Zoledronic Acid (Zometa®)

These instructions are for Children's Hospital of Philadelphia patients who are prescribed zoledronic acid to improve bone health.

Important information about zoledronic acid:

• Zoledronic acid, also known by the brand name Zometa® or Reclast®, is a medicine that helps to strengthen your child's bones and reduce fracture risk. It is used to prevent or treat osteoporosis or osteopenia, Paget's disease of bone, certain cancers or high calcium levels.

• The body normally makes new bone and removes old bone all the time. Zoledronic acid works by slowing the process of breaking down old bone. New bone can then be formed faster than old bones are broken down. This results in stronger bones.

• Zoledronic acid is given as an infusion into a vein (IV) 1-4 times per year. The medicine is usually given over 30 minutes.

• Common side effects include:

  • Feeling dizzy

  • Upset stomach

  • Low calcium blood levels

  • Irritation where the shot is given

  • Feeling tired or weak

  • Headache

  • Diarrhea/constipation

  • Fever and flu-like symptoms

  • Swelling in the arms or legs

  • Bone, joint, or muscle pain

  • Change in blood pressure

• Rarely, patients taking zoledronic acid have:

  • Harm to the jawbone (osteonecrosis)

  • Allergic reaction

Patient instructions: preparing for the infusion

• There are no fasting or dietary restrictions for zoledronic acid infusions, your child may eat and drink normally. Encourage extra fluids for two days before the infusion. This will help your child feel better and may help the team place the IV more quickly.

• Zoledronic acid infusions are given on the Day Medicine Unit located on the 3rd floor of the Buerger Building. Plan to arrive 30 minutes prior to your scheduled appointment time. Please allow extra time to park and check in.

• Plan for childcare for siblings. Due to safety concerns for patients who may have a compromised immune system and limited space on the unit, Day Medicine cannot accommodate siblings

• If you need to cancel the appointment, please notify Day Medicine (215-590-1668) ahead of time so the appointment slot can be offered to another patient.

• Wear short sleeve shirt if possible. If a long sleeve shirt is worn, please be sure it is loose fitting.

• Bring a snack and a drink for your child to enjoy after the infusion is completed.

What to expect during the infusion:

• When you arrive, your child will have an IV placed in the hand or arm. Once this IV is in place, all blood samples needed will be drawn from the IV.

• There is a television in the unit for your child to watch. You may want to bring games, toys, or books to help keep your child occupied.

• This infusion will last approximately 30 minutes.

Instructions following the infusion:

• Your team may recommend that your child take a calcium or vitamin D (calcitriol) supplement for a few days after the infusion. Please check with them for details.

• Plan to give your child acetaminophen and ibuprofen for the first two days following the infusion and as needed after that time for fever, pain and side effects from the infusion. Most symptoms related to the infusion resolve within a few days but can last up to a week.

• Your provider may ask for labs 2-3 days after the infusion. If required, a separate lab slip will be provided. Labs can be obtained at CHOP or at an outside lab such as Quest or LabCorp.

• In most cases more than one zoledronic acid infusion is needed. Ask your healthcare team when to schedule the next infusion.

Please contact your endocrinology provider with questions, concerns or if your child develops symptoms of low calcium, within 1 week of receiving the medicine:

• Numbness

• Tingling

• Muscle cramps

• Muscle twitching

• Vomiting

Division of Endocrinology:

215-590-3174

Contact the Day Medicine Unit for questions about this infusion: 215-590-1668

Reviewed on February 7, 2023, by Dave Weber, MD, MSCE; Jaime Gomes, PharmD