Zolendronic Acid

Indications

Zolendronic Acid is used for: Hypercalcaemia of malignancy, Bone malignancies , Paget's disease of bone, Postmenopausal osteoporosis

Adult Dose

Intravenous Hypercalcaemia of malignancy Adult: 4 mg as a single infusion over at least 15 min. Re-treatment: 4 mg after at least 7 days if necessary. Co-admin oral Ca 500 mg and vit D 400 IU daily. Bone metastases associated with solid tumours; Osteolytic lesions associated with multiple myeloma Adult: 4 mg by infusion over at least 15 min 3-4 wkly. Co-admin oral Ca 500 mg and vit D 400 IU daily. Paget's disease of bone Adult: 5 mg as a single infusion over 15 min. Patients should receive elemental Ca 1,500 mg and vit D 800 IU daily particularly w/in 2 wk after admin. Patients who have relapsed: May be given an additional infusion of 5 mg after an interval of at least 1 yr from the initial dose. Osteoporosis in postmenopausal women; Increase bone mass in men with osteoporosis; Corticosteroid-induced osteoporosis Adult: 5 mg as a single infusion over at least 15 min, once yrly, w/ adequate Ca and vit D intake. Patients w/ low-trauma hip fracture: Start 2 or more wk after hip fracture repair w/ a loading dose of vit D 50,000-125,000 IU given orally or by IM route prior to 1st infusion. Prophylaxis of postmenopausal osteoporosis Adult: 5 mg as a single infusion once every 2 yr.

Child Dose

Renal Dose

Bone metastases associated with solid tumours; Osteolytic lesions associated with multiple myeloma Renal impairment: CrCl (ml/min) Dosage Recommendation <30 Not recommended. 30-39 3 mg 3-4 wkly. 40-49 3.3 mg 3-4 wkly. 50-60 3.5 mg 3-4 wkly. Paget's disease of bone, Osteoporosis Renal impairment: CrCl (ml/min) Dosage Recommendation <35 Contraindicated.

Administration

Reconstitution: Dilute the required amount in 100 mL of NaCl 0.9% or dextrose 5%.

Contra Indications

The drug is contraindicated if patients have hypersensitivity to the active substance or to any of the excipients or to any bisphosphonates, hypocalcaemia, renal impairment (creatinine clearance <35 mL/min), current or recent uveitis, or a history of bisphosphonate-associated uveitis, pregnancy and lactation.

Precautions

Patient w/ aspirin-sensitive asthma. Mild to moderate renal impairment. Pregnancy. Patient Counselling This drug may cause dizziness, if affected, do not drive or operate machinery. Adequately hydrate patients prior to admin. Ensure adequate Ca and vit D intake. Monitoring Parameters Monitor serum Ca, Mg, phosphate and electrolytes; haematocrit/Hb (oncology use); biochemical markers of bone turnover (non-oncology use). Prior to therapy, perform dental exam and preventive dentistry in patients at risk of osteonecrosis.

Pregnancy-Lactation

Interactions

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

Adverse Effects

Side effects of Zolendronic Acid : Arthralgia, fever, flu-like symptoms, myalgia, headache, pain in extremity, nausea, vomiting, diarrhoea, eye inflammation; alopecia, hyperhidrosis, bone/joint/muscle pain, osteonecrosis of the jaw, femoral fracture, hypersensitivity reactions (e.g. urticaria, angioedema), Stevens-Johnson syndrome, toxic epidermal necrolysis, hypotension. Potentially Fatal: Severe hypocalcaemia, severe kidney problems.

Mechanism of Action

Zoledronic acid, an aminobiphosphonate, is a potent inhibitor of bone resorption. It inhibits osteoclastic activity and skeletal calcium release caused by tumours.