Zoledronic acid (Zometa®)

OncoLink
Last Modified: March 24, 2011

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Facts about zoledronic acid

Cancer cells from some tumors (most commonly breast, prostate and lung cancers) can spread to the bone, which is called bone metastasis. Multiple myeloma is a type of cancer affecting plasma cells, which are found in the bone marrow, and thus directly involves bone. In both of these situations, the cancer cells cause breakdown or wearing away of normal bone. In turn, affected bones become more fragile; they may be painful and can even break due to the damage from the cancer cells. Zoledronic acid is a type of drug called a bisphosphonate, which is used to slow the destruction of bone caused by cancer cells.

How to take zoledronic acid

Zoledronic acid is given directly into a vein as an infusion, over 15 minutes, every 3-4 weeks. In addition, your healthcare provider may want you to take calcium and vitamin D supplements to help with your bone health. Talk with your team about what doses are right for you. You should drink plenty of fluids while taking this medication. Try to drink 8-10 glasses of non-alcoholic, non-caffeinated liquids a day.

Side effects of zoledronic acid

Some of the possible side effects and suggestions for dealing with them include:

Fever, Body Aches

More than half of the people receiving this medication experience fever and chills after the first infusion, which may be accompanied by muscle aches (also called myalgias). Anti-inflammatory medications, such as ibuprofen (Motrin) and naproxen (Aleve) may be used to relieve these side effects. Ask your healthcare team if you are able to take these medications if side effects occur. Many patients do not have these side effects after subsequent infusions.

Changes in Laboratory Values

Zoledronic acid can cause imbalances in the electrolytes calcium, magnesium and phosphorus. This medication can also affect the kidneys, causing a rise in serum creatinine (a laboratory value that measures kidney function). Your healthcare team will periodically check these levels with blood tests and may give you supplemental electrolytes or reduce the dose of this medication.

Fatigue

See OncoLink's section on fatigue for helpful tips.

Osteonecrosis of the Jaw and Good Oral Hygiene

Osteonecrosis of the jaw (ONJ) is a rare side effect, however, it is important that you know about it and take steps to protect your dental health. The maxilla (upper jaw bone) and mandible (lower jaw bone) are normally covered by gum tissue. In the case of ONJ, this tissue is gone and the bone is exposed. Typical symptoms associated with ONJ are: pain, swelling or infection of the gums, loosening of the teeth, exposed bone (often at the site of a previous tooth extraction). Some patients may report numbness or tingling in the jaw or a "heavy" feeling jaw. ONJ may have no symptoms for weeks or months and may only be recognized by the presence of exposed bone. ONJ most often occurs soon after a dental procedure, but this is not required for ONJ to occur.

  • Prior to starting therapy with zoledronic acid, you should have a complete dental exam, cleaning, and removal of any teeth in poor health.
  • Dentures should be checked for proper fit.
  • Brush your teeth after meals and at bedtime with a soft brush. Floss gently once a day. If your gums bleed, talk with your healthcare team to see if you can continue to floss.
  • Check your teeth and gums in a mirror daily for any sores, swelling, loose teeth, pain or numbness, or other changes and report these to your dentist or oncology team immediately.
  • Avoid any dental surgery or invasive dental procedures while on bisphosphonate therapy.


News
Bone-modifying agent added; preventive dental treatment to avoid complications recommended

Feb 25, 2011 - The American Society of Clinical Oncology has issued updated guidelines for the use of bone-modifying agents in treating breast cancer patients with bone metastases to include a new drug, denosumab, and provide new advice regarding a potentially serious complication of treatment, osteonecrosis of the jaw; an overview of the guideline update has been published online Feb. 22 in the Journal of Clinical Oncology.



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