Zometa (zoledronic acid)

What is Zometa?

Zometa is a brand-name prescription drug that’s FDA-approved to treat the following conditions* in adults:

• Hypercalcemia due to cancer.† Hypercalcemia is high level of calcium in your blood. In this situation, it’s caused by cancer.
• Multiple myeloma and bone metastases of solid tumors. Multiple myeloma is a form of cancer that affects the tissue inside your bones. Bone metastases of solid tumors are cancers that have spread from their original site to your bones. Solid tumors are cancerous lumps, such as breast and prostate cancers.

* To learn more about the specific uses of Zometa, see the “Zometa uses” section below.
† Zometa has certain limitations of use. For more information, see the “Zometa uses” section below.

Drug details

Zometa contains the active drug zoledronic acid. It belongs to a class of drugs called bisphosphonates. A class of drugs is a group of medications that work in a similar way. Bisphosphonates help to prevent the breakdown of bone.

Zometa comes as a liquid that’s available in two different forms:

• a single-dose, ready-to-use bottle containing 4 milligrams (mg) of drug in 100 milliliters (mL) of solution
• a single-dose vial containing 4 mg of drug in 5 mL of solution

Zometa is given as an intravenous (IV) infusion by a healthcare provider. (An IV infusion is an injection into a vein that’s given slowly over a period of time.)

Effectiveness

For information on the effectiveness of Zometa, see the “Zometa uses” section below.

Zometa generic

Zometa is a brand-name drug that contains the active drug zoledronic acid. The active drug is also available as a generic medication. A generic drug is an exact copy of the active drug in a brand-name medication.

The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

If you’re interested in using the generic form of Zometa, talk with your doctor. They can tell you if it comes in forms and strengths that can be used for your condition.

Note: The generic drug zoledronic acid is also available under the brand-name Reclast. However, Reclast has different approved uses than those of Zometa.

Zometa side effects

Zometa can cause mild or serious side effects. The following lists contain some of the key side effects that may occur during Zometa treatment. These lists don’t include all possible side effects.

For more information on the possible side effects of Zometa, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Zometa, you can do so through MedWatch.

Mild side effects

Mild side effects of Zometa can include:*

• nausea and vomiting
• fatigue (lack of energy)
• anemia (low red blood cell count)
• constipation
• diarrhea
• abdominal (belly) pain
• fever†
• shortness of breath
• insomnia (trouble sleeping)
• loss of appetite
• headache
• dizziness
• hair loss†

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Zometa. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Zometa’s prescribing information.
† For more information on this side effect, see “Side effect details” below.

Serious side effects

Serious side effects from Zometa aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• Hypocalcemia (a low level of calcium in your blood) and imbalances of other electrolytes, such as phosphate, magnesium, and creatine. Symptoms of hypocalcemia can include:
  • muscle cramps, spasms, or twitching
  • numbness or tingling in your fingers, toes, or around your mouth
• Kidney problems, such as reduced kidney function or kidney failure. Symptoms can include:
  • urinating less than usual
  • swollen ankles
  • shortness of breath
  • feeling tired
  • nausea
  • confusion
• Allergic reaction.*
• Severe bone, joint, or muscle pain.*
• Osteonecrosis of the jaw (a type of damage to the jawbone).*
• Atypical femur fracture (a broken thigh bone that occurs after a very minor event, such as a bump, or without any obvious cause).*

* For more information on these side effects, see “Side effect details” below.

How long do side effects of Zometa last?

Some people have a short-term reaction within the first 3 days of receiving Zometa. The side effects of this reaction can include flu-like symptoms, such as:

• fever
• chills (shivering)
• bone, joint, or muscle pain
• fatigue

The symptoms typically ease in a few days. However, for some people, it may take up to 2 weeks or longer for these symptoms to go away.

Most other side effects of Zometa tend to go away either on their own or with treatment. This usually takes a few days to a couple of weeks. However, some rare but serious side effects, such as damage to the jawbone or thigh fractures, can take several weeks or longer to improve.

If you have severe bone, muscle, or joint pain from Zometa, this should improve after you stop treatment.

If you have any questions about how long Zometa side effects may last, talk with your doctor.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after receiving Zometa. It’s not known how often this may have occurred in clinical studies of the drug.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing (warmth, swelling, or redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Call your doctor right away if you have a severe allergic reaction to Zometa. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Hair loss

Hair loss can occur with Zometa use. Hair loss can also occur with cancer treatments that you may have with Zometa. These treatments include chemotherapy or radiation therapy.

In clinical studies of people with multiple myeloma or cancer that had spread to the bones, hair loss occurred in:

• 12% of people who used Zometa
• 14% of people who used a similar drug called pamidronate
• 8% of people who used a placebo (a treatment containing no active drug)

If you have bothersome hair loss with Zometa, talk with your doctor about ways to manage this side effect.

Fever

A fever may occur after receiving Zometa.

In clinical studies, fever occurred in:

• 32% to 44% of people who had treatment with Zometa
• 31% to 33% of people who had treatment with a similar drug called pamidronate
• 20% of people who had a placebo (a treatment containing no active drug)

Fever may be part of a short-term reaction that can develop in the first few days after having Zometa. (To learn more, see “How long do side effects of Zometa last?” above.)

A fever will usually get better in a few days. But if your temperature gets too high, tell your doctor. They may recommend that you take acetaminophen (Tylenol) to reduce the fever. A high fever is a body temperature higher than 103.0°F (39.4°C).

Osteonecrosis of the jaw

Osteonecrosis of the jaw is a serious condition that causes bone cells in your jawbone to die. This leads to damage to your jawbone.

Zometa is a type of drug called a bisphosphonate. Osteonecrosis of the jaw has been reported in people having treatment with intravenous (IV) bisphosphonates, including Zometa. It’s not known how often this side effect may have occurred in clinical studies of the drug.

