Zoledronic Acid (Rheumatology — Osteoporosis)

Indication in the fetched UK SPC (Aclasta 5 mg solution for infusion, eMC product 210) for this dose: treatment of post-menopausal osteoporosis, osteoporosis in men, and osteoporosis associated with long-term systemic glucocorticoid therapy. Patients must be appropriately hydrated prior to administration — especially important for the elderly (65 years and over) and for patients receiving diuretic therapy. Adequate calcium and vitamin D intake are recommended in association with administration. The optimal duration of bisphosphonate treatment for osteoporosis has not been established; the need for continued treatment should be re-evaluated periodically on an individual patient basis, particularly after 5 or more years of use. In patients with a recent low-trauma hip fracture it is recommended to give the infusion at least two weeks after hip fracture repair, and a loading dose of 50 000 to 125 000 IU of vitamin D given orally or via the intramuscular route is recommended prior to the first infusion. Paget's disease (same product, prescribed only by physicians experienced in treating Paget's disease of the bone): a single intravenous infusion of 5 mg; adequate supplemental calcium corresponding to at least 500 mg elemental calcium twice daily is strongly advised for at least 10 days following administration; re-treatment consists of an additional intravenous infusion of 5 mg after an interval of one year or longer from initial treatment in patients who have relapsed (limited data). No dose adjustment is required for hepatic impairment or for the elderly (65 years and over). Patients should be given the package leaflet and the patient reminder card. Paediatric (no per-kg dose is stated, so paedDose is null): the SPC states Aclasta should not be used in children and adolescents below 18 years of age; there are no data available for children under 5 years of age. Verify any under-18 use against a children's formulary.