Precautions and Warnings With Zoledronic Acid

Make sure you learn the precautions and warnings with zoledronic acid before starting the drug to help ensure safe treatment. Prior to taking the medicine, it is important to let your healthcare provider know if you have asthma, liver disease, or kidney disease. You should not take zoledronic acid if you are pregnant, breastfeeding, or allergic to any components of the medication.

Zoledronic Acid: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking zoledronic acid (Reclast®, Zometa®) if you have:
  • Kidney disease, including kidney failure (renal failure)
  • Liver disease, such as liver failure, cirrhosis, or hepatitis
  • Asthma
  • Low blood calcium (hypocalcemia)
  • Hypoparathyroidism
  • Had thyroid or parathyroid surgery
  • Problems absorbing vitamins and minerals from your diet
  • Any allergies, including allergies to food, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding
  • Planning to have a dental procedure.
Make sure to tell your healthcare provider about all other medicines you may be taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Specific Warnings and Precautions for Zoledronic Acid

Warnings and precautions to be aware of prior to taking zoledronic acid include the following:
  • Zoledronic acid can cause kidney damage. In order to decrease this risk, your zoledronic acid dose should be given by IV over a period of at least 15 minutes; giving it more quickly can damage the kidneys. Your healthcare provider should monitor your kidney function closely, using a simple blood test before each zoledronic acid dose. If your kidney function is declining, you may need a lower zoledronic acid dosage, or you may need to postpone your dose until your kidney function improves. If you already have kidney disease, zoledronic acid may not be a good choice for you.


  • There have been rare reports of unusual broken thigh bones in people taking bisphosphonate medications like zoledronic acid. It is not yet clear if the medications are to blame, since the fractures could simply be due to osteoporosis or other factors. These fractures typically were not caused by trauma or injury. Let your healthcare provider know if you have unexplained groin or thigh pain, as these are sometimes signs of thigh fractures. 


  • In rare cases, bisphosphonates (such as zoledronic acid) have caused a condition called osteonecrosis of the jaw. This is a serious, possibly disfiguring problem in which the bone of the jaw dies. Often, there are symptoms (such as pain, infection, or loosening of the teeth), but sometimes there are no symptoms until a person notices exposed bone. This problem is most common when bisphosphonates are given by IV. It seems that people who have dental procedures (such as a tooth extraction) are also at higher risk. Be sure to take good care of your mouth and teeth by seeing your dentist frequently. Let your healthcare provider know right away if you think you may have osteonecrosis of the jaw.
  • Zoledronic acid can cause low blood calcium, phosphate, and magnesium. Your healthcare provider should monitor you closely for these problems.
  • Other bisphosphonates are known to cause problems in people with aspirin-sensitive asthma. Let your healthcare provider know if zoledronic acid seems to make your asthma worse.
  • Bisphosphonates (including zoledronic acid) can cause extreme muscle or bone pain. This usually goes away once the medication is stopped.
  • If you have a medical condition that affects calcium and vitamin D (such as thyroid, parathyroid, or nutritional disorders), you may need to be monitored more closely. In some such cases, zoledronic acid may not be recommended.
  • Zoledronic acid can potentially interact with a few other medications (see Drug Interactions With Zoledronic Acid).
  • Zoledronic acid is considered a pregnancy Category D medication. This means that it is probably not safe for use during pregnancy (see Reclast and Pregnancy or Zometa and Pregnancy).
  • It is not known whether zoledronic acid passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Reclast and Breastfeeding or Zometa and Breastfeeding).
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