Risk factors for osteonecrosis of the jaw

You may have a higher risk for osteonecrosis of the jaw if you:

• have advanced breast cancer or multiple myeloma
• are also having treatment with chemotherapy or corticosteroids
• have long-term treatment with Zometa
• have gum disease or gum damage (from poorly fitting dentures, for instance)
• have invasive dental procedures, such as dental surgery or tooth removal, while being treated with Zometa.

Symptoms of osteonecrosis of the jaw

During your Zometa treatment, see your doctor right away if you have dental problems or symptoms of osteonecrosis of the jaw. Symptoms of this side effect can include:

• a loose tooth
• pain in your jaw, teeth, or mouth
• gum pain, swelling, or discharge
• sores on your gums that don’t heal
• numbness or a feeling of heaviness in your jaw

Dental tips before and during Zometa treatment

You should have a dental checkup before you start receiving Zometa. If needed, any dental work should be completed before you start Zometa treatment.

While having Zometa treatment, keeping your mouth and teeth clean can help reduce your risk for osteonecrosis. Brush and floss your teeth regularly, and use mouthwash if advised by your doctor or dentist. You should also have regular dental exams to check for any problems. In addition, you should avoid invasive dental procedures, such as surgery or tooth removal, during Zometa treatment.

Bone, joint, or muscle pain

You may have pain in your bones, joints, or muscles while receiving Zometa. In rare cases, this pain can be severe or even disabling.* The side effect can also be caused by your cancer or other treatments you may be having for your cancer.

Clinical studies compared these side effects in people receiving Zometa, pamidronate, or a placebo. (A placebo is a treatment containing no active drug.) Here are the percentages of people who had bone pain, muscle pain, or joint pain:

Bone, muscle, or joint pain may be part of a short-term reaction that can develop in the first few days after receiving Zometa. (To learn more, see “How long do side effects of Zometa last?” above.)

If you have bone, joint, or muscle pain while receiving Zometa, talk with your doctor. They can recommend treatments that may help. If you have severe pain, your doctor may suggest that you stop receiving Zometa.

* It’s not known how often severe or disabling bone, joint, or muscle pain may have occurred with Zometa in clinical studies.

Atypical femur fracture

Some people have had atypical femur (thigh bone) fractures while having treatment with Zometa. An atypical fracture is a break that happens after a very minor event, such as a bump. This type of fracture can occur with no obvious cause.

It’s not known how often this type of fracture occurs with Zometa use, but it’s rare. Atypical femur fractures have also been reported in people having treatment with other bisphosphonates. (Zometa is type of drug called a bisphosphonate.)

If you have any pain in your thigh, hip, or groin while receiving Zometa, see your doctor. You may need to have an X-ray to check for fractures.

Zometa dosage

The following information describes dosages that are commonly used or recommended. However, your doctor will determine the best dosage to fit your needs.

In addition, if you have kidney problems, a dosage lower than those listed here may be recommended for you.

Drug forms and strengths

Zometa comes as a liquid in two different forms:

• Single-dose, ready-to-use bottle. It contains 4 milligrams (mg) of the drug in 100 milliliters (mL) of liquid solution.
• Single-dose vial. It contains 4 mg of the drug in 5 mL of liquid solution. The solution will be diluted by a healthcare provider before use.

Zometa is given by intravenous (IV) infusion. This is an injection into a vein that’s given slowly over a period of time. The infusion will be given by a healthcare provider.

Dosage for hypercalcemia from cancer

The typical Zometa dosage for adults with hypercalcemia from cancer is 4 mg, given as a single dose. This should be infused over at least 15 minutes.

If your blood calcium level doesn’t fall to a normal level within 7 days, you may need a second dose of Zometa.

Dosage for multiple myeloma and bone metastasis from solid tumors

The typical Zometa dosage for adults with multiple myeloma or bone metastases from solid tumors is 4 mg, given every 3 to 4 weeks. Each infusion should be given over at least 15 minutes.

Dosage questions

Below are answers to some questions you may have about receiving Zometa.

What if I miss a dose?

It’s important to keep your appointments with your doctor for your Zometa infusions. If you miss an appointment, call your doctor’s office right away to reschedule.

To help make sure you don’t miss a dose, try setting a reminder on your phone for your appointments.

Will I need to use this drug long term?

Zometa is meant to be used as a long-term treatment for multiple myeloma and bone metastases from solid tumors. If you and your doctor determine that Zometa is safe and effective for you, you’ll likely take it long term.

However, if you’re receiving Zometa to treat hypercalcemia, you’ll have only one or two doses to correct your calcium level. If your calcium level increases again, the treatment can be repeated. But it’s not meant as a regular long-term treatment.

Zometa uses

The Food and Drug Administration (FDA) approves prescription drugs such as Zometa to treat certain conditions. Zometa may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Zometa for hypercalcemia from cancer

Zometa is FDA-approved to treat hypercalcemia due to cancer. This is a high level of calcium in your blood that’s caused by cancer.

It’s not known if Zometa is safe or effective for treating hypercalcemia caused by hyperparathyroidism. With hyperparathyroidism, your parathyroid glands (glands found near your thyroid gland in your neck) produce too much parathyroid hormone. This leads to hypercalcemia.

It’s also not known if Zometa is safe or effective for treating hypercalcemia that’s not caused by cancer. This is called non-tumor-related hypercalcemia.

Hypercalcemia explained

Hypercalcemia can cause symptoms such as:

• frequent urination
• feeling more thirsty than usual
• abdominal (belly) pain
• digestive problems, such as nausea, vomiting, and constipation
• bone pain
• muscle weakness
• confusion
• fatigue (lack of energy)
• abnormal heart rhythm

Hypercalcemia is a complication of many different types of cancer. It can develop if the cancer causes too much calcium to be released from your bones into your blood.

