Zoledronic Acid (Intravenous)

Zoledronic acid injections are used to treat high levels of calcium in the blood, otherwise known as hypercalcemia.


Zoledronic acid is used primarily in the treatment of hypercalcemia (high levels of calcium in the blood stream) which patients with certain cancers may experience. The drug can also be used in the treatment of multiple myeloma (tumors that are formed in the cells of bone marrow) or in the cases of specific types of bone metastases (when cancer spreads into the bone).

Paget's disease of the bone can also be treated with annual injections of Zoledronic acid in both men and women. The injection is also frequently used in the treatment of osteoporosis in menopausal women - as well as men with osteoporosis - to help reduce the risk of bone fractures, also administered on an annual basis. It can also help patients with recent fractures who may be at risk of further fractures as a result of their injury (for example, hip fractures).

Zoledronic Acid injections work to lower high blood calcium levels by helping to reduce the amount of calcium released from your bones into your blood. It also helps to slow down, and, in some cases prevent, the complications arising from bone breakdown. Cancer cells which have spread to the bone can release a substance to create tumor cells in the bone called osteoclasts, which then eat away and dissolve, or break down, portions of the bone. When the bone has been attacked and broken down it can end up severely weakened, which can lead to further complications such as bone pain, breaks and fractures or even hypocalcemia.

Condition(s) treated?

  • multiple myeloma
  • certain types of bone metastases
  • Paget's disease of bone
  • osteoporosis

Type of medicine?

  • Injection, solution

Side Effects

It is important to note that most patients will not experience all of these side effects, they are usually completely predictable in terms of duration and effect and almost always reversible once treatment has been completed.

Common side effects include the following:

  • Ostealgia
  • Nausea
  • Fever which is usually quite mild and short-lived
  • Fatigue
  • Anaemia
  • Vomiting
  • Constipation
  • Flu-like symptoms; mild fever, chills, fatigue, and flushing. This usually only occurs with first treatment and will pass quite quickly.

Less common side effects include the following:

  • Shortness of breath
  • Diarrhea
  • Weakness
  • Muscle pain
  • Loss of appetite
  • Cough
  • Lower extremity swelling
  • Joint pain
  • Headaches
  • Dizziness
  • Decreased kidney function
  • Trouble with sleeping
  • Abdominal pain
  • Weight loss
  • Tingling or prickling sensations
  • Anxiety
  • Depression
  • Dehydration
  • Urinary tract infection
  • Confusion
  • Hypophosphatemia (low phosphorus in the blood)
  • Hypoesthesia (reduced sense of touch or sensation)
  • Hair loss
  • Low potassium in the blood
  • Low blood counts
  • Yeast infections
  • Bone pain
  • Low blood pressure
  • Chills
  • Rash
  • Low magnesium in the blood
  • Cold symptoms
  • Upper respiratory infection
  • Heartburn
  • Chest pain
  • Hypocalcaemia (low calcium in the blood)
  • Trouble Swallowing
  • Mouth sores
  • Infections

It is important to note that, while very rarely seen, this medicine may cause jawbone problems such as osteonecrosis of the jaw. The chances of this occurring may be increased if this medicine is taken for long durations of time. The chances may also be higher if you have cancer, dental problems or dentures that do not fit well. It is also higher risk if you suffer from anemia, issues which affect your blood clotting correctly or an infection. The chances may also be higher if you are currently undergoing any dental work, getting chemotherapy, radiation therapy or taking any other drugs that may cause jawbone problems, for example, specific steroid drugs.

To help to reduce your risk of serious complications, your doctor will advise you to:

  • have a full dental check-up before you start your treatment
  • make sure to take care of your teeth and gums during treatment (always ask your dentist for further advice as well)
  • Be sure to tell your dentist that you are taking zoledronic acid before having any dental treatment.

Ask your doctor or pharmacist if you are not sure. Call your doctor right away if you have jaw swelling or pain.


Zoledronic Acid can only be administered by or under the direction and supervision of a doctor and comes in two forms:

  • Solution
  • Powder for solution

Zoledronic Acid is given as an infusion into a vein over a certain period of time. Acetaminophen may also be administered to lower fever and chills. It is advised that you stay hydrated and drink plenty of noncaffeinated drinks before and after treatment, unless told otherwise by your doctor.

