Zoltero 4 Drug Interactions

Anticipated interactions to be considered: Caution is advised when bisphosphonates like Zoledronic acid are administered with aminoglycosides or calcitonin or loop diuretics, since these agents may have an additive effect, resulting in a lower serum calcium level for longer periods than required (see Precautions).
Caution is indicated when Zoledronic acid is used with other potentially nephrotoxic drugs (see Adverse Reactions).
Observed interactions to be considered: Caution is advised when Zoledronic acid is administered with anti-angiogenic drugs as an increase in incidence of ONJ have been observed in patients treated concomitantly with these drugs.
Absence of interactions: In clinical studies, Zoledronic acid has been administered concomitantly with commonly used anticancer agents, diuretics (except for loop diuretics, see Anticipated interactions to be considered as previously mentioned), antibiotics and analgesics without clinically apparent interactions occurring.
No dose adjustment for Zoledronic acid 4 mg is needed when coadministered with thalidomide. In a pharmacokinetic study of 24 patients with multiple myeloma, Zoledronic acid 4 mg given as a 15- minute infusion was administered either alone or with thalidomide (100 mg once daily on days 1-14 and 200 mg once daily on days 15-28).
Coadministration of thalidomide with Zoledronic acid did not significantly change the pharmacokinetics of zoledronic acid or creatinine clearance.
Zoledronic acid shows no appreciable binding to plasma proteins and does not inhibit human P450 enzymes in vitro (see Pharmacology: Pharmacokinetics under Actions), but no formal clinical interaction studies have been performed.