Hypercalcemia can happen with cancer such as multiple myeloma, which develops in your bones and damages the bone tissue. The condition can also happen if cancer spreads to your bones from other parts of your body. Breast cancer and prostate cancer commonly spread to the bones.

Hypercalcemia can also develop with cancer that isn’t in your bones. For example, some types of cancer release certain proteins into your bloodstream. The proteins activate cells that break down bone, causing calcium to be released into your blood. Types of cancer that this happens with include lung cancer, head and neck cancer, kidney cancer, and ovarian cancer.

Zometa helps prevent the breakdown of bone, so it stops calcium from being released into your blood. Zometa lowers the level of calcium in your blood.

Effectiveness for hypercalcemia from cancer

In clinical studies, Zometa was more effective at treating hypercalcemia from cancer than a similar drug called pamidronate. Zometa and pamidronate both belong to a class of drugs called bisphosphonates. (A class of drugs is a group of medications that work in a similar way.) Pamidronate is widely used to treat hypercalcemia from cancer.

The people in the study had blood calcium levels of 12.0 milligrams per deciliter (mg/dL) or higher before treatment. Those whose blood calcium levels dropped to 10.8 mg/dL or lower within 10 days of treatment were said to have had a complete response. (In general, a normal blood calcium level in adults is between 8.6 mg/dL and 10.2 mg/dL. This may vary between labs.)

• By day 7 of treatment, a complete response occurred in:
  • 82.6% of people treated with Zometa
  • 63.6% of people treated with pamidronate
• In 50% of people who had a complete response, the complete response lasted for:
  • 32 days in people treated with Zometa
  • 18 days in people treated with pamidronate

Zometa for multiple myeloma and bone metastases from solid tumors

Zometa is FDA-approved to treat multiple myeloma and bone metastases from solid tumors. The drug is used with standard treatments for cancer, such as chemotherapy, radiation therapy, and hormone therapy. Zometa is also used to treat bone metastases from prostate cancer. It’s used if prostate cancer has worsened after treatment with at least one hormone therapy, such as bicalutamide (Casodex).

Multiple myeloma is a form of cancer that affects the bone marrow tissue inside your bones. Bone metastases from solid tumors are cancers that have spread from their original site to your bones. Solid tumors are cancerous lumps, such as breast and prostate cancers. Breast cancer and prostate cancer commonly spread to the bones.

Zometa helps reduce bone damage and bone pain that can occur when cancer forms in your bones. The drug slows the breakdown of bone, so it can help prevent bone weakening that can lead to fractures. By slowing bone breakdown, Zometa can also make it harder for the cancer to grow in your bones. This can reduce pain and make it less likely that you’ll need radiation therapy or surgery on your bones.

You’ll need to take a daily calcium and vitamin D supplement while being treated with Zometa. This is to keep your calcium level from dropping too low. These supplements should contain 500 milligrams (mg) of calcium and 400 international units (IU) of vitamin D.

Effectiveness for multiple myeloma and bone metastases from solid tumors

In clinical studies, Zometa was found helpful in preventing bone problems in people with multiple myeloma or bone metastases from solid tumors.

These bone issues were:

• fractures (broken bones)
• spinal cord compression (problems caused by cancer in your spine growing and pressing on your spinal cord)
• radiation therapy or surgery to bone

Over the course of the studies, bone issues occurred in:

• 33% of males with bone metastases from prostate cancer who were treated with Zometa
• 44% of males with bone metastases from prostate cancer who were treated with a placebo (treatment containing no active drug)
• 38% of people with bone metastases from other solid tumors such as lung, kidney, colorectal, or bladder cancer who were treated with Zometa
• 44% of people with bone metastases from other solid tumors such as lung, kidney, colorectal, or bladder cancer who were treated with placebo
• 44% of people with multiple myeloma or bone metastases from breast cancer who were treated with Zometa
• 46% of people with multiple myeloma or bone metastases from breast cancer who were treated with pamidronate*

* Pamidronate belongs to the same class of drugs as Zometa. (A class of drugs is a group of medications that work in a similar way.) Pamidronate is widely used to treat multiple myeloma and bone metastases from breast cancer. In clinical studies, the percentage of people with bone issues was 13.1% lower in people treated with pamidronate than those treated with a placebo.

Zometa for other conditions

In addition to the uses listed above, Zometa may also be used off-label for other conditions. Off-label drug use is when an FDA-approved drug is used for a purpose other than what it’s approved for.

And you may wonder if Zometa is used for certain other conditions. Below is information about other possible uses for Zometa.

Zometa for breast cancer (off-label use)

Zometa is sometimes prescribed to people with breast cancer that hasn’t spread to other parts of the body. This is an off-label use of the drug.

Bisphosphonates such as Zometa have been shown to reduce the risk of breast cancer spreading to the bones in some people. Zometa can help prevent bone metastases in females* who have gone through menopause, either naturally or following treatment for their cancer.

The American Society of Clinical Oncology recommends that people in this group receive Zometa once every 6 months.

If you have questions about the use of Zometa for breast cancer, talk with your doctor.

* Use of the term “male” or “female” in this article refers to a person’s sex assigned at birth.

Zometa for osteoporosis (not an appropriate use)

Osteoporosis is a bone disease that causes your bones to become more porous, like honeycomb, and brittle. It results from an increase in bone breakdown and a loss of calcium from your bones. This is called reduced bone mineral density. It makes your bones weak and at risk for fracture. Osteopenia is the stage before osteoporosis when your bones have lost some of their bone mineral density.

Zometa helps strengthen bones and prevent their breakdown, so you may wonder if the drug can be used for these conditions.

