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Patient information - High calcium - Zoledronic acid

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This treatment is not chemotherapy. Your cancer has caused the level of one of the electrolytes (calcium) in your blood to be too high. This treatment is used to lower the level of calcium in the blood.

Zoledronic acid 
This treatment may not need to repeated depending on the response you have. Your doctor will advise you of the number of treatments you will have.
Day Treatment How it is given How long it takes
1 Zoledronic acid 
(ZOE-le-DRON-ik AS-id)		 By a drip into a vein About 30 minutes

Emergency contact details

Ask your doctor or nurse from your treating team when you should get help and who to contact if you have a problem
Daytime: 
Night/weekend: 
Other instructions: 

During your treatment immediately tell the doctor or nurse looking after you if you get any of the following problems: 

  • pain, stinging, swelling or redness around the injection site
  • a skin rash, itching, feeling short of breath, wheezing, fever, shivers, or feeling dizzy or unwell in any way (allergic reaction).

Changes to your dose or treatment delays

Sometimes a treatment may be started at a lower dose or the dose needs to be changed during treatment. There may also be times when your treatment is delayed. This can happen if your doctor thinks you are likely to have severe side effects, if you get severe side effects, if your blood counts are affected and causing delays in treatment, or if you are finding it hard to cope with the treatment. This is called a dose reduction, dose change or treatment delay. Your doctor will explain if you need any changes or delays to your treatment and the reason why.

Blood tests and monitoring 

You may need to have blood tests while you are receiving this treatment. Your doctor or nurse will tell you when to have these blood tests.

Fluid intake

If you do not have any heart or kidney problems, keep your fluids up by drinking at least 8 to 10 glasses of fluid daily

Cancer treatments can cause damage to normal cells in your body, which can cause side effects. Everyone gets different side effects, and some people will have more problems than others.

The table below shows some of the side effects you may get with this treatment. You are unlikely to get all of those listed and you may also get some side effects that have not been listed.

Tell your doctor or nurse about any side effects that worry you. Follow the instructions below and those given to you by your doctor or nurse.

Immediate (onset hours to days)

Flu-like symptoms

  • You may get: 
    • a fever
    • chills or sweats 
    • muscle and joint pain 
    • a cough
    • headaches.
  • Tell your doctor or nurse if you get any of the symptoms listed above. 
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have a temperature of 38°C or higher.

Headache

  • You can take paracetamol if you have a headache.
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you get a very bad headache that is not helped by pain medication.

Nausea and vomiting

  • You may feel sick (nausea) or be sick (vomit).
  • Drink plenty of fluids (unless you are fluid restricted).
  • Eat small meals more frequently.
  • Try food that does not require much preparation.
  • Try bland foods like dry biscuits or toast.
  • Gentle exercise may help with nausea.
  • Anti-sickness medication is usually not needed but may help in some people.
  • Ask your doctor or nurse for eviQ patient information - Nausea and vomiting during cancer treatment. 
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have uncontrolled vomiting or feel dizzy or light-headed.

Early (onset days to weeks)

Low red blood cells (anaemia)

  • You may feel dizzy, light-headed, tired and appear more pale than usual.
  • Tell your doctor or nurse if you have any of these signs or symptoms. You might need a blood transfusion.
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have any chest pain, trouble breathing, or feel like your heart is racing.

Low blood calcium levels (hypocalcaemia) and low blood phosphate levels (hypophosphataemia)

  • This may be found from your routine blood tests and treated by your doctor.
  • If it is severe you may get:
    • muscle cramps or twitches
    • numbness or tingling in your fingers, toes or around your mouth
    •  sleepy or drowsy
  • Tell your doctor or nurse as soon as possible if you get any of the signs or symptoms listed above.

Tiredness and lack of energy (fatigue)

  • You may feel very tired, have no energy, sleep a lot, and not be able to do normal activities or things you enjoy.
  • Do not drive or operate machinery if you are feeling tired.
  • Nap for short periods (only 1 hour at a time)
  • Prioritise your tasks to ensure the best use of your energy.
  • Eat a well balanced diet and drink plenty of fluids (unless you are fluid restricted).
  • Try some gentle exercise daily.
  • Allow your friends and family to help.
  • Tell your doctor or nurse if you get any of the symptoms listed above.

Joint and muscle pain and stiffness

  • You may get muscle, joint or general body pain and stiffness.
  • Applying a heat pack to affected areas may help.
  • Talk to your doctor or nurse about other ways to manage these symptoms. You may need medication to help with any pain.

Stomach pain

  • You may get:
    • dull aches
    • cramping or pain
    •  bloating or flatulence (gas).
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have stomach pain that you are unable to control.

Constipation

  • You may have bowel motions (stools, poo) that are less frequent, harder, smaller, painful or difficult to pass.
  • You may also get:
    • bloating, cramping or pain
    • a loss of appetite 
    •  nausea or vomiting.
  • Drink plenty of fluids (unless you are fluid restricted).
  • Eat plenty of fibre-containing foods such as fruit, vegetables and bran.
  • Take laxatives as directed by your doctor.
  • Try some gentle exercise daily.
  • Tell your doctor or nurse if you have not opened your bowels for more than 3 days.

Diarrhoea

  • You may get bowel motions (stools, poo) that are more frequent or more liquid.
  • You may also get bloating, cramping or pain.
  • Take your antidiarrhoeal medication as directed by your doctor.
  • Drink plenty of fluids (unless you are fluid restricted).
  • Eat and drink small amounts more often.
  • Avoid spicy foods, dairy products, high fibre foods, and coffee.
  • Ask your doctor or nurse for eviQ patient information - Diarrhoea during cancer treatment. 
  • Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if your diarrhoea is not controlled, you have 4 or more loose bowel motions per day, and if you feel dizzy or light-headed.

