Preparing for a zoledronate infusion
Preparing for a zoledronate infusion
Before zoledronate, the aim is to make sure the treatment is appropriate and to reduce the risk of avoidable side effects.
Dental care
If you need major dental treatment, it is sensible to have this completed before the infusion where possible. If you have not had a recent dental check, consider arranging one and letting your dentist know that you are planning zoledronate treatment.
Blood tests
Blood tests are usually arranged 1–2 weeks before the infusion to check:
• kidney function — zoledronate should not be given if eGFR is below 35 mL/min/1.73m²
• serum calcium — this should be normal before treatment
• vitamin D status where clinically appropriate
If kidney function is borderline or there are symptoms that might suggest low calcium, repeat renal function and calcium may be required within a week of the infusion.
Vitamin D and calcium
It is important to be vitamin-D replete and adequately nourished before treatment. If you are not already taking vitamin D, a loading dose may be recommended before the infusion. Adequate dietary calcium intake is also important.
If you are taking oral bisphosphonate tablets such as alendronate/Fosamax, these should be stopped when moving to zoledronate treatment.
On the day
• Eat and drink normally.
• Make sure you are well hydrated. Drink 1–2 large glasses of water before the infusion and continue normal fluid intake afterwards.
• Do not proceed if significantly dehydrated or acutely unwell.
• Avoid NSAIDs such as ibuprofen, and diuretics such as furosemide, on the day of the infusion unless specifically advised otherwise.
• Take 2 paracetamol tablets 30–60 minutes before the infusion.
• Paracetamol can then be taken if required for flu-like symptoms afterwards. Auckland HealthPathways advises that this can be taken up to three times daily for the following three days if needed.
What to expect afterwards
Around 30% of people experience a flu-like reaction after their first zoledronate infusion, which may include muscle or joint aches, headache and fever. This usually settles within a couple of days. The risk is much lower after subsequent infusions, at around 3–4%.
Good hydration and paracetamol are usually sufficient.
Optional dexamethasone
For someone particularly concerned about the acute flu-like reaction, there is New Zealand randomised controlled trial evidence supporting:
- Dexamethasone 4 mg orally approximately 1.5 hours before the infusion, followed by 4 mg once daily for the next two days.
- This three-dose regimen significantly reduced the acute-phase response compared with placebo. An earlier trial found that a single 4 mg dose alone was not effective, so the evidence relates specifically to the three-day approach.
Dexamethasone is not routinely required and needs to be considered individually. Potential short-term effects include sleep disturbance, agitation or mood changes, indigestion and a temporary rise in blood glucose.
Other things to know
Zoledronate can rarely cause inflammation of the eye. A painful red eye, significant light sensitivity or blurred vision following the infusion should prompt medical review.
The small risks associated with treatment also need to be balanced against the much greater consequences of an osteoporotic fracture in someone with established osteoporosis.
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