Zometa isn’t FDA-approved for osteoporosis or osteopenia. However, other drugs in the same class as Zometa are used for osteoporosis. A class of drugs is a group of medications that work in a similar way. Zometa belongs to a class of drugs called bisphosphonates.

In fact, a different brand of zoledronic acid (the active drug in Zometa) is FDA-approved for osteoporosis. This brand is called Reclast. It contains a different dose of zoledronic acid than Zometa.

If you have osteoporosis or osteopenia, talk with your doctor about what treatments may be best for you.

Zometa and children

Zometa isn’t approved for any uses in children.

Zometa cost

As with all medications, the cost of Zometa can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use. In addition, the price depends on the cost of the healthcare provider visits to receive doses of Zometa.

It’s important to note that you’ll have to get Zometa from your doctor or at a specialty pharmacy. This type of pharmacy is authorized to carry specialty medications. These are drugs that may be expensive or may require help from healthcare professionals to be used safely and effectively.

Before approving coverage for Zometa, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Zometa, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Zometa, help is available. Visit Medicine Assistance Tool to find programs that may help lower the cost of your prescription.

Generic version

Zometa is available in a generic form called zoledronic acid. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs.

If your doctor has prescribed Zometa and you’re interested in using zoledronic acid instead, talk with your doctor. They may have a preference for one version or the other.

Alternatives to Zometa

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Zometa, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for hypercalcemia from cancer

Examples of other drugs that may be used to treat hypercalcemia (high calcium levels) caused by cancer include:

• denosumab (Xgeva, Prolia)
• pamidronate (previously available as the brand-name drug Aredia)
• calcitonin (Miacalcin)

Alternatives for multiple myeloma and bone metastasis from solid tumors

Examples of other drugs that may be used to treat multiple myeloma or bone metastases include:

• denosumab (Xgeva, Prolia)
• pamidronate

Zometa vs. Xgeva

You may wonder how Zometa compares with other medications that are prescribed for similar uses. Here we look at how Zometa and Xgeva are alike and different.

Ingredients

Zometa contains zoledronic acid. Xgeva contains denosumab.

Uses

Zometa and Xgeva are both approved by the Food and Drug Administration (FDA) to treat:*

• Hypercalcemia due to cancer.† Hypercalcemia is high level of calcium in your blood. In this situation, it’s caused by cancer. Xgeva is approved for this use only in cases when bisphosphonate drugs such as Zometa haven’t worked.
• Multiple myeloma and bone metastases of solid tumors. Multiple myeloma is a form of cancer that affects the tissue inside your bones. Bone metastases of solid tumors are cancers that have spread from their original site to your bones. Solid tumors are cancerous lumps, such as breast and prostate cancers.

Xgeva is also FDA-approved to treat:

• Giant cell bone tumors. A giant cell bone tumor is a rare, noncancerous type of bone tumor.

* To learn more about the specific uses of Zometa, see the “Zometa uses” section above.
† Zometa has certain limitations of use. For more information, see the “Zometa uses” section above.

Drug forms and administration

Here’s some information about the drug forms for Zometa and Xgeva and how they’re given.

Zometa

Zometa comes as a liquid that’s available in two different forms:

• a single-dose, ready-to-use bottle
• a single-dose vial

Zometa is given by intravenous (IV) infusion. This is an injection dripped into a vein slowly over a period of time. Zometa infusions are given by a healthcare provider over a period of at least 15 minutes. It’s typically done at a healthcare facility, but in some cases, a healthcare provider may give you the drug in your home.

For hypercalcemia caused by cancer, Zometa is given as a single dose. If needed, this may be repeated after 7 days.

For multiple myeloma or cancer that’s spread to your bones, Zometa is given once every 3 to 4 weeks.

Xgeva

Xgeva comes as a liquid solution in a single-dose vial. The drug is given as a subcutaneous injection (an injection just under your skin). You’ll receive Xgeva in your upper arm, upper thigh, or abdomen. This is typically done in doctor’s office or clinic. But in some cases, you can receive the injections from a healthcare provider at home or be trained how to give yourself injections.

For all uses, Xgeva is given once every 4 weeks. For giant cell tumors and hypercalcemia caused by cancer, you’ll also be given extra doses when beginning treatment. These are typically given on days 8 and 15 of the first month of treatment.

Side effects and risks

Zometa and Xgeva can cause some similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with either Zometa or Xgeva, as well as mild side effects that both drugs may share.

• Can occur with Zometa:
  • abdominal (belly) pain
  • fever
  • insomnia (trouble sleeping)
• Can occur with Xgeva:
  • few unique mild side effects
• Can occur with both Zometa and Xgeva:
  • nausea and vomiting
  • fatigue (lack of energy)
  • anemia (low red blood cell count)
  • constipation
  • diarrhea
  • shortness of breath
  • peripheral edema (buildup of fluid causing swollen legs, feet, or ankles)

Serious side effects

These lists contain examples of serious side effects that can occur with either Zometa or Xgeva, as well as serious side effects that both drugs may share.

• Can occur with Zometa:
  • kidney problems, such as reduced kidney function or kidney failure
• Can occur with Xgeva:
  • multiple breaks in the bones in your spine after stopping treatment
  • hypercalcemia (high calcium levels in your blood), after stopping treatment
• Can occur with both Zometa and Xgeva:
  • hypocalcemia (low calcium levels in your blood)
  • allergic reaction
  • osteonecrosis of the jaw (a type of damage to the jawbone)
  • atypical femur fracture (fracture of the thigh bone that happens after a very minor event, such as a bump, or without any obvious cause)
  • severe bone, joint, or muscle pain

Effectiveness

Zometa and Xgeva have different FDA-approved uses, but they’re both used to treat the following conditions:

• hypercalcemia caused by cancer
• multiple myeloma and bone metastases from solid tumors

The use of zoledronic acid (the active ingredient in Zometa) and Xgeva in treating multiple myeloma and bone metastases has been directly compared in several clinical studies. In these studies, Xgeva was found more effective than zoledronic acid for preventing bone problems. These included fractures (broken bones) and spinal cord compression. The problems also included the need for radiation therapy or surgery for bone cancer.

