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Zoledronic acid (Zometa)

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This page tells you about a bisphosphonate drug called zoledronic acid and its possible side effects. There is information about


What zoledronic acid is

Zoledronic acid is a type of bisphosphonate drug. It also has the brand name Zometa. Doctors use it to treat cancers affecting the bone, most commonly

You may also have zoledronic acid to treat high levels of calcium in the blood (hypercalcaemia), which can occur with secondary bone cancer.


How you have zoledronic acid

Zoledronic acid is a clear liquid that goes into your vein as a drip (infusion). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These lines give the drug into a major vein in your chest. They stay in throughout your course of treatment.

The drip usually lasts for about 15 minutes, but you may have it over a longer period.

You may have zoledronic acid in one of two ways

  • As a single treatment to reduce calcium levels in your blood
  • Every 3 to 4 weeks as a treatment to prevent or reduce bone damage – you may need to take calcium and vitamin D supplements if you are having it regularly

We have listed the possible side effects of zoledronic acid below. 

You can find general information about bisphosphonates

We also have general information about cancer drug side effects.


Common side effects

More than 10 in every 100 people have one or more of these.

  • Flu like symptoms, including a fever, chills and headache
  • Low levels of calcium in your blood (hypocalcaemia), causing changes in sensation such as tingling or burning in your lips and tongue – you will have blood tests to check the levels of calcium and other minerals such as potassium, phosphate and magnesium

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Feeling or being sick – this usually only lasts for a few days and can be controlled with anti sickness medicines
  • Loss of appetite
  • Bone pain – this may be worse when you first start treatment and you may need stronger painkillers until it improves
  • Stomach pain occurs in just under 1 in 10 people (10%)
  • Anaemia (a drop in the number of red blood cells)
  • Red and sore eyes (conjunctivitis) – you may need eye drops to soothe your eyes
  • Difficulty in sleeping
  • Mood changes – you may feel anxious or agitated while you are having this drug
  • Kidney changes – your doctor will take blood tests regularly to check how well your kidneys are working
  • Redness and pain at the injection site
  • Changes in blood pressure – during treatment, your blood pressure may be lower or higher than usual so your nurse or doctor will check this regularly
  • Changes to your bowels – you may be constipated or have diarrhoea
  • Tiredness, drowsiness and dizziness – let your doctor or nurse know if you have this
  • Damage to the jawbone (osteonecrosis) can be a side effect of taking bisphosphonates. This usually occurs if they are taken for longer than a year. You need to have a dental check up before you start treatment and tell your dentist that you are having zoledronic acid

Rare side effects

Fewer than 1 in 100 people have breathlessness and a cough due to changes in lung tissue.


Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Medicines that may react with zoledronic acid include

  • Some medicines used to treat severe infections
  • Some anti cancer drugs – your doctor and pharmacist will check this


Zoledronic acid may have a harmful effect on a developing baby. It is important to use reliable contraception so that you do not become pregnant or father a child whilst having it. Talk to your doctor or nurse about contraception before you start treatment if there is any possibility that you or your partner could become pregnant.


Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.


More information on zoledronic acid

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 23 September 2013