Zometa

Zometa is a prescription medication used to treat high blood calcium caused by cancer, and to prevent or delay bone problems due to cancer. Zometa belongs to a group of drugs called biphosphonates, which slow the breakdown of bone. 

This medication comes in an injectable form to be given directly into a vein (IV) by a healthcare provider. For high blood calcium Zometa is given once. For bone problems caused by cancer, it may given every 3 or 4 weeks for as long as 24 months.

Common side effects of Zometa include fever, nausea, bone pain, and fatigue.

Zometa is a prescription medicine used:

• to treat high blood calcium caused by cancer (known medically as hypercalcemia of malignancy, HCM)
• with anti-cancer medicines to prevent or delay bone problems due to cancer (multiple myeloma and solid tumor cancers that have spread to the bone).

​This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

The recommended Zometa dose for treating high blood calcium due to cancer (known medically as hypercalcemia of malignancy) is 4 mg, taken as a single dose.

Zometa is also used to prevent bone problems (such as broken bones) in people with cancer. For this use, the recommended dose is Zometa 4 mg every three to four weeks.

Serious side effects have been reported with Zometa including the following:

• Low calcium levels in your blood (hypocalcemia). Zometa may lower the calcium levels in your blood. If you have low blood calcium before you start taking Zometa, it may get worse during treatment. Your low blood calcium must be treated before you take Zometa. Most people with low blood calcium levels do not have symptoms, but some people may have symptoms. Call your doctor right away if you have symptoms of low blood calcium such as:
  • Spasms, twitches, or cramps in your muscles
  • Numbness or tingling in your fingers, toes, or around your mouth

• Severe kidney problems. Severe kidney problems may happen when you take Zometa. Severe kidney problems may lead to hospitalization or kidney dialysis and can be life-threatening. Your risk of kidney problems is higher if you:
  • already have kidney problems
  • take a diuretic or “water pill"
  • do not have enough water in your body (dehydrated) before or after you receive Zometa
  • are of advanced age since the risk increases as you get older
  • take any medicines known to harm your kidneys

• Severe jaw bone problems (osteonecrosis). Severe jaw bone problems may happen when you take Zometa. Your doctor should examine your mouth before you start Zometa. Your doctor may tell you to see your dentist before you start Zometa. It is important for you to practice good mouth care during treatment with Zometa.
• Possible harm to your unborn baby. Zometa should not be used if you are pregnant. Tell your doctor right away if you are
  pregnant or plan to become pregnant. Zometa may harm your unborn baby.
• Bone, joint, or muscle pain. Some people who take bisphosphonates, such as Zometa, develop severe bone, joint, or muscle pain.
• Femoral fractures. These fractures may occur after minimal or no trauma. Tell your doctor if you have thigh or groin pain.

Do not take Zometa if you:

• are allergic to Zometa or any components of Zometa. Severe allergic reactions have occurred with Zometa use. These reactions, including rare cases of hives and swelling near the eyes and lips, and very rare cases of life-threatening allergic reactions, have been reported.
• are being treated with another medication containing zoledronic acid. Reclast is in a class of drugs called bisphosphonates, and contains the same active ingredient as that found in Zometa.
• have low levels of calcium in your blood.
• have kidney problems, tell your doctor. The risk of adverse reactions (especially related to the kidney) may be greater for you. It is important to get your blood tests while you are receiving Zometa. Your doctor will monitor your kidney function before each dose. Tell your doctor if you are on other drugs, including aminoglycosides, loop diuretics, and drugs which may be harmful to the kidney. See "Drug Interactions" section.

Serious side effects have been reported with Zometa. See the “Zometa Precautions” section.

Hypercalcemia of malignancy (HCM) patients may experience side effects including:

• flu-like symptoms (fever, chills, flushing, bone pain and/or joint or muscle pain)

Common side effects in HCM patients include:

• fever
• nausea
• constipation
• anemia
• shortness of breath
• diarrhea
• abdominal pain
• worsening of cancer
• insomnia
• vomiting
• anxiety
• urinary tract infection
• low phosphate levels
• confusion
• agitation
• a fungal infection called moniliasis
• low potassium levels
• coughing
• skeletal pain
• low blood pressure
• low magnesium levels
• redness and swelling injection site

Common side effects for patients with multiple myeloma and bone metastases due to solid tumors include:

• bone pain
• nausea
• fatigue
• anemia
• fever
• vomiting
• constipation
• shortness of breath
• diarrhea
• weakness
• muscle pain
• anorexia
• cough
• joint pain
• lower-limb swelling
• worsening of your cancer
• headache
• dizziness (excluding vertigo)
• insomnia
• decreased weight
• back pain
• numbness/tingling
• abdominal pain

Eye-related side effects may occur with bisphosphonates, including Zometa. Cases of swelling related to fluid build-up in the eye, as well as inflammation of the uvea, sclera, episclera, conjunctiva, and iris of the eye have been reported.

This is not a complete list of Zometa side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• medicines which may be harmful to the kidney 
• medicines which are excreted by the kidney such as digoxin (Lanoxin)
• aminoglycosides such as amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), neomycin (Neo-Fradin),  streptomycin, tobramycin
• certain diuretics ("water pills") such as bumetanide (Bumex), ethacrynic acid (Edecrin), and furosemide (Lasix).
• non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve)
• vancomycin (Vancocin)

Ask your doctor or pharmacist for a list of these medicines, if you are not sure.

This is not a complete list of Zometa drug interactions. Ask your doctor or pharmacist for more information.

Tell your doctor if you are pregnant, or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Zometa falls into category D. There are no adequate and well-controlled studies of Zometa in pregnant women. Zometa may harm your unborn baby. Zometa should not be used if you are pregnant.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if Zometa passes into your milk and may harm your baby. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using Zometa.

Zoledronic acid is given by intravenous (IV) infusion by a healthcare provider in a hospital or other medical facility. The infusion takes at least 15 minutes.

Your doctor may advise you to take oral calcium supplements and vitamin D daily.

On the day of treatment the patient should eat and drink normally, which includes drinking at least 2 glasses of fluid such as water within a few hours prior to the infusion, as directed by their doctor, before receiving zoledronic acid.