Last updated: October 29, 2014
Trade Names: Reclast
Drug Class: Bisphosphonate
Preparations: 5 mg in 100 mL i.v. preparation
Osteoporosis: for treatment 5 mg i.v. once a year; for prevention 5 mg i.v. every 2 years
Paget’s disease: 5 mg i.v., consider retreatment for relapse
Indications: Treatment and prevention of osteoporosis and glucocorticoid-induced osteoporosis; treatment of Paget’s disease, hypercalcemia of malignancy, multiple myeloma and metastases from solid tumors
Mechanism of Action: Antiresorptive; localizes to areas of bone resorption and inhibits osteoclast activity without any effect on bone formation; increases bone mineral density and significantly reduces fracture rates.
Contraindications: Hypersensitivity, hypocalcemia, not recommended for patients with severe renal insufficiency (creatinine clearance <35 mL/min)
Precautions: A dental exam and preventive dental work should be performed before starting chronic bisphosphonate therapy.
Pregnancy Risk: D
Common: 44% of patients have arthralgia, fever and flu-like symptoms in the first 3 days (can be reduced by administering acetaminophen for 3 days after the infusion), fatigue, headache, dizziness, edema, nausea, vomiting, diarrhea, hypocalcemia
Uncommon: Infusion reaction, atypical subtrochanteric femur fractures, osteonecrosis of the jaw, severe musculoskeletal pain, uveitis, altered taste, urticaria, angioedema, atrial fibrillation, rash, severe hypocalcemia
Drug Interactions: Do not use Reclast and Zometa together – they are the same drug – zoledronic acid
Patient Instructions: Supplement calcium and vitamin D intake if needed.
Comments: Supplemental calcium and vitamin D are co-administered, particularly if treating myeloma or Paget’s. IV bisphosphonates have a higher risk of osteonecrosis of the jaw. The optimal duration of treatment for osteoporosis is uncertain. A temporary discontinuation may be considered after 3-5 years of therapy in patients at low risk of fracture with monitoring of bone density 2-3 years after discontinuation.
Clinical Pharmacology: Renally excreted and not metabolized. Elimination from body over months or years indicating localization and slow release from bone.
McClung M, Harris ST, Miller PD et al. Bisphosphonate therapy for osteoporosis: benefits, risks and drug holiday. Am J Med 2013;126:13-20.PMID: 23177553
Lyles KW, Colón-Emeric CS, Magaziner JS, et al.Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007;357:1799-809. PMID: 17878149.