zoledronic acid
Reclast (zoledronic acid) is used to treat osteoporosis. It's only available as an intravenous (IV) infusion that's given at a clinic or your provider's office. The medication is an option for postmenopausal women with osteoporosis who can't take bisphosphonates by mouth or for those at very high fracture risk. Reclast (zoledronic acid) is a long-lasting medication, so the dosing isn't often (either one-time only, once a year, or once every 2 years). It can cause side effects like muscle and joint pain, headache, and fever. This medication is available under the brand name Reclast and as a generic.
What is Reclast (zoledronic acid)?
What is Reclast (zoledronic acid) used for?
Osteoporosis in women who have gone through menopause (postmenopause)
Osteoporosis in men
Osteoporosis caused by long-term use of corticosteroids
How Reclast (zoledronic acid) works
Reclast (zoledronic acid) is a bisphosphonate. It works to slow down bone breakdown so the body can make new, healthy, and strong bones. Reclast (zoledronic acid) helps raise bone mineral density (BMD), which is a measure of how strong your bones are. A higher BMD means your bones are stronger, which helps lower your risk of bone fractures.
Drug Facts
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What are the side effects of Reclast (zoledronic acid)?
Common Side Effects
- Joint pain (up to 24%)
- Fever (up to 18%)
- Higher blood pressure (up to 13%)
- Headache (up to 12%)
- Muscle pain (up to 12%)
- Arm or leg pain (up to 11%)
- Arthritis (up to 9%)
- Flu-like symptoms (up to 9%)
- Nausea (up to 9%)
- Dizziness (up to 8%)
- Shoulder pain (up to 7%)
- Bone pain (up to 6%)
- Diarrhea (up to 6%)
- Vomiting (up to 5%)
Other Side Effects
- Stomach pain
- Indigestion
- Tiredness
- Chills
- Body weakness
- Arm or leg swelling
- Neck pain
- Muscle spasms
- Feeling unsteady (vertigo)
Serious Side Effects
- New fractures: dull or aching pain in your hips or thigh, severe pain in your bones or joints
Source: DailyMed
More on Reclast (zoledronic acid) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Agitation
black, tarry stools
blurred vision
chills
coma
confusion
convulsions
difficult or labored breathing
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
irregular heartbeat
irritability
lack or loss of strength
lethargy
lower back or side pain
muscle pain or cramps
muscle trembling or twitching
nausea or vomiting
numbness and tingling around the mouth, fingertips, or feet
painful or difficult urination
pale skin
rapid weight gain
seizures
shaking of the hands, arms, feet, legs, or face
skin rash, cracks in the skin at the corners of the mouth, or soreness or redness around the fingernails and toenails
sores, ulcers, or white spots on the lips or mouth
stupor
sudden sweating
swollen glands
tightness in the chest
trouble breathing with exercise
unusual bleeding or bruising
unusual tiredness or weakness
Less common
Feeling of constant movement of self or surroundings
muscle cramps in the hands, arms, feet, legs, or face
neck pain
pounding in the ears
rapid breathing
sensation of spinning
slow or fast heartbeat
sunken eyes
tingling of the hands or feet
Incidence not known
Blurred vision or other change in vision
decreased frequency or amount of urine
decreased vision
eye tenderness
heavy jaw feeling
increased blood pressure
increased tearing
increased thirst
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loosening of a tooth
pain, swelling, or numbness in the mouth or jaw
redness of the eye
sensitivity of the eye to light
severe eye pain
swelling of the face, hands, fingers, lower legs, or ankles
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Abdominal or stomach pain
back pain
bad, unusual, or unpleasant (after) taste
bladder pain
blistering, crusting, irritation, itching, or reddening of the skin
bloody or cloudy urine
bone pain
burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
change in taste
cracked lips
cracked, dry, or scaly skin
difficulty with swallowing
discouragement
ear congestion
feeling sad or empty
frequent urge to urinate
hair loss or thinning hair
headache
hyperventilation
joint pain or swollen joints
loss of appetite
loss of interest or pleasure
loss of voice
muscle stiffness or difficulty with moving
nasal congestion or runny nose
pain, swelling, or redness in the joints
partial loss of feeling
seeing, hearing, or feeling things that are not there
sleepiness or unusual drowsiness
swelling or inflammation of the mouth
thirst
trouble concentrating
trouble sleeping
unusually cold, shivering
vomiting
Less common
Acid or sour stomach
belching
indigestion
red streaks on the skin
stomach discomfort or upset
swelling, tenderness, or pain at the injection site
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
wrinkled skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Reclast (zoledronic acid)
Pros
Lowers the risk of fractures in different parts of the body, including the hip and back
Infusions are one-time only, once a year, or once every 2 years
Can freely choose when to eat, drink, or take other medications
Can use if you can't take other bisphosphonates because of trouble swallowing or too much stomach pain
Can consider using for postmenopausal women with osteoporosis who have very high fracture risk
Cons
Only available as an IV infusion that's given at a clinic or provider's office
Risk of many side effects, including joint or muscle pain and severe jaw problems
Risk of side effects like fever, pain, and chills after each infusion
Might cause breathing problems in people allergic to aspirin
Pharmacist tips for Reclast (zoledronic acid)
Don't take zoledronic acid (Zometa) at the same time as Reclast (zoledronic acid). These two medications contain the same active ingredient (zoledronic acid), but are used for different purposes. Taking Reclast (zoledronic acid) and zoledronic acid (Zometa) at the same time can raise your risk of side effects.
