide (Cytoxan, Neosar); daunorubicin (DaunoXome, Cerubidine), doxorubicin (Adriamycin, Rubex), ifosfamide (Ifex), lomustine (CeeNU), and streptozocin (Zanosar); captopril (Capoten); cyclosporine (Neoral, Sandimmune); dapsone (Avlosulfon); foscarnet (Foscavir); gold sodium thiomalate (Myochrysine); loop diuretics ('water pills') such as bumetanide (Bumex), ethacrynic acid (Edecrin), and furosemide (Lasix); methicillin (Staphcillin); nitrates; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); penicillamine (Cuprimine, Depen); pentamidine (NebuPent); primaquine; rifampin (Rifadin, Rimactane); salicylate pain relievers; sulfonamides such as sulfamethoxazole and trimethoprim (Bactrim); thalidomide (Thalomid); and tacrolimus (Prograf). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you are being treated wtih radiation therapy and if you have or have ever had heart failure (condition in which the heart cannot pump enough blood to other parts of the body); anemia (condition in which red blood cells cannot bring enought oxygen to the other parts of the body); any condition that stops your blood from clotting normally; problems with your mouth, teeth, or gums; an infection, especially in your mouth; asthma, especially if it is made worse by aspirin; or kidney or liver disease.
- tell your doctor if you are pregnant. You should use a reliable method of birth control to prevent pregnancy while you are taking zoledronic acid. If you become pregnant while taking zoledronic acid, call your doctor. Talk to your doctor if you plan to become pregnant at any time in the future because zoledronic acid may remain in your body for years after you stop taking it. Do not breastfeed while you are taking zoledronic acid.
- you should know that zoledronic acid may cause serious problems with your jaws, especially if you have dental surgery or treatment while you are taking the medication. A dentist should examine your teeth and perform any needed treatments before you start to take zoledronic acid. Be sure to brush your teeth and clean your mouth properly while you are taking zoledronic acid. Talk to your doctor before having any dental treatments while you are taking this medication.

# What special dietary instructions should I follow
Unless your doctor tells you otherwise, continue your normal diet.

# What should I do if I forget a dose
If you miss an appointment to receive a zoledronic acid infusion, call your doctor as soon as possible.

# Side Effects

## Mild side effects
Zoledronic acid may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- redness or swelling in the place where you received your injection
- red, swollen, or teary eyes
- constipation
- upset stomach
- vomiting
- diarrhea
- stomach pain
- loss of appetite
- weight loss
- heartburn
- difficulty swallowing
- mouth sores
- pain anywhere in the body
- excessive worry
- agitation
- difficulty falling asleep or staying asleep
- white patches in the mouth
- swelling, redness, irritation, burning, or itching of the vagina
- white vaginal discharge
- hair loss

## Severe side effects
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
- fever, chills, and other signs of infection
- bone, joint, or muscle pain, and other flu-like symptoms
- rash
- itching
- chest pain
- coughing
- weakness
- muscle cramps
- fast, pounding, or irregular heartbeat
- dizziness
- depression
- difficulty walking
- seizures
- confusion
- leg swelling
- shortness of breath
- sudden tightening of muscles
- numbness, burning, or tingling in fingers or toes
- dry mouth
- decreased urination
- sunken eyes
- sluggishness
- headache
- pale skin
- unusual bruising or bleeding
- frequent urination, especially at night
- excessive thirst
- hallucinations (seeing things or hearing voices that do not exist)
- muscle weakness
- double vision
- difficulty speaking
- jaw or mouth pain
Zoledronic acid may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What storage conditions are needed for this medicine
Your doctor will store this medication in his or her office and give it to you as needed.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- fever
- tingling in hands or feet
- weakness
- muscle cramps
- fast, pounding, or irregular heartbeat
- dizziness
- depression
- difficulty walking
- seizures
- confusion
- shortness of breath
- sudden tightening of muscles
- numbness, burning, or tingling in fingers or toes
- muscle weakness
- double vision
- difficulty speaking

# What other information should I know
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to zoledronic acid.

# Brand names
- Zometa