The studies looked at the percentages of people receiving zoledronic acid or Xgeva who reported bone problems. These side effects were studied in people with bone metastases from breast cancer, prostate cancer, or other solid tumors and multiple myeloma. Here’s how often bone problems occurred in each group:

Xgeva hasn’t been directly compared with Zometa for treating hypercalcemia caused by cancer. However, both Zometa and Xgeva have been found effective for treating this condition.

Costs

The costs of Zometa and Xgeva will vary depending on your treatment plan. The actual price you’ll pay for either drug also depends on your insurance plan, your location, and the pharmacy you use. In addition, the price depends on the cost of the healthcare provider visits to receive doses of either drug.

Zometa is a brand-name drug. Zometa is also available in a generic form called zoledronic acid. Brand-name medications usually cost more than generics.

Xgeva is a biologic drug that’s available only as a brand-name medication. It doesn’t come in a biosimilar form.

A biologic drug is made from living cells, while other drugs are made from chemicals. Drugs made from chemicals can have generics, which are exact copies of the active drug in the brand-name medication. Biologics, on the other hand, can’t be copied exactly. Therefore, instead of a generic, biologics have biosimilars. Biosimilars are “similar” to the parent drug, and they’re considered to be just as effective and safe.

Zometa vs. Prolia

Zometa and Prolia are prescribed for similar uses. Here we look at how these drugs are alike and different.

Ingredients

Zometa contains zoledronic acid. Prolia contains denosumab.

Uses

Zometa and Prolia are both approved by the Food and Drug Administration (FDA) to treat:*

• Hypercalcemia due to cancer.† Hypercalcemia is high level of calcium in your blood. In this situation, it’s caused by cancer.
• Multiple myeloma and bone metastases of solid tumors. Multiple myeloma is a form of cancer that affects the tissue inside your bones. Bone metastases of solid tumors are cancers that have spread from their original site to your bones. Solid tumors are cancerous lumps, such as breast and prostate cancers.

Prolia is also FDA-approved for use in the following people who have a high risk for bone fractures:

• females‡ with osteoporosis who have gone through menopause
• males with osteoporosis
• males and females with osteoporosis caused by drugs called corticosteroids
• males having androgen deprivation therapy (treatment to reduce testosterone levels) for prostate cancer that hasn’t spread to other parts of the body
• females having adjuvant aromatase inhibitor therapy (treatment to reduce estrogen levels) for breast cancer

* To learn more about the specific uses of Zometa, see the “Zometa uses” section above.
† Zometa has certain limitations of use. For more information, see the “Zometa uses” section above.
‡ Use of the term “male” or “female” in this article refers to a person’s sex assigned at birth.

Drug forms and administration

Here’s some information about the drug forms for Zometa and Prolia and how they’re given.

Zometa

Zometa comes as a liquid that’s available in two different forms:

• a single-dose, ready-to-use bottle
• a single-dose vial

Zometa is given by intravenous (IV) infusion. This is an injection dripped into a vein slowly over a period of time. Zometa infusions are given by a healthcare provider over a period of at least 15 minutes. It’s typically done at a healthcare facility, but in some cases, a healthcare provider may give you the drug in your home.

For hypercalcemia caused by cancer, Zometa is given as a single dose. If needed, this may be repeated after 7 days.

For multiple myeloma or cancer that’s spread to your bones, Zometa is given once every 3 to 4 weeks.

Prolia

Prolia comes as a liquid solution in a single-dose prefilled syringe. The drug is given as a subcutaneous (under the skin) injection by a healthcare provider. Prolia is typically given at a healthcare facility. But in some cases, a healthcare provider may be able to give you the drug at home. You’ll likely receive Prolia once every 6 months.

Side effects

Zometa and Prolia can cause some similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with either Zometa or Prolia, as well as mild side effects that both drugs may share.

• Can occur with Zometa:
  • fatigue (lack of energy)
  • diarrhea
  • shortness of breath
  • fever
• Can occur with Prolia:
  • few unique mild side effects
• Can occur with both Zometa and Prolia:
  • anemia (low red blood cell count)
  • constipation
  • nausea and vomiting
  • peripheral edema (buildup of fluid causing swollen legs, feet, or ankles)
  • abdominal (belly) pain
  • insomnia (trouble sleeping)

Serious side effects

These lists contain examples of serious side effects that can occur with either Zometa or Prolia, as well as serious side effects that both drugs may share.

• Can occur with Zometa:
  • kidney problems, such as reduced kidney function or kidney failure
• Can occur with Prolia:
  • multiple breaks in the bones in your spine after stopping treatment
  • hypercalcemia (high calcium level in your blood) after stopping treatment
  • serious infections, including skin infections
• Can occur with both Zometa and Prolia:
  • hypocalcemia (low calcium level in your blood)
  • allergic reaction
  • osteonecrosis of the jaw (a type of damage to the jawbone)
  • atypical femur fracture (fracture of the thigh bone that happens after a very minor event, such as a bump, or without any obvious cause)
  • severe bone, joint, or muscle pain

Effectiveness

Zometa and Prolia have different FDA-approved uses, so they haven’t been directly compared in clinical studies. However, studies have found both Zometa and Prolia to be effective for treating their separate approved uses.

Costs

The costs of Zometa and Prolia will vary depending on your treatment plan. The actual price you’ll pay for either drug also depends on your insurance plan, your location, and the pharmacy you use. In addition, the price depends on the cost of the healthcare provider visits to receive doses of either drug.

