ZOLEDRONIC ACID
(zo-le-dron′ic)
Aclasta , Reclast, Zometa
Classifications: BISPHOSPHONATE; BONE METABOLISM REGULATOR
Therapeutic: BONE METABOLISM REGULATOR
Prototype: Etidronate disodium
Pregnancy Category: D
AVAILABILITY
Solution for injection
ACTION & THERAPEUTIC EFFECT
Zoledronic acid inhibits various stimulatory factors of osteoclastic activity produced by bone tumors. It also induces osteoclast apoptosis. Zoledronic acid blocks osteoclastic resorption of bone, thus reducing the amount of calcium released from bone.
USES
Treatment of hypercalcemia of malignancy, multiple myeloma, and bony metastases from solid tumors, Paget’s disease (Reclast), postmenopausal or glucocorticoidinduced osteoporosis (Reclast).
CONTRAINDICATIONS
Hypersensitivity to zoledronic acid or other bisphosphonates; preexisting hypocalcemia; serum creatinine less than 35 ml/min; pregnancy (category D); lactation.
CAUTIOUS USE
Aspirin-sensitive asthma; cancer chemotherapy; renal and/or hepatic impairment; dental work; multiple myeloma; older adults. Safety and effectiveness in children have not been established.
ROUTE AND DOSAGE
Hypercalcemia of Malignancy (Zometa)
Adult:
IV 4 mg over a minimum of 15 min. May consider retreatment if serum calcium has not returned to normal, may repeat after 7 days
Multiple Myeloma and Bony Metastases from Solid Tumors (Zometa)
Adult: IV 4 mg over a minimum of 15 min q3–4wk
Osteoporosis (Reclast)
Adult: IV 5 mg infusion once/year
Osteoporosis Prophylaxis in Postmenopausal Women
Adult: IV 5 mg every other year
Paget’s Disease (Reclast)
Adult: IV 5 mg dose, retreatment may be necessary
Renal Impairment Dosage Adjustment (Zometa)
CrCl 50–60 mL/min: 3.5 mg; 40–49 mL/min: 3.3 mg; 30–39mL/min: 3 mg; less than 30 mL/ min: Do not use
Renal Impairment Dosage
Intravenous
Do not administer to anyone who is dehydrated or suspected of being dehydrated. Consult prescriber.
- Do not administer zoledronic acid unless patient is adequately rehydrated.
- Do not administer until serum creatinine values have been evaluated by the prescriber.
PREPARE: IV Infusion:
Injection Concentrate: Withdraw required dose from the 4 mg/5 mL vial and dilute in 100 mL of D5W or NS. DO NOT use lactated Ringer’s solution.
- If not used immediately, refrigerate. The total time between reconstitution and end of infusion must not exceed 24 h.
ADMINISTER: IV Infusion:
Infuse a single dose over NO LESS than 15 min.
INCOMPATIBILITIES:
Solution/additive and Y-site: Do not mix or infuse with calcium-containing solutions (e.g., lactated Ringer’s).
- Store at 2°–8° C (36°–46° F) following dilution.
- Must be completely infused within 24 h of reconstitution
ADVERSE EFFECTS
(≥1%) Body as a Whole: Fever, flu-like syndrome, redness and swelling at injection site, asthenia, chest pain, leg edema, mucositis, rigors. CNS: Insomnia, anxiety, confusion, agitation, headache, somnolence. CV: Hypotension. GI: Nausea, vomiting, constipation, abdominal pain, anorexia, dysphagia. Hematologic: Anemia, granulocytopenia, thrombocytopenia, pancytopenia. Metabolic: Hypophosphatemia, hypokalemia, hypomagnesemia, hypocalcemia, dehydration. Musculoskeletal: Skeletal pain, arthralgias, osteonecrosis of the jaw in cancer patients. Respiratory: Dyspnea, cough, pleural effusion. Skin: Alopecia, dermatitis. Urogenital: Renal deterioration (increase in Scr).
INTERACTIONS
Drug: LOOP DIURETICS may increase risk of hypocalcemia; thalidomide and other NEPHROTOXIC DRUGS may increase risk of renal toxicity.
PHARMACOKINETICS
Onset: 4–10 days. Duration: 3–4 wk. Metabolism: Not metabolized. Elimination: In urine. Half-Life: 146 h.
NURSING IMPLICATIONS
Assessment & Drug Effects
- Notify prescriber immediately of deteriorating renal function as indicated by rising serum creatinine levels over baseline value.
- Withhold zoledronic acid and notify prescriber if serum creatinine is not within 10% of the baseline value.
- Monitor closely patient’s hydration status. Note that loop diuretics should be used with caution due to the risk of hypocalcemia.
- Monitor for S&S of bronchospasm in aspirin-sensitive asthma patients; notify prescriber immediately.
- Montior lab tests: Baseline kidney function tests prior to each dose and periodically thereafter; periodic ionized calcium or corrected serum calcium levels, serum phosphate and magnesium, electrolytes, CBC with differential, Hct and Hgb. Patient & Family Education
- Maintain adequate daily fluid intake. Consult with prescriber for guidelines.
- Report unexplained weakness, tiredness, irritation, muscle pain, insomnia, or flu-like symptoms.
- Use reliable means of birth control to prevent pregnancy. If you suspect you are pregnant, contact prescriber immediately.
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