Eat and drink as you normally do on the day of your infusion. Drink at least 2 glasses of water within a few hours before your infusion to help prevent kidney damage from the medication.
You might have body aches, fever, or chills after you get your Reclast (zoledronic acid) infusion. Most of these infusion-related side effects happen within the first 3 days after the infusion. They typically go away within 3 days, but can last up to 2 weeks. Talk to your provider if you have these infusion-related side effects. They might recommend that you take acetaminophen (Tylenol) to relieve these symptoms.
It's recommended that you take at least 1,200 mg of calcium (600 mg twice a day) and 800 to 1,000 international units (IU) of vitamin D every day. This can prevent low calcium levels and help your bones grow stronger.
If you have Paget's disease, it's recommended that you take a total of 1,500 mg of calcium and 800 IU of vitamin D every day during the 2 weeks after your Reclast (zoledronic acid) infusion. People with Paget's disease have a higher risk of abnormal calcium levels. To make sure all the calcium gets absorbed into your body, separate out your calcium throughout the day (750 mg twice a day or 500 mg three times a day).
It's important to take care of your teeth and mouth when you're taking Reclast (zoledronic acid). This helps lower the risk of jaw problems from the medication. Let your dentist know you're taking Reclast (zoledronic acid) before starting the medication.
If you have trouble swallowing, pain when you swallow, or any pain around your hips, thighs, or jaw, stop taking Reclast (zoledronic acid) and tell your healthcare provider right away.
Frequently asked questions about Reclast (zoledronic acid)
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What are the risks and warnings for Reclast (zoledronic acid)?
Reclast (zoledronic acid) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Breakdown of the jaw (osteonecrosis)
Risk factors: Gum or dental disease or surgery | Anemia (low red blood cell count) | Bleeding problems | Cancer | Taking cancer medications or corticosteroids | Radiation therapy | Poor mouth care or dentures that don't fit well | Taking Reclast (zoledronic acid) or other bisphosphonates for a long period of time
Although rare, Reclast (zoledronic acid) can break down and weaken the jawbone (osteonecrosis of the jaw, ONJ). This breakdown is more likely if you get a tooth extraction, dental implants, bone surgery around or in your mouth, or an infection in the mouth that hasn't healed while taking Reclast (zoledronic acid). Keeping your teeth healthy with regular brushing and flossing can lower your risk of this problem. If you notice pain or swelling in your jaw, talk to your provider or dentist right away. It's also important to let your dentist know that you're taking Reclast (zoledronic acid). Your provider might recommend that you complete any routine or necessary dental work before starting Reclast (zoledronic acid). Avoid dental work while taking the medication if possible.
Low calcium in the blood
Risk factors: History of abnormal electrolyte levels (like calcium) in the blood | Paget's disease
Reclast (zoledronic acid) can lower the calcium levels in your blood. If you already have low calcium levels or other abnormal electrolyte levels, you'll need to get treated for these problems before you can start Reclast (zoledronic acid). This helps prevent your calcium levels from reaching dangerously low levels. If you have Paget's disease, you're also at risk of low calcium levels with Reclast (zoledronic acid) treatment. It's recommended that you take calcium and vitamin D supplements to help prevent low calcium levels. Talk to your healthcare provider if you notice muscle spasms or twitching, or numbness and tingling in your fingers, toes, or around your mouth, as these can be signs of low calcium.
Kidney damage
Risk factors: History of kidney problems | Taking a diuretic (water pill) at the same time | Taking other medications that can cause kidney damage | Not enough fluids in your body | Age 65 years or older
Reclast (zoledronic acid) can cause kidney damage, especially in people who already have kidney problems or who are also taking other medications that can harm the kidneys. You'll need to get blood tests done before each infusion to check your kidney health. This helps your provider make sure the medication is safe for you. Be sure to drink enough fluids before each infusion. Staying hydrated during treatment can help prevent kidney damage from the Reclast (zoledronic acid) infusions. If you notice that you're not urinating as often as usual, or have shortness of breath or swelling in your ankles or legs, talk to your healthcare provider right away. These can be symptoms of kidney problems. Reclast (zoledronic acid) shouldn't be used if you have severe kidney problems.
