Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: zoledronic acid

BRAND NAME: Reclast

DRUG CLASS AND MECHANISM: Zoledronic acid is an injectable drug belonging to a class of drugs called bisphosphonates that strengthen bone and are used primarily to treat osteoporosis. Zoledronic acid also is the active drug in Zometa.  Other injectable biphosphonates include etidronate (Didronate) and pamidronate (Aredia).  Bone is in a constant state of remodeling in which old bone is removed by cells called osteoclasts, and new bone is laid down by cells called osteoblasts. Zoledronic acid inhibits bone removal by osteoclasts. The FDA approved Reclast in August 2007.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Solution: 5 mg/100 ml

STORAGE: Unopened bottles should be kept at room temperature 15-30°C (59-86°F). Opened bottles of solution are stable for 24 hours at 2-8°C (36-46°F).

PRESCRIBED FOR: Zoledronic acid is used for treatment of osteoporosis in postmenopausal women and Paget's disease of bone in men and women.

DOSING: Zoledronic acid is given intravenously over no less than 15 minutes. Administration of acetaminophen or ibuprofen may reduce infusion related reactions.

• For treatment of postmenopausal osteoporosis, a single 5 mg infusion once a year is recommended.
   
• Paget's disease of bone is treated with a single 5 mg infusion. Patients with Paget's disease should also receive 1500 mg of elemental calcium and 800 IU vitamin D daily, especially during the 2 weeks after the injection of zoledronic acid.

DRUG INTERACTIONS: Combining zoledronic acid with aminoglycosides or loop diuretics may lead to reduced calcium in blood. Zoledronic acid should be used with caution in patients who are taking drugs that affect kidney function.

Since reclast contains the same active ingredient as Zometa (zoledronic acid), patients treated with Zometa should not receive Reclast.

PREGNANCY: Zoledronic acid should not be administered to pregnant women. Women of childbearing age should be advised to use a reliable method of birth control.

NURSING MOTHERS: It is not known whether zoledronic acid is excreted in human milk. Since many drugs are excreted in human milk, and zoledronic acid binds to bone long-term, zoledronic acid should not be administered to nursing women.

SIDE EFFECTS: The most common adverse reactions of zoledronic acid are fever, muscle pain, and headache, arthralgia, and pain in hands and feet. Severe bone, joint, and muscle pain may occur. Postmenopausal women treated with Reclast have rarely reported osteonecrosis (bone death) of the jaw.

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