Zoledronic Acid (infusion once a year)

Red

Brand Name(s):Aclasta

Indication:Bone malignancies and Pagets disease, Treat osteoporosis in men and reduce risk of new fractures following hip fracture

Rationale:1,2

Considered:Oct-06

Review Date:Nov-20

Comments:
NG35
Myeloma: diagnosis and management
Full document available at:http://www.nice.org.uk/guidance/ng35/resources/myeloma-diagnosis-and-management-1837394042821
Feb 2016
Drug Safety Update
Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal
Full details can be found at: https://www.gov.uk/drug-safety-update/bisphosphonates-very-rare-reports-of-osteonecrosis-of-the-external-auditory-canal
Dec 2015

The following precautions should be taken into account to minimise the risk of
renal adverse reactions with zoledronic acid

For all patients receiving zoledronic acid:
* Renal function should be measured before each infusion of zoledronic acid
* Patients, especially elderly patients and those receiving diuretic therapy,
should be appropriately hydrated before administration of zoledronic acid
* The duration of infusion of zoledronic acid should be at least 15 minutes
* Monitoring of renal function after zoledronic acid infusion should be
considered, particularly in at-risk patients such as: those with pre-existing
renal dysfunction; those of advanced age; those using concomitant
nephrotoxic drugs or diuretic therapy; or those who are dehydrated
* Zoledronic acid should be used with caution when used concomitantly with
medicines that could affect renal function

For patients receiving Aclasta
* A single dose of Aclasta for the treatment of osteoporosis and Paget’s
disease of the bone should not exceed 5 mg
* Aclasta should not be used in patients with creatinine clearance
<35 mL/min MHRA Drug Safety Update Volume 3 Issue 9 April 2010