Zometa is a brand-name drug. Zometa is also available in a generic form called zoledronic acid. Brand-name medications usually cost more than generics.

Prolia is a biologic drug that’s available only as a brand-name medication. It doesn’t come in a biosimilar form.

A biologic drug is made from living cells, while other drugs are made from chemicals. Drugs made from chemicals can have generics, which are exact copies of the active drug in the brand-name medication. Biologics, on the other hand, can’t be copied exactly. Therefore, instead of a generic, biologics have biosimilars. Biosimilars are “similar” to the parent drug, and they’re considered to be just as effective and safe.

Zometa precautions

Before receiving Zometa, talk with your doctor about your health history. Zometa may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

• Kidney problems. Zometa is removed from your body by your kidneys. If your kidneys don’t work well, this can cause Zometa to build up in your body and increase your risk for side effects. Zometa can also worsen your kidney function and lead to kidney failure. If you have kidney problems, talk with your doctor about whether Zometa is right for you. They may prescribe a lower dose of Zometa than usual. Or they may prescribe a different medication. If you receive Zometa, you’ll likely have regular tests to check your kidneys.
• Dental problems or upcoming dental work. Zometa can sometimes cause a side effect called osteonecrosis of the jaw. Your risk for this side effect is higher if you have gum disease or gum damage from dentures that don’t fit well. The risk is also increased if you have invasive dental procedures, such as dental surgery or tooth extractions during Zometa treatment. Before you have treatment with Zometa, you should have a dental checkup. If needed, any dental work should be completed before you take Zometa.
• Asthma. Zometa is a class of drug called a bisphosphonate. (A drug class is a group of medications that work in a similar way.) Some people who are sensitive to aspirin have had asthma attacks when treated with a bisphosphonate drug. But this wasn’t reported in clinical studies of Zometa. If you have asthma that’s made worse by aspirin, talk with your doctor about whether Zometa is right for you.
• Low calcium level. Zometa lowers the level of calcium in your blood. You shouldn’t receive Zometa if you already have a low calcium level. If you’re receiving Zometa for multiple myeloma or cancer that’s spread to your bones, you’ll need to take daily calcium and vitamin D supplements. (To learn more, see the “Zometa use with other treatments” section below.)
• Allergic reaction. If you’ve had an allergic reaction to Zometa or any of its ingredients, you shouldn’t take Zometa. Ask your doctor what other medications are better options for you.
• Pregnancy. You shouldn’t have Zometa if you’re pregnant or plan to become pregnant. For more information, see the “Zometa and pregnancy” section below.
• Breastfeeding. You shouldn’t breastfeed while receiving Zometa or if you’ve ever had Zometa treatment. For more information, see the “Zometa and breastfeeding” section below.

Note: For more information about the potential negative effects of Zometa, see the “Zometa side effects” section above.

Zometa and alcohol

It isn’t known if alcohol interacts with Zometa. However, drinking alcohol during Zometa treatment could worsen certain side effects of the drug. Some examples of these side effects are nausea, diarrhea, headache, and dizziness. (For more information, see the “Zometa side effects” section above.

If you drink alcohol, ask your doctor how much is safe to have when receiving Zometa.

Zometa interactions

Zometa can interact with several other medications. Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Zometa and other medications

Below are examples of medication that can interact with Zometa. This section doesn’t contain all drugs that may interact with Zometa.

Before receiving Zometa, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Zometa and diuretics

Diuretics are drugs that help your body get rid of excess fluid through urination. These drugs can sometimes cause hypocalcemia (a low level of calcium in your blood). Diuretics can also cause problems that affect how well your kidneys work.

Zometa can cause hypocalcemia and kidney problems, too. If you use Zometa with diuretics, your risk for these problems can increase.

Examples of diuretics that can raise your risk for hypocalcemia and kidney problems include:

• furosemide (Lasix)
• bumetanide (Bumex)

If Zometa is used with a diuretic, your doctor will likely recommend frequent blood tests. These tests are used to check your calcium level and kidney function.

Zometa and calcitonin

Calcitonin (Miacalcin) is a drug that’s used to treat hypercalcemia (a high level of calcium in your blood). Zometa is also used to treat hypercalcemia. Both drugs lower your calcium level. If they’re used together, there may be a risk that your blood calcium level becomes too low. This is known as hypocalcemia.

If Zometa is used with calcitonin, you’ll likely have frequent blood tests to check your calcium level.

Zometa and aminoglycoside antibiotics

Antibiotics are drugs that treat bacterial infections. Aminoglycosides are a specific type of antibiotic. These drugs can cause hypocalcemia (a low level of calcium in your blood). And aminoglycosides can sometimes cause problems with how well your kidneys work.

Zometa can cause hypocalcemia and kidney problems, too. If you use Zometa with aminoglycoside antibiotics, your risk for these problems may be higher.

Examples of aminoglycoside antibiotics that can raise your risk for hypocalcemia and kidney problems include:

• amikacin
• gentamicin
• tobramycin

If Zometa is used with one of these antibiotics, you’ll likely have frequent blood tests to check your calcium level and kidneys.

Zometa and other drugs that can affect your kidneys

Zometa can sometimes cause problems with how well your kidneys work. If Zometa is used with other drugs that can cause kidney problems, your risk for kidney problems may be higher.

Examples of other drugs that can cause kidney problems include:

• drugs for high blood pressure or heart failure called angiotensin converting enzyme (ACE) inhibitors, such as lisinopril (Zestril, Prinivil)
• drugs that relieve pain and swelling, called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Ibu-Tab, Motrin)
• certain drugs that reduce the strength of the immune system, such as cyclosporine (Neoral, Sandimmune, Gengraf)
• certain antiviral drugs, such as acyclovir (Sitavig)
• certain antibacterial drugs, such as vancomycin (Vancocin)

If Zometa is used with another drug that can affect your kidneys, you’ll likely have frequent blood tests. These tests are used to check your kidney function.