A nurse, doctor or another trained health professional will prescribe and give you this medicine. This medicine is given through a needle placed in one of your veins and must be injected slowly into the blood, meaning your IV tube will have to remain in place for at least 15 minutes.

For the treatment of hypercalcemia, this medicine is usually administered only once. If your doctor feels that you need additional doses, you will receive more medicine again after at least a week has passed. Treatment typically will continue until your body responds to the medicine.

For the treatment of bone cancer and multiple myeloma, this medicine is usually administered every three or four weeks. Treatment typically will continue until your body responds to the medicine.

For the treatment of osteoporosis, this medicine is usually administered as a 5mg infusion once a year and treatment typically will continue until your body responds to the medicine.

For the treatment of Paget's disease of bone, this medicine also usually administered as a 5mg infusion once a year and treatment typically will continue until your body responds to the medicine.

Your doctor may also administer other vitamins usually containing Vitamin D and calcium. Tell your doctor if you are unable to take these supplements.

The doctor may also give you other medicines to help keep your body from losing too much fluid. Before and after your treatment, be sure to drink extra fluids so you will pass more urine while you are using this medicine. This extra fluid will keep your kidneys working well and help prevent kidney problems. However, it is very important to not drink too much liquid. Be sure to discuss with your doctor what the right amount of liquids are for you.

This medicine comes with a Medication Guide and it is very important that you read and understand this information. Always be sure to ask your doctor about anything you do not understand.


Taking multiple drugs can cause interactions which may change how all your medications work or could increase your risk for more serious side effects. It is important to note that this document does not contain every possible drug interaction and you should discuss any other medications you take with your doctor. Ensure you keep a list of all the products you use (including all prescription and non-prescription drugs, as well as any herbal products you may take) and share it with your doctor and pharmacist. You must not start, change or stop the dosage of any prescribed medicines without your doctor's approval.

While using this medication, you should make sure you are not treated with other bisphosphonates, including other brands of zoledronic acid used to prevent or treat bone loss (osteoporosis).

Some products that may interact with this drug include calcium-containing IV fluids, "water pills" (diuretics such as bumetanide, furosemide).

Also tell your doctor or pharmacist of drugs that may be harmful to your kidneys such as aminoglycoside antibiotics (e.g., gentamicin, tobramycin), amphotericin B, nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen), tacrolimus.

There is a total of 34 major drug interactions known with Zoledronic Acid, and as such, it is advised against using the following medications while you are treated with Zoledronic Acid:

  • AccessPak for HIV PEP Expanded with Kaletra (emtricitabine / lopinavir / ritonavir / tenofovir)
  • AccessPak for HIV PEP Expanded with Viracept (emtricitabine / nelfinavir / tenofovir)
  • Angiografin (diatrizoate)
  • Astagraf XL (tacrolimus)
  • Atripla (efavirenz / emtricitabine / tenofovir)
  • BabyBIG (botulism immune globulin)
  • Bivigam (immune globulin intravenous)
  • botulism immune globulin
  • Cardiografin (diatrizoate)
  • Carimune (immune globulin intravenous)
  • Carimune NF (immune globulin intravenous)
  • Cholografin Meglumine (iodipamide)
  • cidofovir
  • Conray (iothalamate)
  • Conray-30 (iothalamate)
  • Conray-400 (iothalamate)
  • Conray-43 (iothalamate)
  • Cysto-Conray (iothalamate)
  • Cysto-Conray II (iothalamate)
  • Cystografin (diatrizoate)
  • Cystografin-Dilute (diatrizoate)
  • CytoGam (cytomegalovirus immune globulin)
  • cytomegalovirus immune globulin
  • deferasirox
  • diatrizoate
  • diatrizoate / iodipamide
  • efavirenz / emtricitabine / tenofovir
  • emtricitabine / lopinavir / ritonavir / tenofovir
  • emtricitabine / nelfinavir / tenofovir
  • Envarsus XR (tacrolimus)
  • etelcalcetide
  • Exjade (deferasirox)
  • Flebogamma (immune globulin intravenous)
  • Gamimune (immune globulin intravenous)
  • Gamimune N 10% (immune globulin intravenous)
  • Gamimune N 5% (immune globulin intravenous)
  • Gammagard (immune globulin intravenous and subcutaneous)
  • Gammagard S / D (immune globulin intravenous)
  • Gammaked (immune globulin intravenous and subcutaneous)
  • Gammaplex (immune globulin intravenous)
  • Gammar IV (immune globulin intravenous)
  • Gammar-P I.V. (immune globulin intravenous)
  • Gamunex (immune globulin intravenous)
  • Gamunex-C (immune globulin intravenous and subcutaneous)
  • Gastrografin (diatrizoate)
  • Hecoria (tacrolimus)
  • Hexabrix (ioxaglate)
  • Hypaque (diatrizoate)
  • Hypaque Cysto (diatrizoate)
  • Hypaque Meglumine (diatrizoate)
  • Hypaque Sodium (diatrizoate)
  • Hypaque-76 (diatrizoate)
  • Hypaque-M (diatrizoate)
  • immune globulin intravenous
  • immune globulin intravenous and subcutaneous
  • iodamide
  • iodipamide
  • iodixanol
  • iohexol
  • iopamidol
  • Iopamidol-370 (iopamidol)
  • iopromide
  • iothalamate
  • ioversol
  • ioxaglate
  • ioxilan
  • Isovue-128 (iopamidol)
  • Isovue-200 (iopamidol)
  • Isovue-250 (iopamidol)
  • Isovue-300 (iopamidol)
  • Isovue-370 (iopamidol)
  • Isovue-M-200 (iopamidol)
  • Isovue-M-300 (iopamidol)
  • Iveegam En (immune globulin intravenous)
  • Jadenu (deferasirox)
  • Jadenu Sprinkle (deferasirox)
  • MD-76 (diatrizoate)
  • MD-76 R (diatrizoate)
  • MD-Gastroview (diatrizoate)
  • metrizamide
  • Myelo-Kit (iohexol)
  • Octagam (immune globulin intravenous)
  • Omnipaque 140 (iohexol)
  • Omnipaque 180 (iohexol)
  • Omnipaque 180 Redi-Unit (iohexol)
  • Omnipaque 210 (iohexol)
  • Omnipaque 240 (iohexol)
  • Omnipaque 240 Redi-Unit (iohexol)
  • Omnipaque 300 (iohexol)
  • Omnipaque 350 (iohexol)
  • Omnipaque Flexipak (iohexol)
  • Optiray 160 (ioversol)
  • Optiray 240 (ioversol)
  • Optiray 300 (ioversol)
  • Optiray 320 (ioversol)
  • Optiray 350 (ioversol)
  • Oraltag (iohexol)
  • Oxilan (ioxilan)
  • Panglobulin (immune globulin intravenous)
  • Panglobulin NF (immune globulin intravenous)
  • Parsabiv (etelcalcetide)
  • Polygam S / D (immune globulin intravenous)
  • Privigen (immune globulin intravenous)
  • Prograf (tacrolimus)
  • Rapamune (sirolimus)
  • Reno-30 (diatrizoate)
  • Reno-60 (diatrizoate)
  • Reno-Dip (diatrizoate)
  • Reno-M-30 (diatrizoate)
  • Reno-M-60 (diatrizoate)
  • Reno-M-DIP (diatrizoate)
  • Renocal-76 (diatrizoate)
  • Renografin-60 (diatrizoate)
  • Renografin-76 (diatrizoate)
  • Renovist (diatrizoate)
  • Renovist II (diatrizoate)
  • Renovue-65 (iodamide)
  • Renovue-Dip (iodamide)
  • RespiGam (respiratory syncytial virus immune globulin)
  • respiratory syncytial virus immune globulin
  • Sandoglobulin (immune globulin intravenous)
  • Sinografin (diatrizoate / iodipamide)
  • sirolimus
  • tacrolimus
  • Ultravist (iopromide)
  • Urografin 150 (diatrizoate)
  • Urografin 325 (diatrizoate)
  • Urografin 370 (diatrizoate)
  • Urovison (diatrizoate)
  • Venoglobulin-S 10% (immune globulin intravenous)
  • Venoglobulin-S 5% (immune globulin intravenous)
  • Visipaque (iodixanol)
  • Vistide (cidofovir)


