Zoledronic acid (sometimes called zoledronate) is in a group of medicines called bisphosphonates (bis FOS fo nayts). Zoledronic acid inhibits the release of calcium from bones.

Zoledronic acid is used to treat high levels of calcium in the blood associated with malignancy (cancer). Zoledronic acid also treats Paget’s disease and multiple myeloma (a type of bone marrow cancer).

Zoledronic acid may also be used for purposes other than those listed in this medication guide.

Zoledronic acid is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting. The medicine must be given slowly through an IV infusion, and can take at least 15 minutes to complete.

Drink at least 2 glasses of water within a few hours before your injection to keep from getting dehydrated.

Your doctor may want you to take a calcium and/or vitamin D supplement while you are being treated with zoledronic acid. Carefully follow your doctor’s instructions about the type and strength of calcium to take.

To be sure this medication is helping your condition and not causing harmful side effects, your blood will need to be tested on a regular basis. Your kidney function may also need to be tested. It is important that you not miss any scheduled visits to your doctor.

Before receiving zoledronic acid, tell your doctor if you are using any of the following drugs:

• a diuretic (water pill) such as furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin), or torsemide (Demadex);

• an antibiotic such as amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), neomycin (Mycifradin, Neo-Fradin, Neo-Tab), netilmicin (Netromycin), streptomycin, tobramycin (Nebcin, Tobi);

• other medicines that can harm your kidneys, such as pentamidine (Nebupent), tacrolimus (Prograf), amphotericin B (Fungizone, AmBisome, Amphotec, Abelcet), capreomycin (Capastat), rifampin (Rifadin, Rimactane, Rifater), vancomycin (Vancocin, Vancoled), acyclovir (Zovirax), adefovir (Hepsera), cidofovir (Vistide), or foscarnet (Foscavir); or

• cancer medicine such as aldesleukin (Proleukin), carmustine (BiCNU, Gliadel), cisplatin (Platinol), ifosfamide (Ifex), oxaliplatin (Eloxatin), plicamycin (Mithracin), streptozocin (Zanosar), thalidomide (Thalomid), or tretinoin (Vesanoid).

If you are using any of these drugs, you may not be able to receive zoledronic acid, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect zoledronic acid. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Avoid having any type of dental surgery while you are being treated with zoledronic acid. It may take longer than normal for you to recover.

Seek emergency medical attention if you think you have received too much of this medicine. The symptoms of a zoledronic acid overdose may include numbness or tingling in your hands and feet, muscle stiffness, spasms in the muscles of your face, uneven heartbeats, and wheezing or trouble breathing.

Contact your doctor if you miss a dose of zoledronic acid.

Do not receive zoledronic acid without telling your doctor if you have had an allergic reaction to zoledronic acid or similar medicine such as alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel), or tiludronate (Skelid).

Do not use this medication without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Your doctor may recommend you have a dental exam for preventive tooth and gum care before you start your treatment with zoledronic acid. This is especially important if you have cancer, if you are undergoing chemotherapy or using steroids, or if you have poor dental health.

Some people using medicines similar to zoledronic acid have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms of this condition may include jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums. You may be more likely to develop osteonecrosis of the jaw if you have cancer or have been treated with chemotherapy, radiation, or steroids. Other conditions associated with osteonecrosis of the jaw include blood clotting disorders, anemia (low red blood cells), and pre-existing dental problems.

Avoid having any type of dental surgery while you are being treated with zoledronic acid. It may take longer than normal for you to recover.

You should not receive this medication if you are allergic to zoledronic acid or similar medicine such as alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel), or tiludronate (Skelid), or if you:

• have low levels of calcium in your blood; or

• if you are pregnant or breast-feeding.

Zometa and Reclast are two different brands of zoledronic acid. You should not be treated with Reclast if you are already receiving Zometa. Before receiving a Reclast injection, tell your doctor if you are already being treated with Zometa.

Before receiving zoledronic acid, tell your doctor if you have:

• asthma, or a sulfite allergy;

• a thyroid or parathyroid disorder;

• malabsorption syndrome (an inability to absorb food and nutrients properly);

• a history of surgical removal of part of your intestine;

• bone cancer; or

• kidney disease.

If you have any of these conditions, you may not be able to receive zoledronic acid, or you may need a dosage adjustment or special tests during treatment.

Your doctor may recommend you have a dental exam for preventive tooth and gum care before you start your treatment with zoledronic acid. This is especially important if you have cancer, if you are undergoing chemotherapy or using steroids, or if you have poor dental health.

Some people using medicines similar to zoledronic acid have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms of this condition may include jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums.

You may be more likely to develop osteonecrosis of the jaw if you have cancer or have been treated with chemotherapy, radiation, or steroids. Other conditions associated with osteonecrosis of the jaw include blood clotting disorders, anemia (low red blood cells), and dental surgery or pre-existing dental problems.

FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not receive zoledronic acid without telling your doctor if you are pregnant. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Zoledronic acid can pass into breast milk and may harm a nursing baby. Do not receive this medication without telling your doctor if you are breast-feeding a baby.

Your pharmacist has information about zoledronic acid written for health professionals that you may read.

Zoledronic acid is available with a prescription under the brand name Zometa. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.