Zometa and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Zometa. However, you should still check with your doctor or pharmacist before using any of these products while receiving Zometa.

Zometa and foods

There aren’t any foods that have been specifically reported to interact with Zometa. If you have any questions about eating certain foods with Zometa, talk with your doctor.

Zometa use with other treatments

For multiple myeloma, you’ll be given Zometa along with your cancer treatment. Your cancer treatment may include chemotherapy, radiation therapy, hormone therapy, or targeted therapy.

You’ll also likely take a daily calcium and vitamin D supplement with Zometa. This is to help prevent your calcium level from dropping too low. These supplements should contain 500 milligrams (mg) of calcium and 400 international units (IU) of vitamin D.

If you have high calcium levels due to cancer, you may receive Zometa with other treatments that help lower the levels. These treatments include:

• Receiving fluids given through a drip into a vein to rehydrate you.
• Taking diuretic medications, such as furosemide (Lasix). These drugs can help increase urination and remove the excess calcium when you urinate.

How Zometa is given

You should take Zometa according to your doctor’s or healthcare provider’s instructions.

Zometa is given by intravenous (IV) infusion. An IV infusion is a type of injection. The medication is dripped slowly into your vein through a tube. Zometa infusions take at least 15 minutes.

Your healthcare provider will give you your Zometa infusion. It will typically be given at a healthcare facility. But in some cases, a healthcare provider may be able to give you the drug at home.

When it’s given

For high calcium levels caused by cancer, Zometa is typically given as a single dose. This may be repeated after 7 days if your calcium level is still too high.

For multiple myeloma or cancer that has spread to your bones, Zometa is usually given once every 3 to 4 weeks. (Multiple myeloma is a form of cancer that affects the bone marrow tissue inside your bones.)

How Zometa works

Zometa is approved to treat the following conditions* in adults:

• Hypercalcemia due to cancer.† Hypercalcemia is high level of calcium in your blood. In this situation, it’s caused by cancer.
• Multiple myeloma and bone metastases of solid tumors. Multiple myeloma is a form of cancer that affects the tissue inside your bones. Bone metastases of solid tumors are cancers that have spread from their original site to your bones. Solid tumors are cancerous lumps, such as breast and prostate cancers.

* To learn more about the specific uses of Zometa, see the “Zometa uses” section above.
† Zometa has certain limitations of use. For more information, see the “Zometa uses” section above.

About calcium and bones

Calcium is a mineral that’s stored in your bones, and it helps to keep your bones strong. But throughout your life, your bones are constantly being rebuilt by cells called osteoclasts and osteoblasts.

Osteoclasts break down bone and release calcium into your blood. Osteoblasts repair bone and move calcium from your blood back into your bone. This process helps repair areas of damaged bone and control the level of calcium in your blood.

How cancer affects your bones and calcium level

Certain types of cancer can make osteoclasts more active than usual. When osteoclasts are overactive, too much calcium is released from your bones into your blood. A high level of calcium in your blood is called hypercalcemia. This condition can cause symptoms such as:

• nausea and vomiting
• fatigue (lack of energy)
• confusion
• urinating more often than usual
• thirst

If cancer develops in your bones, this can stimulate the osteoclasts and cause hypercalcemia. Cancers that can develop in your bones include multiple myeloma. This is a type of cancer that forms in the bone marrow tissue inside your bones.

Some types of cancer can spread to your bones from other parts of your body. These are called bone metastases. Advanced breast cancer and prostate cancer commonly spread to the bones.

Hypercalcemia can also develop with cancer that isn’t in your bones. For example, some types of cancer release certain proteins that flow through your bloodstream. These proteins activate the osteoclasts, causing calcium to be released into your blood. This occurs in various types of cancer, including:

• lung cancer
• head and neck cancer
• kidney cancer
• ovarian cancer

If you lose too much calcium from your bones, they can become weak and likely to fracture. And if you have cancer growing in your bones, this can cause your bones to have further damage, weakness, and pain.

What Zometa does

Zometa works by slowing the breakdown of bone. It attaches to your bones, making it harder for osteoclasts to break down the bone tissue. Zometa is also absorbed into the osteoclasts, stopping them from working. In addition, the drug encourages the osteoclasts to die more quickly than usual.

When bone breakdown is slowed, less calcium is released into your blood. This helps protect and strengthen your bones. By slowing bone breakdown, Zometa can also make it harder for cancer to grow in your bones.

With hypercalcemia, Zometa lowers the level of calcium in your blood. With multiple myeloma and bone metastases, Zometa helps protect your bones from damage due to the cancer. The drug can help strengthen your bones and ease bone pain. Zometa can also help lessen the need for radiation therapy or bone surgery. If the cancer is in your spine, Zometa can help lower the risk of the cancer pressing on your spinal cord.

How long does it take to work?

If you have hypercalcemia, the Zometa infusion typically lowers your calcium level to normal within a few days. This should help relieve your symptoms. You may need a second infusion if your calcium level isn’t back to normal within 7 days.

For multiple myeloma and bone metastases, the Zometa infusion should start working to protect your bones within the first few days. You’re unlikely to notice the drug working. However, if you have bone pain from your cancer, you should start seeing improvement within a few weeks. Your doctor may do various tests to see if the treatment is working. To keep benefitting from Zometa, you’ll need to have an infusion every 3 to 4 weeks.

Zometa and pregnancy

Zometa isn’t safe to receive during pregnancy. Studies in animals found that the drug can harm a developing fetus and cause miscarriage.

