Q: I have read your columns on medications such as Boniva, Actonel, etc. and the recent one on Atelvia. What is your opinion on the one-year Reclast infusion?
A: Reclast (zoledronic acid) is in a group of medicines known as bisphosphonates. The medication is administered intravenously annually by a physician or nurse and takes about 15 minutes to complete. Calcium and vitamin D supplements are recommended to those on the drug. Reclast was designed to treat and prevent osteoporosis in women and Paget’s disease in men. The benefits of the drug are believed to last a year, yet the side effects will not last that long. Flu-like symptoms, muscle or joint pain, nausea, vomiting, diarrhea, fever and headache may appear within three days of the infusion but will generally dissipate in about two weeks. Fluids should be ingested prior to receiving the IV to help reduce the incidence of kidney difficulties that may lead to hospitalization that can be extremely serious. It is also used by people who expect to take steroid medication for a year or longer.
There are unwanted potential side effects, to include non-traumatic femur fracture, kidney damage when specific medications such as anti-virals, injected antibiotics, drugs for pain, arthritis and chemotherapy are used. Osteonecrosis of the jaw has been reported with side effects of jaw pain, loose teeth, anemia, clotting disorders, numbness and inflammation. Risk factors for developing osteonecrosis include being on chemotherapy for cancer, or the use of radiation and steroids. Individuals who should not use Reclast include those with low levels of calcium (hypokalemia), and those who are pregnant or are breast feeding because of potential harm to the baby.
You don’t indicate your age but I am guessing you are attempting to treat or prevent osteoporosis. Bisphosphonates to include Fosamax, Actonel and Boniva have been prescribed for more than 10 years. With time comes knowledge. For example, when an individual takes an oral medication for osteoporosis, only a portion of the drug gets into the bone where it is needed. Thus, the frequency of oral usage. It is believed that with infusion, the medication bypasses the stomach, passes through the bloodstream, and ends up in the bones where it increases their density. Reclast was first introduced into the market in August 2001. Because of its annual simplicity of dosing and FDA approval, it quickly became one of the most popular bisphosphonate medications in our country. However, on the downside, recent studies suggest that prolonged treatment of zoledronic acid’s pharmacodynamics may be linked with the risk of those femur fractures, kidney disorders and osteonecrosis mentioned above.
Suffice it to say I am a skeptic. We might think 12 years on the market would tell it all. In my view, the drug is, in some respects, in its infancy. I am not privy to your medical history or any other drugs you may be on. Therefore, I defer to your primary care physician. If he or she feels strongly that it is better for you than over-the-counter calcium with vitamin D taken daily, go for it. If any question remains, take the easy road and hold off. This is no reflection on the drug itself, only on the unknown.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Osteoporosis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
