9 Reclast Side Effects You Should Know About

Osteoporosis is a condition that affects millions of people around the world. And lifestyle changes, such as eating a calcium-rich diet and doing weight-bearing exercises, aren’t always enough to prevent it.

Thankfully, there are medications such as Reclast (zoledronic acid) that can help treat and prevent osteoporosis to lower your risk of fractures. Reclast is part of the bisphosphonate drug class. But it’s not an oral medication. Instead, Reclast is an infusion that you’ll receive every 1 or 2 years.

Even though Reclast isn’t a daily medication, you should still be aware of side effects you may experience. Here, we’ll look at Reclast side effects you should know about. 

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Reclast side effects at a glance

Here’s an overview of the Reclast side effects you may experience after receiving an infusion of Reclast. 

Common side effects:

• Mild to moderate joint or muscle pain

• Headache

• Nausea

• Flu-like symptoms (fever, chills, fatigue)

• Dizziness

• Fatigue

Less common side effects:

• Infusion site reactions, such as itching, redness, or pain

• Severe muscle, bone, or joint pain

• Vomiting

• Muscle spasms

• Loss of appetite

• Diarrhea

• Swollen or irritated eyes

Rare but serious side effects:

• Kidney problems

• Damage to the jawbone

• Leg fractures

• Irregular heartbeat (arrhythmia)

EXPERT PICKS: WHAT TO READ NEXT

• Safety first: Exercise is important for your overall health. But not all movements are created equally. Find out which exercises are safe for people living with osteoporosis. 

• Monitoring the status of your bone health: Read on to find out how bone health is measured using a DEXA scan.

• Reclast vs. Prolia: Reclast (zoledronic acid) and Prolia (denosumab) are two long-acting injectable medications for osteoporosis. Here’s how they compare.

Let’s take a closer look at nine possible Reclast side effects and how to manage them.

1. Fever and other flu-like symptoms

You may experience flu-like symptoms after receiving Reclast. This includes:

• Fever

• Muscle aches

• Chills

• Fatigue 

Flu-like symptoms usually appear within 3 days of your infusion. They should go away on their own within a few days. But it may take a week or two before you start feeling better. Flu-like side effects should be less of an issue with each dose of Reclast you receive.

Your prescriber may recommend taking acetaminophen (Tylenol) the day you receive Reclast and for 3 days afterward. Studies show that this helps reduce flu-like side effects. But it’s best to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Mortin, Advil) unless your healthcare team OKs it. NSAIDs can raise your risk of kidney damage if you take them with Reclast.

If you have a high fever that doesn’t go away, let your prescriber know. There could be something else causing it, such as an infection.

2. Pain in your joints, bones, or muscles

Another possible Reclast side effect is pain in your joints, bones, or muscles. Most of the time, you’ll feel achy for just a few days after your infusion. Taking acetaminophen can provide some relief. But as mentioned, avoid NSAIDs unless your prescriber OKs them.

In rare cases, Reclast may cause severe pain. This isn’t common, but it can happen at any time after receiving your infusion. If you develop severe pain after receiving Reclast, let your prescriber know. They’ll likely want to make sure there isn’t something else causing it, such as a bone fracture. And they can recommend a safe treatment option for you.

3. Upset stomach

Reclast can cause nausea, and in some cases you may also lose your appetite. Heartburn and diarrhea are less common, but they can sometimes happen.

Generally, stomach-related side effects will go away on their own. Until they do, try eating smaller meals throughout the day. And avoid spicy and fried foods, since they can make things worse. Do your best to stay hydrated too, since this helps protect your kidneys.

If nausea is severe or doesn’t go away, contact your prescriber. They may recommend an anti-nausea medication to help you feel better.

4. Headache

Headaches are a common Reclast side effect. They’ll usually go away on their own, but hydration and breathing exercises may help.

If needed, you can take an OTC pain reliever, such as acetaminophen. But as mentioned, avoid taking NSAIDs for your headache. They can raise your risk of kidney damage if you take them with Reclast.

5. Infusion site reactions

As mentioned, Reclast is an infusion into your vein (IV) administered by a healthcare professional. In some cases, you may experience an infusion site reaction — a reaction in the area where the IV is inserted.

These reactions aren’t common with Reclast. But if they happen, you may notice itching, redness, or pain where your IV line is inserted. If you develop these symptoms during your infusion, let someone in the office know right away. They’ll take appropriate action to manage it.

If you’re at home and notice swelling, itching, or pain where your IV was inserted, contact your prescriber. They can suggest the best treatment option. But if the pain and swelling are severe, or don’t go away after a few days, it could be a sign of infection. In this case, you should have it examined by your prescriber or seek care at an urgent care center as soon as possible.

6. Low calcium levels

Reclast helps your bones hold on to calcium. So calcium levels in your blood may drop after the infusion. In rare cases, they could drop too low. This can cause symptoms such as muscle spasms, numbness, or even seizures if left untreated.

Your prescriber will likely check your calcium levels before you receive Reclast. If they’re low, you may need a calcium and vitamin D supplement to prevent this side effect from happening. Your prescriber will let you know if this is the case. In most cases, you’ll start taking a supplement at least 2 weeks before your infusion. But you’ll receive more specific dose and timing directions from your healthcare team based on your needs.

7. Kidney damage

Reports of kidney damage have occurred with Reclast treatment, but this is very rare. It’s more likely if you have existing kidney damage, are dehydrated, or are taking a diuretic (water pill). And remember to avoid NSAIDs, since they can also make kidney problems more likely. 

Your prescriber will check your kidney function before each Reclast infusion to make sure they’re working properly. You won’t receive Reclast if they aren’t. You also need to be fully hydrated in order to receive Reclast. You should drink at least two full (16 oz) glasses of water within a few hours before your infusion appointment. The extra fluid will help flush Reclast through your body and protect your kidneys.

If you’re peeing less often than usual after receiving Reclast, let your prescriber know right away. They may want to check your kidney function to make sure no damage has occurred. 

8. Thigh bone fractures

Reclast can raise your risk of atypical bone fractures of the thigh bone. An atypical fracture means that it happens without a known cause, such as a fall. Instead, they develop on their own. This side effect is rare, and the benefits of Reclast outweigh this risk for most people. Researchers estimate that for every thigh bone fracture caused by Reclast, more than 1,200 osteoporosis-related fractures are prevented by it.

If you notice a dull, aching feeling in your thigh or groin area at any time after receiving Reclast, be sure to let your prescriber know. If the pain is severe, seek emergency care right away.

9. Damage to the jawbone

Although rare, jawbone damage is a possible Reclast side effect. It’s more likely in people with cancer who are receiving Zometa — a different zoledronic acid medication that’s infused more often than Reclast.

The risk for jaw damage goes up the more times you receive Reclast. But keep in mind that the chance of jaw damage from Reclast is extremely rare (less than 0.15%).

Practicing good oral hygiene can help prevent jaw damage. Here are some tips:

• Brush twice a day with a fluoride toothpaste

• Floss daily

• Get regular dental check-ups

• Avoid tobacco products

It’s best to have any major dental work done before starting Reclast. And be sure to tell your dentist you take Reclast during future appointments. If you notice pain or swelling in your jaw at any time after receiving Reclast, let your dentist or prescriber know.

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Written by:

Emilie White, PharmD

Emilie White is a clinical pharmacist with over a decade of hospital pharmacy experience. Her professional areas of interest include critical care as well as infectious and autoimmune diseases.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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