ZOLEDRONIC ACID (RECLAST, ZOMETA, GENERIC)
USES: *Hypercalcemia of malignancy (HCM), ↓ skelet al-related events in community-acquired pneumonia, multiple myeloma, & metastatic bone lesions (Zometa)*; *prevent/Treat of postmenopausal osteoporosis, Paget disease, ↑ bone mass in men w/ osteoporosis, steroid-induced osteoporosis (Reclast).*
ACTIONS: Bisphosphonate; ↓ osteoclastic bone resorption.
DOSE: Zometa HCM: 4 mg IV over ≥15 min; may retreat in 7 days w/ adequate renal function. Zometa bone lesions/myeloma: 4 mg IV over >15 min, repeat q3–4wk PRN; extend w/ ↑ Cr. Reclast Treat osteoporosis: 5 mg IV annually. Reclast: Prevent postmenopausal osteoporosis 5 mg IV q2y. Paget: 5 mg IV × 1.
W/P: [D, ?/−] w/ Diuretics, aminoglycosides; ASA-sensitive asthmatics; avoid invasive dental procedures.
CI: Bisphosphonate allergy; hypocalcemia, angioedema, CrCl <35.
DISP: Vial 4 mg, 5 mg.
SE: Fever, flu-like syndrome, GI upset, insomnia, anemia; electrolyte abnormalities, bone, joint and muscle pain, AF, ONJ, atyp femur Fx.
NOTES: Requires vigorous prehydration; do not exceed rec doses/Inf duration to ↓ renal dysfunction; follow Cr; effect prolonged w/ Cr ↑; avoid oral surgery; dental exam recommended prior to Treat; ↓ dose w/ renal dysfunction; give Ca2+ and vit D supls; may ↑ atypical subtrochanteric femur fractures.
