Zoledronic acid is generally well tolerated and adverse effects are usually mild and do not require discontinuance of the drug.
Body as a Whole:
Fever and flu-like syndrome (usually at the start of treatment), fatigue, chills, rigors, malaise and flushing, progression of cancer, weakness, rigors.
Hypotension (associated with syncope or circulatory collapse primarily in patients with underlying risk factors), hypertension, bradycardia, atrial fibrillation, edema of lower limb/peripheral edema, chest pain.
Insomnia, sleep disorder/disturbance, somnolence, anxiety, depression, confusion, agitation, headache, dizziness, vertigo, asthenia, paresthesia, taste disturbance, hypoesthesia, hyperesthesia, tremor, hallucination.
Abdominal pain, nausea, anorexia, dyspepsia, constipation, diarrhea, vomiting, stomatitis, sore throat, decreased weight, increased weight, dehydration, decreased appetite, dry mouth, thirst, peptic ulceration.
Hemic and Lymphatic System:
Anemia, neutropenia, granulocytopenia, thrombocytopenia, leukopenia, pancytopenia.
Rare reports of allergic reactions including angioedema; very rare cases of anaphylactic reaction/shock.
Injection Site Reactions:
Local reactions at the infusion site (including redness or swelling, pain, irritation, induration), thrombophlebitis.
Hypophosphatemia, hypomagnesemia, hyperkalemia, hypokalemia, hypernatremia, increased blood creatinine and blood urea, hypocalcemia.
Musculoskeletal, Connective Tissue and Bone Disorders:
Musculoskeletal pain (which may be severe and incapacitating), bone pain, myalgia, arthralgia, back pain, pain in the limb, muscle cramps, generalized pain, joint stiffness, ONJ, atypical subtrochanteric and diaphyseal femoral fractures.
Uveitis, scleritis, episcleritis, conjunctivitis, blurred vision, iritis, and orbital inflammation.
Renal and Urinary Disorders:
Renal impairment, acute renal failure, renal deterioration, hematuria, proteinuria, urinary tract infection.
Dyspnea, cough, upper respiratory tract infection, bronchoconstriction.
Skin and Subcutaneous Tissue Disorders:
Alopecia, dermatitis, hyperhidrosis, pruritus, urticaria, rash (including erythematous and macular rash).