Parenteral Manual

Zoledronic acid

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Bone metabolism regulator
Original Date: 
August 2005
Revised Date: 
January 2016
  • Tumor-induced hypercalcemia following adequate saline rehydration to maintain adequate fluid balance and restore urine output
  • Bone metastases of solid tumors and osteolytic lesions of multiple myelomas
Reconstitution and Stability: 
  • Available as 0.8 mg/mL solution in 5 ml vial stable at room temperature
  • Dilute concentrate immediately - for doses less than or equal to 1 mg - add to 50 ml 0.9% NaCl
                                                  - for doses greater than 1 mg - add to 100 mL 0.9% NaCl
  • Discard any unused portion of vial
  • Use diluted product immediately or refrigerate and bring to room temperature prior to administration - total time between dilution and end of administration must not exceed 24 hours
  • Inspect visually for particulate matter and discoloration - only clear solution should be used
  • Discard any unused solution

- Solutions Compatible: D5W, 0.9% NaCl

- Additive/Above Cassette Compatible: no information

- Y-site Compatible: should be administered as a single IV solution in a line separate from all other drugs

Incompatible: calcium-containing infusion solutions (e.g. ringer's lactate)


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct NO
IV Intermittent Infusion


Usual Dilution: for doses less than or equal to 1 mg - add to 50 mL minibag of 0.9% NaCl

                      for doses greater than 1 mg -  add to 100 mL minibag of 0.9% NaCl

Infusion time: 30 minutes

IV Continuous Infusion NO






(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • 0.0125 to 0.05 mg/kg/dose IV
  • Maximum dose 4 mg


  • 4 mg as a single dose IV infusion
  • After 1 week, if retreatment is needed, 8 mg as a single dose
Potential hazards of parenteral administration: 
  • Renal dysfunction
  • Administration-associated: fever, flu-like symptoms (chills, bone pain, arthralgia) which normally subside after 24-48 hours
  • Occasional nausea and vomiting following IV infusion
  • Infrequent local reactions (redness, swelling) at the infusion site
  • Monitor serum creatinine, electrolytes, calcium, magnesium, phosphate, CBC, hematocrit and hemoglobin
  • Not recommended for use in patients with severe renal impairment unless the benefits outweigh the risks

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