Zoledronic Acid

Zoledronic Acid Uses, Dosage, Side Effects, Food Interaction and all others data.

Zoledronic Acid belongs to the class of nitrogen-containing bisphosphonates and acts primarily on bone. It is an inhibitor of osteoclast-mediated bone resorption. The action of bisphosphonates on bone is based on their high affinity for mineralized bone. Intravenously administered Zoledronic Acid is rapidly distributed to bone. The main molecular target of Zoledronic Acid in the osteoclast is the enzyme farnesyl pyrophosphate synthase, but this does not exclude other mechanisms. Clinical studies in tumour-induced hypercalcemia demonstrated that the effect of Zoledronic Acid is characterized by decreases in serum calcium and urinary calcium excretion. In addition to its inhibitory activity against bone resorption, Zoledronic Acid also possesses anti-tumour activity, anti-angiogenic activity, anti-pain activity, cytostatic and pro-apoptotic activity on tumour cells and synergistic cytostatic effect with other anti-cancer drugs. There was no accumulation of the active substance in plasma after multiple doses given every 28 days. Zoledronic Acid is not metabolized and is excreted unchanged via the kidney.

Zoledronic Acid is a third generation, nitrogen containing bisphosphonate that inhibits osteoclast function and prevents bone resorption. The therapeutic window is wide as patients are unlikely to suffer severe effects from overdoses and the duration of action is long. Patients should be counselled regarding the risk of electrolyte deficiencies, renal impairment, osteonecrosis of the jaw, atypical femoral fractures, bronchoconstriction, hepatic impairment, hypocalcemia, and embryo-fetal toxicity.

Trade Name Zoledronic Acid
Generic Zoledronic acid
Zoledronic acid Other Names ácido zoledrónico, Zoledronate, Zoledronic acid
Weight 4mg/100ml, 4mg/5ml, 5mg/100ml,
Type Intravenous Solution, Intravenous, Injection
Formula C5H10N2O7P2
Weight Average: 272.0896
Monoisotopic: 271.996323708
Protein binding

Zoledronic acid is 23-53% protein bound in plasma.

Groups Approved
Therapeutic Class Bisphosphonate preparations
Manufacturer Seacross Pharmaceuticals Ltd, Ferron Par Pharmaceuticals
Available Country United Kingdom, Canada, United States, Indonesia
Last Updated: September 19, 2023 at 7:00 am
Zoledronic Acid
Zoledronic Acid


Zoledronic Acid is used for:

  • Hypercalcaemia of malignancy,
  • Bone metastases associated with solid tumours, Osteolytic lesions associated with multiple myeloma,
  • Corticosteroid-induced osteoporosis, Increase bone mass in men with osteoporosis, Osteoporosis in postmenopausal women
  • Paget's disease of bone
  • Prophylaxis of postmenopausal osteoporosis

Zoledronic Acid is also used to associated treatment for these conditions: Bone Metastases, Hypercalcemia of Malignancy, Multiple Myeloma (MM), Osteoporosis, Osteoporosis caused by Glucocorticoid Treatment, Osteoporosis caused by glucocorticoid, Paget's Disease of Bone, Paget’s Disease, Bone Mineral Density

How Zoledronic Acid works

Bisphosphonates are taken into the bone where they bind to hydroxyapatite. Bone resorption by osteoclasts causes local acidification, releasing the bisphosphonate, which is taken into the osteoclast by fluid-phase endocytosis. Endocytic vesicles become acidified, releasing bisphosphonates into the cytosol of osteoclasts where they act.

Osteoclasts mediate resorption of bone. When osteoclasts bind to bone they form podosomes, ring structures of F-actin. Etidronic acid also inhibits V-ATPases in the osteoclast, though the exact subunits are unknown, preventing F-actin from forming podosomes. Disruption of the podosomes causes osteoclasts to detach from bones, preventing bone resorption.

Nitrogen containing bisphosphonates such as zoledronate are known to induce apoptosis of hematopoietic tumor cells by inhibiting the components of the mevalonate pathway farnesyl diphosphate synthase, farnesyl diphosphate, and geranylgeranyl diphosphate. These components are essential for post-translational prenylation of GTP-binding proteins like Rap1. The lack of prenylation of these proteins interferes with their function, and in the case of Rap1, leads to apoptosis. zoledronate also activated caspases which further contribute to apoptosis.


Zoledronic Acid dosage

Hypercalcemia of malignancy: The maximum recommended dose of Zoledronic Acid in hypercalcemia of malignancy (serum calcium 12 mg/dl or 3.0 mmol/l) is 4 mg. The 4 mg dose must be given as a single-dose intravenous infusion. Dose adjustment of Zoledronic Acid is not necessary in treating patients for hypercalcemia of malignancy presenting with mild-to-moderate renal impairment. Re-treatment with Zoledronic Acid may be considered if serum calcium does not return to normal after initial treatment. It is recommended that a minimum of 7 days elapse before re-treatment, to allow for full response to the initial dose.Multiple myeloma and bone metastases of solid tumors: The recommended dose of Zoledronic Acid in patients with multiple myeloma and metastatic bone lesions from solid tumors is 4 mg infused every 3-4 weeks. Patients should also be administered an oral calcium supplement of 500 mg and 400 IU of Vitamin-D daily.