Leg bone fractures
Very rarely, leg bone fractures can happen without any known cause in people taking Reclast (zoledronic acid). If you notice new dull or aching pain in your hips or thighs, talk to your healthcare provider as soon as possible.
Severe bone, joint, or muscle pain
Though rare, some people taking Reclast (zoledronic acid) have had rare severe pain in their bones, joints, or muscles. It can happen as quickly as one day to several months after starting Reclast (zoledronic acid). But it should go away after you've stopped treatment. If you feel severe pain in these areas during Reclast (zoledronic acid) treatment, talk to a provider right away.
Harm to unborn baby
Based on animal studies, Reclast (zoledronic acid) might cause harm to an unborn baby if it's taken during pregnancy. For this reason, you shouldn't take this medication if you're pregnant. Talk to your provider about this risk if you're pregnant or thinking of becoming pregnant. It's best to avoid becoming pregnant while you're getting Reclast (zoledronic acid) treatment. Let your provider know right away if you become pregnant during treatment.
Reclast (zoledronic acid) dosage forms
Typical dosing for Reclast (zoledronic acid)
This medication is an intravenous (IV) infusion that's given through your veins by a healthcare provider over at least 15 minutes.
Treatment of osteoporosis: The typical dose is 5 mg given as an IV infusion once a year.
Prevention of osteoporosis (only in postmenopausal women): The typical dose is 5 mg given as an IV infusion once every 2 years.
Treatment of Paget's disease: The typical dose is 5 mg given as a one-time IV infusion.
More on Reclast (zoledronic acid) dosage forms
Reclast (zoledronic acid) Reviews
GoodRx has partnered with PatientsLikeMe to provide reviews on the different aspects of Reclast (zoledronic acid).
Effectiveness
Learn more about the effectiveness of Reclast (zoledronic acid) based on real life experiences.
Overall Rating
Based on 36 people taking this medication
1.8
Effectiveness by condition:
osteoporosis28 reviews
3.1
osteopenia7 reviews
2.1
osteopetrosis1 reviews
0.0
Severity of side effects
Based on 34 people taking this medication
0%
50%
100%
Top side effects
Bone pain
6%
Flu like symptoms
6%
Allergic reaction
3%
Broken leg (right)
3%
Extreme flu like malaise
3%
Reasons people stopped taking Reclast (zoledronic acid)
Based on 26 people who have taken this medication
Doctor's advice
43%
Course of treatment ended
20%
Side effects too severe
16%
Other
12%
Change in health plan coverage
4%
Did not seem to work
4%
Expense
4%
How long people take Reclast (zoledronic acid)
Based on 44 people taking this medication
0%
50%
100%
Interactions between Reclast (zoledronic acid) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
How much does Reclast (zoledronic acid) cost?
Reclast (zoledronic acid) contraindications
Severe kidney problems
Sudden kidney damage (because of high risk of kidney failure with Reclast (zoledronic acid) treatment)
What are alternatives to Reclast (zoledronic acid)?
Osteoporosis in women who have gone through menopause (postmenopause)
Osteoporosis in men
Osteoporosis caused by long-term use of corticosteroids
Osteoporosis in women who have gone through menopause (postmenopause)
Osteoporosis in men
Osteoporosis caused by long-term corticosteroid use
Paget's disease
Prevention and treatment of osteoporosis in females
Treatment of osteoporosis in males
What is the latest news about Reclast (zoledronic acid)?
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References
Best studies we foundAmerican College of Rheumatology. (2023). Osteonecrosis of the jaw (ONJ).
Camacho, P. M., et al. (2020). American Association of Clinical Endocrinologists/ American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis— 2020 update. Endocrine Practice.
Centers for Disease Control and Prevention. (2024). Preventing Oral Diseases and Conditions in Communities.
Fresenius Kabi USA, LLC. (2023). ZOLEDRONIC ACID injection, solution [package insert]. DailyMed.
Hayes, K. N., et al. (2021). Duration of bisphosphonate drug holidays in osteoporosis patients: A narrative review of the evidence and considerations for decision-making. Journal of Clinical Medicine.
Lewis, J. L., III. (2022). Hypocalcemia (Low level of calcium in the blood). Merck Manual.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2022). Paget’s disease of bone.
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