Zometa (zoledronic acid)

How does it work?

Zometa infusion contains the active ingredient zoledronic acid, which is a type of medicine called a bisphosphonate. Bisphosphonates are medicines that reduce the turnover of bone.

Bone is not a static structure. It is continually shaped, reformed and rebuilt by cells called osteoblasts and osteoclasts. These cells continously deposit and remove calcium and phophorous, stored in a protein network that makes up the structure of the bone. Old bone is broken down by the osteoclasts and new bone is formed by the osteoblasts.

Biphosphonates work by binding very tightly to the bone tissue and preventing the calcium being removed by the osteoclasts. This stops the osteoclasts from breaking down the bone.

Cancers involving the bone (for example breast or prostate cancer that has spread to the bone, or bone marrow cancer (multiple myeloma)) can cause excessive bone breakdown. This causes areas of bone weakness that can lead to bone pain and fractures. Zoledronic acid can be used in these situations to bind to the bone and prevent it being broken down.

Zoledronic acid also has some anti-cancer effect on the cancerous cells in the bone that helps reduce the growth of the cancer in the bones. This can help prevent the cancer from pressing on nerves, particularly in the spine, and reduce the need for surgery or radiotherapy on the bones.

When the osteoclasts remove calcium from the bones, the calcium then seeps into the blood. The excessive breakdown of bone that occurs when cancer spreads to the bones can therefore lead to high levels of calcium in the blood. This can cause symptoms such as nausea, tiredness and confusion. As zoledronic acid prevents the calcium being removed from the bone, it can be used to treat high levels of calcium in the blood that are a result of cancer.

For preventing bone complications of cancer, Zometa infusion is given via a drip into a vein (intravenous infusion) over at least 15 minutes every three to four weeks.

As the medicine slows bone turnover and so prevents calcium being reabsorbed from the bones into the blood, it can cause the amount of calcium in your blood to fall too low. Your doctor will therefore ask you to take calcium and vitamin D supplements to prevent this. (Vitamin D is needed by the body to help it absorb calcium.)

Zometa infusion is given as a single dose to lower high blood calcium levels that are the result of tumours.

What is it used for?

Preventing bone complications (such as fractures, bone complications requiring radiotherapy or surgery, compression of nerves in the spine, or high blood calcium levels) in people with advanced cancer involving the bones (for example breast cancer or prostate cancer that has spread to the bones, or bone marrow cancer (multiple myeloma)).

Reducing high levels of calcium in the blood (hypercalcaemia) caused by tumours.

Warning!

You will need to have regular blood tests while you are having treatment with this medicine, in order to check your kidney function and the level of calcium and other minerals in your blood.

It is important that you drink enough fluid both before and after your infusion to prevent dehydration. However, it is important to follow your doctors instructions regarding this, particularly if you have a heart condition or are at risk of heart failure. If you are unable to take fluids by mouth your doctor may need to give you a drip to rehydrate you.

The class of medicines that zoledronic acid belongs to (bisphosphonates) has been associated with a condition called osteonecrosis of the jaw. The majority of cases of this condition have been in cancer patients treated with bisphosphonates by injection into a vein and many of these patients were also having treatment with chemotherapy or corticosteroids. However, the risk may also be increased by poor oral hygiene, dental problems, teeth extractions and oral surgery. For this reason, your doctor may want you to have a dental examination and, if necessary, appropriate preventive dentistry, before you start treatment with this medicine. Discuss this with your doctor. It is important to look after your mouth and teeth as much as possible while you are receiving this medicine. Invasive dental procedures such as tooth extraction or surgery should be avoided if possible. If you need to see a dentist during treatment, make sure they know you are receiving this medicine.

Use with caution in

Decreased kidney function.

Dehydration.

Not to be used in

People with a low level of calcium in their blood (hypocalcaemia).

Allergy to bisphosphonates.

Children.

Pregnancy.

Breastfeeding.

This medicine is not recommended for people with severely decreased kidney function.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

The safety of this medicine during pregnancy has not been established. It should not be used during pregnancy. Seek medical advice from your doctor.

It is not known if this medicine passes into breast milk. It should not be given to women who are breastfeeding. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Flu-like symptoms.

High temperature (fever).

Fatigue.

Headache.

Gut disturbances such as nausea, vomiting, diarrhoea, constipation or indigestion.

Loss of appetite.

Inflammation of the membrane lining the eye (conjunctivitis).

Anaemia.

Bone pain.

Pain in the muscles or joints.

Low blood calcium or phosphate level (hypocalcaemia or hypophosphataemia).

Pain, swelling or redness at the infusion site.

Pins and needles or numb sensations.

Dizziness.

Decreased numbers of white blood cells or platelets in the blood.

Blurred vision.

Sleep disturbance.

Shortness of breath.

Kidney problems.

Rash or itching.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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