Prior to administration, the required amount of concentrate from one vial must be further diluted with 100 ml of calcium-free infusion solution (0.9% w/v sodium chloride solution or 5% w/v glucose solution). The duration of infusion must not be less than 15 minutes. After addition of the solution to the infusion media, the infusion solution should be used as soon as possible. If storage of the infusion solution is necessary, hold at 2-8º C for not more than 24 hours. If refrigerated, the solution must be allowed to reach room temperature before administration.Zoledronic Acid must not be mixed with calcium or other divalent cation-containing infusion solutions, such as Lactated Ringer's solution, and should be administered as a single intravenous solution in a line separate from all other drugs.

Side Effects

The post-dose side-effects are headache, nausea, anorexia, fatigue, osteonecrosis of jaw, anemia, bone pain, constipation, fever, vomiting, flu-like syndrome, hypocalcemia, myalgia, arthralgia and hypophosphataemia.


Patients experiencing an overdose may present with renal impairment, hypocalcemia, hypophosphatemia, and hypomagnesemia. Overdose should be managed through intravenous administration of the insufficient ions.


Patients must be appropriately hydrated prior to administration of Zoledronic Acid. This is especially important in the elderly and for patients receiving diuretic therapy. Adequate hydration can be achieved by the patient drinking two glasses of fluid (such as water) before and after the infusion. Serum levels of calcium, phosphate, magnesium and potassium, as well as serum creatinine should be carefully monitored after initiating Zoledronic Acid therapy. If hypocalcemia, hypophosphatemia or hypomagnesemia occurs, short-term supplemental therapy may be necessary. Moreover, careful renal function monitoring should be considered.


In clinical studies, Zoledronic Acid has been administered concomitantly with commonly used anticancer agents, diuretics, antibiotics and analgesics without interactions. Caution is advised when Zoledronic Acid are administered with aminoglycosides, since these agents may have an additive effect to lower serum calcium level for prolonged periods. In multiple myeloma patients, the risk of renal dysfunction may be increased when Zoledronic Acid is used in combination with thalidomide. Concomitant use of loop diuretics with Zoledronic Acid increases the risk of hypocalcemia. Caution is indicated when Zoledronic Acid is used with other potentially nephrotoxic drugs.

Food Interaction

No interactions found.

Elimination Route

A 4mg intravenous dose reaches a Cmax of 370±78.5ng/mL, with a Tmax of 0.317±0.014h, and an AUC of 788±181ng*h/mL. A 5mg intravenous dose reaches a Cmax of 471±76.1ng/mL, with a Tmax of 0.368±0.005h, and an AUC of 917±226ng*h/mL.

Half Life

Zoledronic Acid has a terminal elimination half life of 146 hours.


Zoledronic Acid has a renal clearance of 3.7 ± 2.0 L/h.

Elimination Route

Zoledronic Acid is 39 ± 16% eliminated in the urine as the unmetabolized parent drug.

Pregnancy & Breastfeeding use

Zoledronic Acid is contraindicated during pregnancy and in breast-feeding women. It is also not recommended for use in children and adolescents below 18 years of age.


The drug is contraindicated if patients have hypersensitivity to the active substance or to any of the excipients or to any bisphosphonates; severe renal impairment (Creatinine clearance <30 ml/min); pregnancy and lactation.

Special Warning

Patients with renal impairment: The use of Zoledronic Acid is not recommended in patients with severe renal impairment (Creatinine clearance <30 ml/min). No dose adjustment is necessary in patients with creatinine clearance >60 ml/min. Based on creatinine clearance the following dose should be used in patient with impaired renal function:

  • CrCl > 60 ml/min: 4 mg (5 ml)
  • CrCl 50-60 ml/min: 3.5 mg (4.4 ml)
  • CrCl 40-49 ml/min: 3.3 mg (4.1 ml)
  • CrCl 30-39 ml/min: 3 mg (3.8 ml)

Acute Overdose

Clinical experience with acute over dosage is limited. Over dosage may cause hypocalcemia, hypophosphatemia, and hypomagnesemia. In such case, reduction in serum levels of calcium, phosphorus, and magnesium should be corrected by intravenous administration of calcium gluconate, potassium or sodium phosphate and magnesium sulfate respectively.

Storage Condition

Store below 30° C prior to opening. Protect from moisture and light. Zoledronic Acid must be kept out of the reach and sight of children.

