Caution is advised when bisphosphonates are administered with aminoglycosides ,since both agents may have an additive effect resulting in serum calcium levels for longer period than required

Caution is indicated when used with other potentially nephrotoxic drugs

Attention to be paid to the possibility of hypomagnesiumia developing during treatment In multiple myloma patients riskof renaldysfunction may be increased when intravenous bisphosohonatesare used n combination with thalidomide

Laboratory abnormalities-

Hypophospatemia,blood creatinine and blood urea increased,

hypocalcemia uncommon- Hypomagnasemia rare-hyperkalemia , hypokalemia, hypernatremia

Commonly reported adverse reactions are- Fever, arthralgia, myalgia, whichare assocated with an acute phase-reaction.

Uncommon- thrombocytopenia, leukopenia, headache, dizziness, paraethesia, taste disturbances,hypoaesthesia tremor, anxiety, sleep disturbances,

Contraindicated in pregnancy, breast feeding women, in patients with significant hypersensitivity to zoledronic acid, other bisphosphonates or any excepients in the formulation.

High risk groups- Pregnancy and lactation- not enough data on safety andefficacy for use in pregnant women.

Pediatric patients- safety and efficacy not established Renal patients- not recommended.

Hepatic insufficiency- limited data, no specific recommendation.

Cardiac care- overhydration to be avoided Effects on ability to drive or use machines- no data available.

Indication-

Malignancies involving bones

Zoledronic acid must be used by clinicians exoerienced in the administration of intervenous Bisphophates.

Dosages-

The maximum recommended dose of Zoledronic acid is 4mg as a single intervenous infusion administered over no less than 15 minutes.

In patients with multiple myeloma and metastastic bone lesions from solid tumors, Zoledronic Acid should be infused every 3 or 4 weeks.

Pharmacology

Zoledronic acid belongs to the class of bisphonates and acts primarily on bone. It is an inhibitor of osteoclastic resorption. The selective action of bisphonates on bone is based on their affinity for mineralised bone,but the precise molecular mechanism leading to the inhibition of osteoclastic activity is still unclear.

Pharmacology- The terminal elimination half life of 167 hrs. describes the low conc of zoledronic acid inplasma upto 28 days. About 44% +/- 18% of dose administered was recovered in the urine within 24 hours.

Pregnancy and lactation.

 Not enough data on safety and efficacy for use in pregnant, and breast feeding women.

Pediatric patients-

Safety and efficacy not established