Zoltero 4 mg Injection belongs to the class of medicines called 'bisphosphonates' used to treat osteoporosis (weak and brittle bones) caused by menopause or long-term steroid use. Zoltero 4 mg Injection also treats Paget’s bone and high calcium levels caused by cancer. Osteoporosis is a bone disease that weakens and thins bones by decreasing bone density, common in post-menopausal women.  As the density of bones decreases, they weaken and are more likely to break. 

Zoltero 4 mg Injection contains Zoledronic acid that works by binding to the bone tightly and preventing the removal of calcium by osteoclasts (a type of bone cell that destroys bone tissue). This prevents osteoclasts from breaking down the bone and keeps the bones strong and minimizes the risk of bones breaking.

A doctor or nurse will administer Zoltero 4 mg Injection. In some cases, you may experience headache, fever, nausea, dizziness, vomiting, back pain, diarrhea, pain in the muscles, joints, or bones, swelling, or pain at the infusion site. Most of these side effects of Zoltero 4 mg Injection do not require medical attention and gradually resolve over time. However, if the side effects persist or worsen, please consult your doctor.

If you are allergic to Zoltero 4 mg Injection or any other medicines, please tell your doctor. Avoid taking Zoltero 4 mg Injection if you are pregnant or breastfeeding and consult a doctor. Zoltero 4 mg Injection is not recommended for children below 18 years as the safety and effectiveness were not established. Avoid taking Zoltero 4 mg Injection if you have hypocalcemia (low calcium levels in the blood) and severe kidney problems. Drive only if you are alert as Zoltero 4 mg Injection may cause dizziness. Zoltero 4 mg Injection may cause osteonecrosis of the jaw (ONJ) in some patients. Therefore, if you experience any problems with teeth or mouth such as loose teeth, swelling or pain, non-healing of sores, or discharge, consult your doctor and dentist as these might be signs of osteonecrosis of the jaw.

Zoltero 4 mg Injection contains Zoledronic acid used to treat postmenopausal osteoporosis, Paget’s disease, and hypercalcemia of malignancy (bone cancer in which excess of calcium exits). Zoltero 4 mg Injection binds to the bone tightly and prevents calcium removal by osteoclasts (a type of bone cell that destroy bone tissue). This prevents osteoclasts from breaking down the bone, strengthening bones, and minimizing the risk of bones breaking. Also, Zoltero 4 mg Injection may reduce calcium levels in the blood by preventing calcium reabsorption from bones to the blood. Thus, it helps in treating high calcium levels in the blood caused by cancer.

• Headache
• Fever
• Nausea
• Dizziness
• Vomiting
• Back pain
• Diarrhoea
• Flu-like symptoms (chills, tiredness, muscle, and joint pain)
• Pain in the muscles, joints, or bones
• Swelling or pain at the infusion site

If you are allergic to Zoltero 4 mg Injection or any other medicines, please tell your doctor. Avoid taking Zoltero 4 mg Injection if you are pregnant or breastfeeding and consult a doctor. Zoltero 4 mg Injection is not recommended for children below 18 years as the safety and effectiveness were not established. Avoid taking Zoltero 4 mg Injection if you have hypocalcemia (low calcium levels in the blood) and severe kidney problems. Drive only if you are alert as Zoltero 4 mg Injection may cause dizziness. If you are not able to take daily calcium supplements, have had sections of the intestine or some or all of the parathyroid glands in the neck surgically removed, have cancer, gum disease, poor dental health, or planned tooth extraction or kidney problem, inform your doctor before taking Zoltero 4 mg Injection. If you are a smoker, inform your doctor before receiving Zoltero 4 mg Injection as it may increase the risk of dental problems. Zoltero 4 mg Injection may cause osteonecrosis of the jaw (ONJ) in some patients. Therefore, if you experience any problems with teeth or mouth such as loose teeth, swelling or pain, non-healing of sores, or discharge, consult your doctor and dentist as these might be signs of osteonecrosis of the jaw. You are recommended to drink at least 2 glasses of fluids before and after treatment with Zoltero 4 mg Injection as advised by your doctor to prevent dehydration. Take calcium and vitamin D supplements as prescribed by your doctor as Zoltero 4 mg Injection may reduce calcium levels in the blood.

Drug-Drug Interaction: Zoltero 4 mg Injection may interact with antibiotics (gentamicin) and water pills (furosemide).

Drug-Food Interaction: No interactions found.

Drug-Disease Interaction: Avoid taking Zoltero 4 mg Injection if you have hypocalcemia (low calcium levels in the blood) and severe kidney problems. If you have cancer, gum disease, poor dental health, or planned tooth extraction or kidney problem, inform your doctor before taking Zoltero 4 mg Injection.

• GENTAMICIN
• FUROSEMIDE

• Include dairy products like milk, yoghurt, cheese, or milk-based custard in your diet.
• Eat daily a serving of broccoli, cabbage, bok choy (Chinese white cabbage), spinach, and other green leafy vegetables.
• Snack on calcium-rich nuts like Brazil nuts or almonds.
• Sprinkle sesame seeds over your food, vegetables, and salads. Sesame seeds are high in calcium.
• Avoid or reduce the intake of caffeine, soft drinks, and alcohol that inhibit calcium absorption.
• Replace the meat with tofu or tempeh for extra calcium in your food.

• A preventive dental check-up is required before using Zoltero 4 mg Injection as it has been reported to cause osteonecrosis of the jaw. 
• A blood test is recommended before taking each dose of Zoltero 4 mg Injection to monitor kidney functioning. 
• Regular intake of calcium and vitamin D may be recommended by your doctor while taking treatment with Zoltero 4 mg Injection. 
• While using Zoltero 4 mg Injection, you may experience musculoskeletal pain, in this case, stop taking Zoltero 4 mg Injection and consult a doctor. 

Osteoporosis: It is a bone disease that weakens and thins bones by decreasing bone density.  As the density of bones decreases, they weaken and are more likely to break. Post-menopausal women are more likely to develop osteoporosis than men because, at menopause, women’s ovaries stop producing estrogen (a female hormone) essential to keeping bones healthy. Following menopause, bone loss occurs, making bones weak and more likely to break. Also, long-term use of steroids may affect bone strength and cause osteoporosis in both men and women. Signs and symptoms include back pain caused by a fractured or collapsed vertebra, loss of height over time, a stooped posture, and a bone that breaks much more easily than expected.

Paget’s disease: In Paget’s disease, bone remodeling (removal of old bone and replacement with new bone material) is too quick, and new bone is formed in a disordered manner making it weaker than normal. If left untreated, the bone may become deformed, painful, and broken.

Hypercalcemia in cancer: In some cancers like breast cancer, lung cancer, or blood cancer, there is too much calcium level in the bloodstream. A patient suffering from a high level of calcium might include nausea, vomiting, constipation, headache, and loss of appetite.