zoledronic acid
Brand names: Reclast, Zometa
Zoledronic acid injection is a medicine that helps treat high calcium levels in the blood and bone problems caused by cancer. It belongs to a class of drugs called bisphosphonates and is given through a vein.
Drug Pricing (NADAC)
Generic Price
$0.59/unit
Generic Available
Yes (20 manufacturers)
Pricing data from NADAC (CMS), effective December 18, 2024. Compare all drug costs →
What it does
This medicine can treat high calcium levels in your blood caused by cancer.
Common side effects
Nausea, Tiredness, Anemia (low red blood cells)
Key warnings
Do not take zoledronic acid if you are also taking Reclast or other bisphosphonates.
How It Works
Zoledronic acid works by slowing down the breakdown of bone. It does this by targeting cells called osteoclasts, which are responsible for breaking down bone tissue. By slowing down bone breakdown, it can lower calcium levels in the blood and reduce bone pain and fractures.
How to Take It
Zoledronic acid is given into your vein through an IV. For high calcium, you'll get a 4 mg dose over at least 15 minutes. For bone problems, you'll get a 4 mg dose every 3 to 4 weeks. You should also take daily calcium (500 mg) and vitamin D (400 IU) supplements.
Pregnancy & Breastfeeding
Zoledronic acid can harm an unborn baby. If you are a woman who could become pregnant, use effective birth control while taking this medicine. Do not breastfeed while using this medicine.
Missed Dose
If you miss an appointment to receive zoledronic acid, call your doctor as soon as possible to reschedule.
Storage
Store at room temperature, away from heat and light. Discard any unused medicine.
Side Effects (from patient reports)
Based on 25,681 FDA adverse event reports.
FDA Adverse Event Report Analysis
Detailed analysis of 38,197 reports from the FDA Adverse Event Reporting System (FAERS). Reports span 2003–2025.
Total Reports
38,197
Death-Related Reports
4,999
Hospitalization Reports
11,023
Top Indication
Product Used For Unknown Indication
Gender Distribution
Age Distribution
Most Reported Adverse Reactions (FAERS)
| # | Reaction | Reports |
|---|---|---|
| 1 | ARTHRALGIA | 3,083 |
| 2 | PAIN | 3,046 |
| 3 | PYREXIA | 2,701 |
| 4 | NAUSEA | 2,690 |
| 5 | FATIGUE | 2,657 |
| 6 | OSTEONECROSIS OF JAW | 2,613 |
| 7 | DEATH | 2,438 |
| 8 | HEADACHE | 2,278 |
| 9 | DIARRHOEA | 2,189 |
| 10 | VOMITING | 1,983 |
| 11 | ASTHENIA | 1,893 |
| 12 | MYALGIA | 1,806 |
| 13 | OFF LABEL USE | 1,661 |
| 14 | PAIN IN EXTREMITY | 1,624 |
| 15 | DYSPNOEA | 1,594 |
Reactions in Death Reports
Reactions in Hospitalization Reports
Source: FDA FAERS (Adverse Event Reporting System) FDA FAERS (Adverse Event Reporting System) Reports are voluntary and do not establish causation
Serious Warnings
Do not take zoledronic acid if you are also taking Reclast or other bisphosphonates. This medicine can cause kidney problems, especially if you already have kidney issues. It can also cause a rare but serious condition called osteonecrosis of the jaw (ONJ). Tell your doctor right away if you have severe bone, joint, or muscle pain. This medicine may also increase your risk of unusual thigh bone fractures.
Known Drug Interactions
7.1 Aminoglycosides and Calcitonin Caution is advised when bisphosphonates are administered with aminoglycosides or calcitonin, since these agents may have an additive effect to lower serum calcium level for prolonged periods.
Mechanism: Both of these medicines lower the amount of calcium in your blood. Taking them together can cause your calcium levels to drop too low for a long time.
What to do: Your doctor will likely check your blood calcium levels regularly. You may need to take calcium supplements while using these drugs.
Common Questions
What should I do before each treatment?
Can I take this with other medications?
What if I have dental problems?
How long will I be on this medication?
What are the signs of kidney problems?
What are the symptoms of osteonecrosis of the jaw (ONJ)?
Can this medicine affect my fertility?
What if I have pain in my thigh or groin?
Do I need to drink more water while taking this?
Are there any foods I should avoid?
What are the common side effects of zoledronic acid?
Does zoledronic acid interact with other medications?
What drug class is zoledronic acid?
Is zoledronic acid safe during pregnancy?
Related Medications in Bisphosphonate (IV)
Other drugs grouped near zoledronic acid — same-class peers and common alternatives.
abaloparatide
Tymlos
Tymlos is a medicine to treat osteoporosis.
Compare with zoledronic acid →
alendronate
Fosamax
Binosto is a medicine that helps make your bones stronger.
Compare with zoledronic acid →
calcitonin
Miacalcin, Fortical
Calcitonin is a medicine that helps manage calcium levels in your body.
Compare with zoledronic acid →
denosumab
Prolia, Xgeva
Stoboclo is a medicine that helps to treat osteoporosis and increase bone mass.
Compare with zoledronic acid →
ibandronate
Boniva
Ibandronate (Boniva) is a medicine that helps treat and prevent bone loss in women after menopause.
Compare with zoledronic acid →
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What the FDA Data Shows for zoledronic acid
The FDA label for zoledronic acid (sold under brand names such as Reclast, Zometa) classifies it as a prescription-only medication in the Bisphosphonate (IV) class. This medicine can treat high calcium levels in your blood caused by cancer. Official labeling lists 8 commonly reported side effects, including Nausea, Tiredness, Anemia (low red blood cells).
Post-market surveillance from the FDA Adverse Event Reporting System (FAERS) captures real-world experience. For this drug, FAERS contains 25,681 voluntary reports. The database also lists 1 documented drug interaction derived from FDA labeling, with the top-flagged interaction rated moderate severity. NADAC pricing from CMS shows a generic unit cost of $0.59.
Report counts do not establish causation — a FAERS entry documents a temporal association, not proof that the drug produced the outcome. Widely prescribed medications naturally accumulate more reports than niche therapies, so raw totals must be interpreted alongside total exposure. Shortage status, recall history, and patent information further shape supply and switching decisions. This page summarizes public FDA data for educational purposes only and is not a substitute for professional medical advice — always consult a licensed healthcare provider before starting, stopping, or changing any medication.
Data Sources
Drug labeling: FDA Drug Labels (SPL/DailyMed). Adverse events: FDA Adverse Event Reporting System (FAERS). Pricing: CMS National Average Drug Acquisition Cost (NADAC).
FAERS reports are voluntary and do not establish causation. Drug interactions are derived from FDA labeling and clinical references. Always consult a healthcare professional before making medication decisions.
Last updated: September 18, 2023
Read our methodology — how this data is sourced, computed, and verified.
All federal data sources used on this page
- FDA Orange Book — approved drug products with therapeutic equivalence. accessdata.fda.gov/cder/ob
- FDA DailyMed — NIH-hosted drug labeling for FDA-approved meds. dailymed.nlm.nih.gov
- FDA Adverse Event Reporting System (FAERS) — post-marketing safety surveillance. fda.gov/drugs/faers
- NLM RxNorm — standardized clinical drug nomenclature. nlm.nih.gov/research/umls/rxnorm
- CMS Medicare Part B Drug Average Sales Price Files — federal drug pricing data. cms.gov/medicare/part-b-drugs/asp
- FDA Drug Shortages Database — current and resolved drug shortage tracking. accessdata.fda.gov/drugshortages