From the Guidelines
Reclast (zoledronic acid) can cause several side effects, including flu-like symptoms, bone, muscle, or joint pain, gastrointestinal issues, and more serious but less common side effects like osteonecrosis of the jaw, atypical femur fractures, severe kidney problems, and hypocalcemia, as reported in the most recent study 1.
Common Side Effects
- Flu-like symptoms such as fever, muscle and joint pain, headache, and fatigue, which typically occur within the first three days after infusion and usually resolve within a few days
- Bone, muscle, or joint pain that can last for several days
- Gastrointestinal issues like nausea, vomiting, and diarrhea
- Dizziness or eye inflammation
Serious Side Effects
- Osteonecrosis of the jaw (particularly in patients with dental issues), with a 9.5-fold greater risk compared to pamidronate, as shown in the study by Zervas et al 1
- Atypical femur fractures with long-term use
- Severe kidney problems (especially in those with existing kidney disease)
- Hypocalcemia (low blood calcium)
Recommendations
- Patients should stay well-hydrated before and after treatment
- Take acetaminophen for flu-like symptoms
- Maintain good dental hygiene
- Report any severe or persistent side effects to their healthcare provider immediately
- Monitoring of creatinine clearance is required to guide dosing of zoledronic acid, and it should be dose reduced in patients with impaired renal function (estimated creatinine clearance 30–60 mL/min) 1
- Denosumab may be administered to patients with impaired renal function or even patients on hemodialysis, but the risk for severe hypocalcemia and hypophosphatemia is greater 1
From the FDA Drug Label
Common Adverse Reactions Advise patients that the most common side effects of zoledronic acid injection are nausea, fatigue, anemia, bone pain, constipation, fever, vomiting, and dyspnea. The common side effects of Reclast (zoledronic acid) include:
- Nausea
- Fatigue
- Anemia
- Bone pain
- Constipation
- Fever
- Vomiting
- Dyspnea 2
From the Research
Common Side Effects of Reclast (Zoledronic Acid)
- Hypocalcemia (low calcium levels in the blood) 3, 4, 5
- Hypophosphatemia (low phosphate levels in the blood) 4
- Muscle twitching, spasms, and tingling 3
- Trismus (lockjaw) 3
- Severe back pain and strain (although Reclast may also have a positive effect on chronic low back pain) 3
Rare but Serious Side Effects
- Renal deterioration (kidney problems) 4
- Acute cardiac problems (if the patient is left unmonitored after infusion) 3
Importance of Monitoring and Patient Information
- Patients should be monitored for at least 24 hours after Reclast infusion to prevent serious side effects 3
- Patients should receive sufficient information about the possibility of side effects following Reclast administration 3
- Evaluating calcium and vitamin D levels before initiating Reclast treatment is crucial, especially in patients with widespread vitamin D deficiency 5