Not to be mixed w/ Ca or other divalent cation-containing infusion soln eg, lactated Ringer's soln. Discontinue in patients w/ suspected atypical femur fracture. Withhold treatment in patients w/ renal deterioration. Osteonecrosis of the jaw (ONJ); bone, joint &/or muscle pain; signs of local infection including osteomyelitis; atypical subtrochanteric & diaphyseal femoral fractures; hypocalcaemia (severe &/or life-threatening), cardiac arrhythmias & neurologic adverse events including seizures, numbness & tetany. Patients who are smoking & w/ comorbid conditions eg, anaemia, coagulopathies, infection; w/ history of dental disease, poor oral hygiene, periodontal disease, invasive dental procedures & poorly fitting dentures. Recurrence of musculoskeletal pain when rechallenged w/ therapy or another bisphosphonate. Assess patients to ensure adequate hydration prior to administration. Determine serum creatinine & CrCl in patients w/ multiple myeloma or metastatic bone lesions from solid tumours when initiating treatment. Monitor Ca, phosphate & Mg serum levels after initiating therapy; renal function. Assess serum creatinine levels prior to each dose. Consider dental exam w/ appropriate preventive dentistry prior to treatment. Evaluate patients w/ thigh, hip or groin pain for incomplete femur fracture. Avoid overhydration in patients at risk of cardiac failure; invasive dental procedures while on treatment. Concomitant use w/ other medicines containing zoledronic acid or any other bisphosphonate; chemotherapies, RT, corticosteroids. May influence ability to drive & use machines. Not recommended in severe renal impairment (CrCl <30 mL/min). Severe hepatic insufficiency. Not to be used during pregnancy. Contraindicated in lactation. Childn 1-17 yr.
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