If you have any other medical problems, make sure you notify your doctor before they administer this medicine. This is especially important for the following issues:

  • Anaemia
  • Aspirin-sensitive Asthma
  • Bleeding problems
  • Bowel resection
  • Dehydration which may increase the risk of severe kidney problems.
  • Dental problems
  • Dental procedures
  • History of cancer
  • Heart disease
  • Hypocalcemia (lower levels of calcium in the blood)
  • Kidney disease
  • Poor oral hygiene
  • Mineral imbalances - especially high or low calcium, magnesium, phosphorus or potassium in the blood. This medicine should be used with caution as it may make these conditions worse.
  • Parathyroid disease (eg, hypoparathyroidism)
  • Parathyroid surgery
  • Surgery especially dental surgery as this may increase the risk of severe jaw problems.
  • Stomach absorption problems
  • Thyroid surgery - This may increase your risk of having hypocalcemia (lower levels of calcium in the blood).
  • Severe kidney disease (kidney failure) - Should not be used in patients with this condition.

If any of the following side effects occur during or after use, contact your doctor immediately:

  • Signs of an allergic reaction, which include rashes, hives, skin itching, skin that is red, swollen, blistered or peeling with or without a fever, wheezing, tightness of the chest or throat, difficulty breathing or speaking, unusual hoarseness or swelling of or around the mouth, face, lips, tongue or throat
  • Signs of low calcium levels such as muscle cramps and spasms, unusual numbness, tingling or seizures.
  • Signs of kidney problems such as an inability to pass urine, a significant change in how much urine is passed, the presence of blood in the urine or an unexpectedly large weight gain.
  • Very bad bone, muscle or joint pain.
  • New or unusual groin, hip, or thigh pain.
  • Chest pains
  • Faster, slower or abnormal feeling heartbeat
  • Changes in eyesight such as blurriness, pain in the eye or unusual or painful eye irritation
  • Sores around or inside of the mouth
  • Difficulties with swallowing or swallowing has become very painful
  • High fever or unexplained chills.
  • Sore throat.
  • Unexplained bruising or bleeding.
  • Feeling very lethargic and weak
  • Sudden or extreme mood changes.
  • Localised pain at the site where the shot was administered.
  • Unusual redness or swelling at the site where the shot is given.
  • Any weakness to one side of the body, trouble talking or thinking clearly, a change in balance, drooping to one side of the face, or blurred eyesight.
  • Call your doctor right away if you have jaw swelling or pain.

Zoledronic acid may be harmful to the foetus, so it is not advised for use during pregnancy or breastfeeding. Any women who are pregnant or become pregnant must inform their doctor immediately.

It is not advised to give Zoledronic acid injections to children.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, you should call a poison control center right away. US residents should call their local poison control center on 1-800-222-1222. Canadian residents should call a provincial poison control center. The symptoms of overdose may include a change in the amount of urine, muscle spasms or weakness, mental or mood changes, faster, slower or irregular heartbeat and seizures.


Zoledronic acid is mostly administered by a healthcare professional. However, if you need to store zoledronic acid at home, you should discuss storage with your doctor, nurse, or pharmacist.


Zoledronic acid belongs to a particular class of drugs known as bisphosphonates. It works by lowering the high blood calcium levels by helping to reduce the amount of calcium released from your bones into your blood. It also works by helping to slow the breakdown of your bones by cancer which can help to prevent future bone fractures. Using this medication can help to strengthen the affected bones and reduce your pain. It can also help to bring calcium levels in the blood back to normal.

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

This can help strengthen the bones and reduce pain. It can also help to bring blood levels of calcium back to normal.

It is important to discuss all medication with a medical professional and discuss your current circumstances before starting any new treatments and be sure to discuss any forthcoming dental work with both your dentist and doctor while taking Zoledronic acid.

Last Reviewed:
December 22, 2017
Last Updated:
April 26, 2018
Content Source: