Bones remain healthy when adequate bone mass is present in them. Inadequate or low bone mass can lead to conditions like weakening of bones and fractures. These are symptoms characteristic of osteoporosis. Other bone conditions include hypercalcemia – which is common among people living with cancers. Drugs are administered to treat such disorders which affect bone health. One such drug is zoledronic acid. This drug has the clearance of the food and drug administration (FDA) for treating bone disorders of the elderly. However, zoledronic acid is known to trigger a few side effects. It is important to know about its adverse side effects in order to help manage them effectively.

Bone problems are common among people who are aged. These problems may affect both men and women. Among men, fall in hormone levels such as testosterone are often linked to bone conditions. In women, menopause can lead to reduction in bone mass; largely driven by the inadequacy of estrogen hormone. Also, women whose ovaries are surgically removed may report a lower bone mass. Certain other medical conditions can lead to a higher concentration of calcium; for example, hypercalcemia, cancers, deficiency of vitamin D, renal dysfunction, etc.

Deterioration of bone health is labelled as osteoporosis. Apart from a lower mass, this condition can also be triggered by higher bone mass. Hypercalcemia is a condition wherein your blood calcium level spikes; this often leads to other complications and discomforts. You may witness signs such as pain in bones, weakness of muscles, etc. Highly active thyroid function is another reason for a higher presence of calcium in blood.

Use of zoledronic acid

Doctors prescribe bone medications to treat an increased presence of calcium in blood. One such drug is zoledronic acid, used for a wide range of bone problems. This drug is categorized under a class of meds known as bisphosphonates. Conditions for which this drug is prescribed include breakage of bones owing to cancers, presence of large traces of calcium in your blood (i.e., hypercalcemia) and a few bone re-modelling conditions at the cellular level. The primary action of this drug is to slow down the rate of bone damage. Such damages can become more common when cancerous growth has reached your bone mass. Zoledronic acid essentially minimises the release of calcium from bones. Thus, it helps prevent or reduce the rupture of bones caused by cancerous conditions such as breast cancers or bone tumors.

As risks of renal repair are triggered by zoledronic acid, your physician may recommend intake of more fluids to reduce renal stress. If you are taking this drug for hypercalcemia (high blood calcium), a lot of water or fluids are consumed before taking the drug. On the other hand, if you taking this drug to treat bone conditions caused by cancers, your dosage plan may vary. It is highly recommended to talk to your treating physician to know the rationale behind your dosages and medication plan. You may also be advised to take vitamin D supplements while taking this drug.

In general, the positive outcomes of this drug are slow to show up. In normal circumstances, it may take say, upto 10 days for the first signs of relief to come by. The dosages are repeated based on the calcium levels in your blood.

Side effects of zoledronic acid

Zoledronic acid is likely to cause a few adverse side effects. Most commonly witnessed adverse effects and discomforts include weakness, blood conditions like anemia, inflammation of ankles, increase in body temperature, etc. Owing to weakness, you may also develop pain in muscles. In some cases, people have reported infections similar to flu; signs include tremors or chills, soreness of throat, headache, fever and dehydration.

Allergic reactions

It is a good practice to tell your doctor if you are allergic to drugs belonging to a family of meds called bisphosphonates. It is likely that a few passive (or relatively inactive) ingredients present in these drugs can cause a few side effects. You are hence advised to talk to your treating doctor about prior allergies and episodes of hypersensitivity. In general, people who use this drug very rarely report allergic reactions. However, in some remote instances, a few users have experienced allergies such as itchiness, hives, rashes on skin, swelling and respiratory problems like wheezing or shortness of breath. An acute spell of dizziness has also been observed in some users.

Serious side effects of zoledronic acid

In some people, zoledronic acid has triggered some serious side effects. These include acute pain in your hip or joints, discomforts in the inner ears, pain in the lower jaw, blurring of eyesight, erratic heartbeat, increased pulse rates, etc. In a few people, a sharp pain has been observed in bones or muscles and a numbing sensation have also been observed. Near-fatal or fatal outcomes triggered by zoledronic acid are very rare. However, if you witness adverse side effects like altered output of urine, discoloration of urine, epileptic fits or convulsions, it is highly recommended to seek medical attention on an emergency basis. It may be noted that changes in output of urine are often associated with a possible renal problem. Upon noticing such changes, you are advised to undergo a renal function test. This diagnostic test can help understand the filtering efficiency of kidneys and overall renal wellbeing.

Safety precautions to be taken to minimise or avoid side effects of zoledronic acid
Dosage levels of zoledronic acid depend on multiple factors; a few among these factors are your age, gender, prior medical conditions as well as how well your body responds to the initial doses of this drug. It is equally important to tell your physician about prior medical conditions; especially, if you experience frequent spells of dehydration, renal disorders or respiratory disorders triggered by intake of meds like aspirin.

Also, if you have disorders or ailments associated with your jawbones, you need to stay careful while taking zoledronic acid. It is likely this drug may worsen your dental problems. As a safety precaution, your doctor will test your dental health condition prior to administering dosages of this drug. During dental check-ups, it is equally important to inform the dentist about the intake of zoledronic acid. Those who are taking this drug may also need to undergo regular dental check-ups to ensure healthier gums and teeth. People who notice pain in their jaw must quickly tell their physician about it. Your doctor may prescribe safer alternatives or may recommend substitutes that suit your system well.

Pregnancy and breastfeeding

It is possible that zoledronic acid may harm your fetus. Hence, it is strongly advised to avoid getting pregnant while you are taking this drug. It is recommended to use suitable contraceptives or mechanisms to control birth. As the ingredients of this drug may remain active in your system for a long time, you may need to avoid pregnancy even after discontinuing the intake of this drug. Above all, it is very important to talk to your physician to understand the risks associated with becoming pregnant.

The side effects of this drug on women who are breastfeeding remain largely unknown. It is not clear if the ingredients pass through mother’s milk. As the odds of side effects in the feeding baby are high, breastfeeding mothers are advised not to take this medication. Since the active substances of this drug may remain intact for many months (at times, for several years), you may need to talk to your physician before nursing your baby.

Possible interactions of zoledronic acid with other drugs

The medications you are already consuming (to treat prior medical conditions) may interact with this drug. As a result, the efficacy of zoledronic acid may sharply decrease. It is essential to share details about the drugs you are already consuming. While compiling the list of drugs currently taken, ensure to include over the counter (OTC) drugs, prescription meds as well as supplements such as vitamins, etc.

Foremost of all, never take zoledronic acid with other drugs forming part of the bisphosphonate genre. Such a plan may soon lead to overdose and may also lead to toxicity. The typical signs of overdose are muscular weakness, mood shifts or mental conditions like depression, erratic pulse rates, faster heartbeats, epileptic fits, convulsions, spasms, pains, etc. At an acute stage, excessive dosage can also lead to loss of consciousness as well as passing out. A few people may also develop respiratory conditions like gasping or wheezing. In such instances, it is highly recommended to take medical help at the earliest possible time.

As the likelihood of renal damage is high, you must stay wary of co-administering drugs that are harmful to your renal wellbeing; such drugs include nonsteroidal anti-inflammatory drugs like ibuprofen, naproxen, etc., immuno-suppressants such as tacrolimus and similar ones. Last but not the least, stay extremely careful while taking zoledronic acid along with diuretics or water pills as well as calcium supplements.

Measures to be taken prior to a surgery or dental procedure

Surgery or a dental intervention are commonly done after administering needful doses of anesthetic drugs. As zoledronic acid may make you drowsy, it may worsen the effects of drugs used for anesthesia. So, it becomes important to share your medication and treatment plans with your surgeon or dentist. In most cases, your surgeon may advise discontinuation of this drug for a few weeks prior to the date of your surgical or dental procedure.

Owing to the likelihood of excessive dizziness associated with the intake of this drug, you must never take alcohol or other intoxicants along with it. Intake of alcohol, cannabis / marijuana or similar drugs may only aggravate the levels of drowsiness. Those having a history of substance abuse or drug addiction issues must talk to their doctor before starting to take this drug. As drowsiness or dizziness are likely side effects of zoledronic acid, you are advised not to perform activities that may need a high level of mental agility and concentration; for example, stay away from doing activities such as driving or working on heavy machines.

You need to remember that the aforesaid list of discomforts do not constitute a complete list of side effects or possible allergies. It is possible to witness a few adverse side effects which are not mentioned here. Upon noticing newer side effects, you are advised to consult your treating physician immediately. You can also report to the helpline numbers of the food and drug administration (FDA); this agency monitors the side effects caused by drugs it has cleared. If the side effects are severe, it is highly recommended to call 911 on an emergency basis. If you are living in a Canadian province, it is a good practice to call Health Canada or reach out to a poison control center.

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