Innovators Monograph

You find simplified version here Zoledronic Acid

Zoledronic Acid contains Zoledronic acid see full prescribing information from innovator Zoledronic Acid Monograph, Zoledronic Acid MSDS, Zoledronic Acid FDA label


What is the use of Zoledronic Acid?

Zoledronic Acid is used to treat high blood calcium levels  that may occur with cancer.Zoledronic Acid is also used with cancer chemotherapy to treat bone problems that may occur with multiple myeloma and other types of cancer (such as breast, lung) that have spread to the bones.

How safe is Zoledronic Acid?

Zoledronic Acid had an acceptable safety profile; no adverse events were considered to be drug related. Treatment with Zoledronic Acid improved bone health by enhancing bone mineral density and reducing bone turnover, even in high-risk patients.

How effective is Zoledronic Acid?

Zoledronic Acid was significantly more effective than placebo on most efficacy measures in patients with bone metastases secondary to other solid tumours and showed sustained efficacy for up to 15 months.

What are the long term side effects of Zoledronic Acid?

  • Blurred vision or other change in vision.
  • decreased frequency or amount of urine.
  • decreased vision.
  • eye pain.
  • eye tenderness.
  • heavy jaw feeling.
  • increased blood pressure.
  • increased tearing.

How fast does Zoledronic Acid work?

Zoledronic Acid can take 2 to 3 months before you notice the full effects.

Does Zoledronic Acid affect my teeth?

If you are having dental procedures while receiving this Zoledronic Acid, you may have an increased chance of having a severe problem with your jaw.

Does Zoledronic Acid cause bone pain?

Zoledronic Acid can cause bone, joint and/or muscle pain that can be severe. This can occur from 1 day to several months after starting the medication.

Does Zoledronic Acid affect my immune system?

Zoledronic Acid can affects the immune system and inflammation, and both of those are important in fighting infection and cardiovascular disease.

Does Zoledronic Acid affect kidneys?

Zoledronic Acid is associated with reports of renal impairment and renal failure, especially in patients with pre-existing renal dysfunction or other risk factors. Renal function should be measured before each dose, and patients should be adequately hydrated before treatment.

Does Zoledronic Acid strengthen bones?

Zoledronic Acid is an osteoporosis medication prescribed to help strengthen your bones and reduce your risk of breaking a bone. It is available as an annual intravenous infusion (drip).Brand is a 'bisphosphonate' - a group of medications that work by slowing down the cells that break down bone.

Why is Zoledronic Acid given once a year?

Zoledronic Acid is given once a year as an intravenous (IV) infusion to treat osteoporosis. It is also given every two years as an IV infusion to prevent osteoporosis. Zoledronic Acid increases bone density and reduces the incidence of the spine and non-spine fractures, including hip fractures.

How long does a Zoledronic Acid infusion take?

The infusion time must not be less than 15 minutes and the infusion rate should be constant.

Does Zoledronic Acid cause atrial fibrillation?

Zoledronic Acid is associated with a 25% increased risk of atrial fibrillation during its first year of use for osteoporosis compared to treatment with denosumab.

What happens after Zoledronic Acid infusion?

The majority of the side effects, such as fever and chills, pain in the muscles or joints, and headache, occur within the first three days following the dose of Zoledronic Acid 5 mg. The symptoms are usually mild to moderate and go away within three days.

How long does Zoledronic Acid stay in my body?

Zoledronic Acid medication is a long-acting drug. As such, it stays in your body longer than 12 months (probably more than 24 months).

How do I give Zoledronic Acid injection?

Zoledronic Acid(5 mg in 100 ml ready-to-infuse solution) is administered via a vented infusion line and given slowly at a constant infusion rate. The infusion time must not be less than 15 minutes.

Can Zoledronic Acid be taken orally?

Reclast and Zometa Zoledronic Acid are administered by intravenous (IV) injection once a year. The other bisphosphonates come in pills, taken orally.

Does Zoledronic Acid make me tired?

Zoledronic Acid may cause changes in the blood. For example, it can cause low levels of red blood cells (anaemia). Symptoms of anaemia include feeling very tired and breathless.

Does Zoledronic Acid affect the heart?

Patients treated with Zoledronic Acid had a higher risk for heart failure, among other cardiovascular conditions, according to a study presented at the American Society for Bone and Mineral Research (ASBMR) 2017 Annual Meeting held September 8-11 in Denver, Colorado.

Does Zoledronic Acid cause diarrhea?

Oral non-aminobisphosphonates are known to cause diarrhoea that is usually mild and self-limited.

Is Zoledronic Acid a chemo drug?

Zoledronic Acid is not cancer chemotherapy.Zoledronic Acid is in a class of medications called bisphosphonates.

How soon does Zoledronic Acid start working?

Zoledronic Acid can take 2 to 3 months before you notice the full effects. If you are having Zoledronic Acid to lower calcium levels in your blood, it is usually given as a single dose.

*** Taking medicines without doctor's advice can cause long-term problems.