Zometa attaches to the bones and is released into the bloodstream over a long period of time. This can occur over weeks or sometimes years. As a result, Zometa could harm a fetus if you become pregnant after you finish treatment with the drug.

Your doctor may want you to have a pregnancy test before you begin Zometa treatment to make sure you’re not pregnant.

If you’re pregnant or planning to become pregnant, you shouldn’t receive Zometa. Talk with your doctor about other treatment options.

Zometa and fertility

Studies in animals found that Zometa may reduce fertility in females.* (Fertility is the ability to become pregnant.) Animal studies don’t always predict what will happen in humans. However, if you plan to become pregnant in the future, talk with your doctor. They can help you decide whether Zometa or a different drug is right for you.

It’s not known if Zometa affects fertility in males.

* Use of the term “male” or “female” in this article refers to a person’s sex assigned at birth.

Zometa and birth control

Zometa isn’t safe to receive during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Zometa.

For more information about receiving Zometa during pregnancy, see the “Zometa and pregnancy” section above.

Zometa and breastfeeding

If you’re breastfeeding or plan to breastfeed, you shouldn’t receive Zometa.

It’s not known if Zometa passes into breast milk or if the drug affects the way your body makes breast milk. However, if Zometa does pass into breast milk, the drug could be harmful to a breastfed child.

Zometa attaches to the bones and is then released into the bloodstream over long periods of time. This can occur over weeks or sometimes years. As a result, you shouldn’t breastfeed while receiving Zometa or if you’ve ever had Zometa treatment.

If you’re breastfeeding or plan to breastfeed, talk with your doctor about treatment options other than Zometa.

Common questions about Zometa

Here are answers to some frequently asked questions about Zometa.

Will Zometa cure my condition?

Zometa can’t cure cancer. But the drug can help protect your bones from damage caused by having cancer in your bones. Keep in mind that cancer doesn’t have a cure yet.

Zometa can treat hypercalcemia (a high level of calcium in your blood) that’s caused by the cancer. However, hypercalcemia could come back and need to be treated again.

If you have any questions about how Zometa will treat your condition, talk with your doctor.

Is Zometa chemotherapy?

No, Zometa isn’t chemotherapy. Zometa belongs to a class of drugs called bisphosphonates. (A class of drugs is a group of medications that work in a similar way.)

Chemotherapy is a form of cancer treatment. It uses powerful drugs to kill cancer cells. Bisphosphonates, on the other hand, are drugs that help prevent the breakdown of bone. Bone breakdown can be a side effect of some types of cancer.

Depending on your type of cancer, you may have Zometa treatment to reduce damage to your bones and relieve bone pain. Or you may have the treatment to lower high calcium levels caused by the cancer breaking down your bones.

You may also have chemotherapy along with Zometa. The chemotherapy will treat your cancer while Zometa will treat the bone-related complications of the cancer.

If you have any questions about Zometa or chemotherapy, talk with your doctor.

If I have asthma, can I use Zometa?

You may be able to have Zometa treatment if you have asthma, but you should check with your doctor.

Zometa is a type of drug called a bisphosphonate. Some people who are sensitive to aspirin have had asthma attacks when treated with a bisphosphonate drug. But this wasn’t reported in clinical trials of Zometa.

If you have asthma that’s made worse by aspirin, be sure to tell your doctor before starting Zometa treatment. They can help you decide if Zometa or a different medication is best for you.

Can I use Zometa with Reclast?

No, you shouldn’t have Zometa treatment if you’re using Reclast. These medications contain the same active drug, zoledronic acid. Taking these medications together can increase your risk for the side effects of zoledronic acid. These include kidney problems and osteonecrosis (death of bone cells) of the jaw.

To read more about the side effects of Zometa, see the “Zometa side effects” section above.

And if you have questions about Zometa or Reclast, talk with your doctor.

If I have kidney problems, can I use Zometa?

You may be able to have Zometa treatment if you have kidney problems. It depends how severe your kidney problems are and what Zometa is treating. For example, if you have multiple myeloma or cancer that has spread to the bones, Zometa isn’t recommended if you also have severe kidney problems. (Multiple myeloma is a form of cancer that affects the marrow inside your bones.)

Your kidneys work to remove Zometa from your system. If your kidneys don’t work well, the drug can build up in your body. This can increase your risk for side effects. (To learn more, see the “Zometa side effects” section above.) Zometa can also worsen kidney problems that you already have.

If you have kidney problems, talk with your doctor about whether Zometa is right for you. Your doctor may prescribe a lower dosage of Zometa than usual.

It’s important that your kidneys are monitored while you receive Zometa. You’ll need to have frequent blood tests to check how they’re working. If your kidney function worsens, your doctor may reduce your Zometa dose. Or they may have you switch to a different drug.

Can I have dental work done while taking Zometa?

No, it’s best not to have dental work during Zometa treatment. Doing so can raise your risk for a serious side effect called osteonecrosis of the jaw. With this condition, bone cells in your jawbone die, leading to damage to your jawbone.

Before being treated with Zometa, you should have a dental checkup. If you need dental work, it should be completed before you receive the drug.

To help keep your mouth healthy during Zometa treatment, brush and floss your teeth on a regular basis. Also, use mouthwash if your doctor or dentist recommends it. In addition, you should have regular dental exams to check for any problems. Invasive dental procedures such as surgery or tooth extractions should be avoided while you’re receiving Zometa.

It’s also helpful to know the symptoms of osteonecrosis of the jaw so you know what to look for. To learn more, see “Osteonecrosis of the jaw” in the “Zometa side effects” section above.

If you have any dental problems, such as pain, while receiving Zometa, tell your dentist and doctor right away.

Zometa overdose

Do not use more Zometa than your doctor recommends. For some drugs, doing so may lead to unwanted side effects or overdose.

What to do in case you take too much Zometa

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.