Zoledronate (zoledronic acid)

What is zoledronate?

Zoledronate, or zoledronic acid, belongs to a family of medicines called bisphosphonates. Bisphosphonates slow down the rate of bone breakdown. Zoledronate increases bone strength and decreases bone pain. It may also help reduce the chance of fractures in children who have certain types of bone conditions, such as osteogenesis imperfecta or osteoporosis, or who have fragile bones from other causes, such as long-term steroid treatment.

You may hear zoledronate called by its brand name, Zometa. Zoledronate is given as an infusion through a vein.

Before your child receives zoledronate

Please tell your health-care provider if your child has:

• reacted badly to zoledronate or any other bisphosphonate medication (e.g., alendronate, risedonate, pamidronate and etidronate) before
• kidney problems
• a heart problem, particularly abnormal heartbeat
• problems with their teeth or the inside of their mouth, such as open wounds in the mouth, tooth or gum pain or infection
• planned dental procedures in the near future

Your child may need to have a dental examination before starting zoledronate. Zoledronate treatment may increase the risk of your child developing problems with their jawbone, especially children who already have problems with their teeth, gums or mouth.

Your child will need to be taking enough vitamin D and calcium from either their diet or supplements. Please discuss your child's calcium and vitamin D needs with your health-care provider. If needed, a calcium supplement should be taken as prescribed.

While receiving zoledronate, your child will be given a prescription for a medication called calcitriol or alfacalcidol. Your child must take this medication for the three days before, the day of and three days after every zoledronate infusion. This helps to decrease the risk of low calcium levels after the zoledronate infusion.

How is zoledronate given?

Zoledronate is given as an infusion through a vein. This most commonly occurs in the hospital. Generally, children do not need to stay overnight at the hospital to receive zoledronate.

The first infusions are usually six weeks apart, followed by an infusion every three to six months. Your health-care provider will let you know if your child has a different schedule.

What should you do if your child misses a dose of zoledronate?

If your child must miss an infusion due to illness or another matter, please contact the infusion clinic to reschedule their infusion as soon as possible.

What are the possible side effects of zoledronate?

Your child may have some side effects while they are receiving zoledronate. Check with your child's health-care provider if your child continues to have any of these side effects and they do not go away, or they bother your child:

• flu-like symptoms: fever (should go away within 48 hours), body aches, joint pain, tiredness and nausea
• these symptoms often only occur with the first two doses of zoledronate and rarely with later infusions. Acetaminophen (Tylenol, Tempra) will help with pain and fever, and dimenhydrinate (Gravol) may help with nausea.
  
• symptoms of low calcium levels, such as:
• tingling, pins and needles, or numbness around the mouth, fingers or toes
• muscle cramps or spasms
• headache

Other side effects are possible but are uncommon. Call your doctor or nurse should your child develop any of these symptoms:

• rash, itchiness, red eyes or irritation
• sores in the mouth that do not heal
  
• unexpected loosening of tooth or tooth pain
• oozing of pus from inside the mouth
• eye problems, including sensitivity to light, eye pain

What other important information should you know about zoledronate?

During treatment with zoledronate, your child should avoid invasive dental procedures that may cause bleeding or open wounds in the mouth, if possible. It is important that your child practices good dental hygiene, such as brushing and flossing, and has regular dental checkups during treatment.

If your child has Duchenne muscular dystrophy, they will need to take a stress dose with Deflazacort if they experience fever, vomiting or dark-coloured urine.

There are some medicines that should not be taken together with zoledronate. It is important that you tell your doctor or pharmacist if your child takes any other medications (prescription, over the counter or herbal).

How will I know if the zoledronate is working?

Most children will have an improvement in bone pain.

Your child's response to zoledronate will be monitored by blood tests and other tests such as bone mineral density scans, which look at the density of your child's bones, and X-rays of your child's spine.

At SickKids

Zoledronate is most commonly given in the Medical Day Unit on 4C in the hospital. Contact 4C at 416-813-7654 x 206583 to book infusions. The infusions are administered during the week (Monday – Friday).

For any urgent issues, please call he Endocrine fellow on call at 416-813-7500.

Keep out of your child’s sight and reach and locked up in a safe place. If your child takes too much , call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.