Zoledronic acid: safe, effective — and not covered
When should I prescribe zoledronic acid (Aclasta), and what should I know about the drug’s side effects? A. Schlanger, MD, Toronto, ON
Zoledronic acid is an effective treatment for osteoporosis, with a substantial body of evidence in multiple scenarios (for example post hip fracture controlled trials). It’s an annual intravenous infusion, the cost of which is only somewhat higher than the cumulative annual cost of most standard bisphosphonates (exclusive of generics). But it requires access to an infusion program (the company has established a network of these), and of course, a patient willing to undergo this type of procedure. It isn’t covered by certain provincial formularies (i.e. here in Ontario) and the message given is that it won’t be covered for standard use by these agencies in the near term, except in the special situation where a patient is NPO or unable to tolerate any oral meds. It’s an obvious consideration for such individuals or those who have seemingly “failed” these treatments (adverse events, primary inefficacy). To date the safety profile is excellent, and the only minor side effect is an unusual “flu” like syndrome that occurs in a minority of cases after the first infusion. This resolves over a few days at most and is treated with OTC analgesics/antipyretics.