Low blood pressure (hypotension)

  • You may get low blood pressure from this treatment.
  • You may feel dizzy or light-headed.
  • Tell your doctor if you are taking blood pressure medication.
  • Your doctor will monitor your blood pressure regularly while you are on this treatment.
  • Drink plenty of fluids (unless you are fluid restricted).
  • When you want to get up from a sitting or lying down position, get up slowly to let your body adjust to the new position.
  • Do not drive or operate machinery if you feel dizzy or light-headed.
  • Tell your doctor or nurse if you get any of the signs or symptoms listed above.

Difficulty sleeping (insomnia)

  • You may have trouble falling or staying asleep. 
  • Try some gentle exercise daily.
  • Avoid coffee, tea and other caffeinated drinks around bedtime.
  • Try something to relax before bed, like a bath or meditation.
  • If you can't sleep get up and do something quietly, such as reading, until you feel tired.
  • Tell your doctor or nurse if you have difficulty sleeping.

Delayed (onset months to years)

Jaw problems (osteonecrosis of the jaw)

  • You may get the following signs or symptoms during treatment, or after you have stopped treatment:
    • pain, swelling or infection in the gums
    • loosening of teeth
    • numbness or heaviness in the jaw
    •  poor healing of gums and sockets, especially after dental treatment
  • Do your mouth care regularly. 
  • See a dentist before you begin treatment and then for 6 monthly check ups.
  • Make sure you tell your dentist that you are starting treatment with a bisphosphonate or denosumab.
  • If you need a tooth removed, talk to your doctor first, as you will need to stop treatment 6 to 8 weeks before the dental work. Only start treatment again when the tooth socket has healed.
  • Tell your doctor or dentist immediately if you get any of the symptoms listed above.

Lung problems

  • Lung problems are rare, but can be serious. They may occur throughout treatment or after the completion of treatment. 
  • You may get:
    • shortness of breath
    • fever
    • dry cough
    • wheezing
    • fast heartbeat
    •  chest pain.
  • Your doctor will monitor how well your lungs are working during your treatment.
  • Tell your doctor or nurse immediately, or go to the nearest hospital Emergency Department if you have chest pain or become short of breath.

Blood clot risk

  • Cancer and anticancer drugs can increase the risk of a blood clot (thrombosis).
  • Tell your doctor if you have a family history of blood clots.
  • A blood clot can cause pain, redness, swelling in your arms or legs, shortness of breath or chest pain.
  • If you have any of these symptoms go to your nearest hospital Emergency Department.

Medications and vaccinations 

  • Before you start treatment, tell your doctor about any medications you are taking, including vitamins or herbal supplements.
  • Don’t stop or start any medications during treatment without talking to your doctor and pharmacist first.
  • Vaccinations such as flu and tetanus vaccines are safe to receive while you are having treatment. If you are unsure, check with your doctor before you have any vaccinations. 

Other medical and dental treatment

  • If you go to hospital or any other medical appointment (including dental appointments), always tell the person treating you that you are receiving anticancer drugs.
  • Before you have any dental treatment, talk to your doctor. 

Diet 

  • While you are receiving this treatment it is important that you try to maintain a healthy diet.
  • Speak to your doctor or nurse about whether drinking alcohol is safe with your treatment.
  • If you have any concerns about recent weight loss or weight gain or questions about your diet, ask to speak to a dietitian.

Fertility

  • Some cancer treatments can reduce your fertility. This can make it difficult or impossible to get pregnant or father a child.
  • Talk to your doctor or nurse before you start any treatment. Depending on your situation there may be fertility sparing options available to you and/or your partner, discuss these with your doctor or nurse. 

Pregnancy and breastfeeding 

  • Some cancer treatments can be dangerous to unborn babies. Talk to your doctor or nurse if you think there is any chance that you could be pregnant.
  • Do not try to get pregnant or father a child during this treatment. Contraception should be used during treatment and after stopping treatment. Ask your doctor or nurse about what type of contraception you should use.
  • If you are planning pregnancy/fatherhood after completing this treatment, talk to your doctor. Some doctors advise waiting between 6 months and 2 years after treatment.
  • Do not breastfeed if you are on this treatment, as anti-cancer medications can also pass into breast milk.

Sex life and sexuality 

  • The desire to have sex may decrease as a result of this treatment or its side effects. 
  • Your emotions and the way you feel about yourself may also be affected by this treatment. 
  • It may help to discuss your concerns with your partner and doctor or nurse.

Quitting smoking

  • It is never too late to quit smoking. Quitting smoking is one of the best things you can do to help your treatment work better.
  • There are many effective tools to improve your chances of quitting.
  • Talk to your treating team for more information and referral to a smoking cessation support service.

Staying active

  • Research shows that exercise, no matter how small, has many benefits for people during and after cancer treatment.
  • Talk to your doctor before starting an exercise program. Your doctor can advise whether you need a modified exercise program.

For more information about cancer treatment, side effects and side effect management see our Patient and carers section. 

Telephone support

  • Call Cancer Council 13 11 20 for cancer information and support

General cancer information and support

Quit smoking information and support

Quitting smoking is helpful even after you have been diagnosed with cancer. The following resources provide useful information and support to help you quit smoking. Talk to your treating team about any other questions you may have.

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https://www.eviq.org.au/pi/1504

20 Apr 2024