My mother has been in myeloma treatment for 7 months, including monthly Zometa. This has been given during weekly supplemental hydration appointments at the hospital. Her now bi-weekly cancer treatments are given at the oncologist office in a different town.
Last week, however, the oncologist office somehow decided to give the Zometa during the bi-weekly treatment but failed to update the order at the hospital. Upshot: she received a second dose of Zometa last week during the Friday hydration appointment. Just found this out today.
I'm trying not to be livid as I do not understand the safety implications of two Zometa doses in one week and don't find related information online. Can anyone here help me out with how to think about this?
She has not shown any indication of bad effect.
Asking the oncologist questions has not so far proven to be very effective, which is why I'm here.
Thank you, from a newbie to this forum.
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Re: Zometa given twice in one week: how worried should I be?
Hi SaltySea,
I'm sorry about what happened with your mother's Zometa infusions. I suspect, however, that she will not experience any significant side effects from the higher-than-usual dose of the drug. The main side effects associated with the drug occur in the day or two after infusions, and it appears she hasn't really had any of those side effects. So she's probably going to be fine.
Do you know what the dose of Zometa is that she has been receiving every month? That may help put things in perspective when you read the information I've included below from the Zometa prescribing information.
Also, how are your mother's kidneys? If she has any kidney-related issues, you may want to discuss with her doctor whether she should have her kidney function tested soon to make sure the double dose of Zometa did not damage her kidneys in any way. In fact, that may be worth doing regardless of whether your mother has any history of kidney issues.
There is a discussion of Zometa overdose experiences in the Zometa prescribing information approved by the U.S. Food and Drug Administration (FDA). You can view the entire document here:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021386s004lbl.pdf
The relevant text about overdoses is as follows:
"Clinical experience with acute overdosage of Zometa is limited. Two patients received Zometa 32 mg over 5 minutes in clinical trials. Neither patient experienced any clinical or laboratory toxicity. Overdosage may cause clinically significant hypocalcemia, hypophosphatemia, and hypomagnesemia. Clinically relevant reductions in serum levels of calcium, phosphorus, and magnesium should be corrected by intravenous administration of calcium gluconate, potassium or sodium phosphate, and magnesium sulfate, respectively.
In an open-label study of zoledronic acid 4 mg in breast cancer patients, a female patient received a single 48-mg dose of zoledronic acid in error. Two days after the overdose, the patient experienced a single episode of hyperthermia (38°C), which resolved after treatment. All other evaluations were normal, and the patient was discharged seven days after the overdose.
A patient with non-Hodgkin’s lymphoma received zoledronic acid 4 mg daily on four successive days for a total dose of 16 mg. The patient developed paresthesia and abnormal liver function tests with increased GGT (nearly 100U/L, each value unknown). The outcome of this case is not known.
In controlled clinical trials, administration of Zometa 4 mg as an intravenous infusion over 5 minutes has been shown to increase the risk of renal toxicity compared to the same dose administered as a 15-minute intravenous infusion. In controlled clinical trials, Zometa 8 mg has been shown to be associated with an increased risk of renal toxicity compared to Zometa 4 mg, even when given as a 15-minute intravenous infusion, and was not associated with added benefit in patients with hypercalcemia of malignancy [see Dosage And Administration (2.4)]."
I'm sorry about what happened with your mother's Zometa infusions. I suspect, however, that she will not experience any significant side effects from the higher-than-usual dose of the drug. The main side effects associated with the drug occur in the day or two after infusions, and it appears she hasn't really had any of those side effects. So she's probably going to be fine.
Do you know what the dose of Zometa is that she has been receiving every month? That may help put things in perspective when you read the information I've included below from the Zometa prescribing information.
Also, how are your mother's kidneys? If she has any kidney-related issues, you may want to discuss with her doctor whether she should have her kidney function tested soon to make sure the double dose of Zometa did not damage her kidneys in any way. In fact, that may be worth doing regardless of whether your mother has any history of kidney issues.
There is a discussion of Zometa overdose experiences in the Zometa prescribing information approved by the U.S. Food and Drug Administration (FDA). You can view the entire document here:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021386s004lbl.pdf
The relevant text about overdoses is as follows:
"Clinical experience with acute overdosage of Zometa is limited. Two patients received Zometa 32 mg over 5 minutes in clinical trials. Neither patient experienced any clinical or laboratory toxicity. Overdosage may cause clinically significant hypocalcemia, hypophosphatemia, and hypomagnesemia. Clinically relevant reductions in serum levels of calcium, phosphorus, and magnesium should be corrected by intravenous administration of calcium gluconate, potassium or sodium phosphate, and magnesium sulfate, respectively.
In an open-label study of zoledronic acid 4 mg in breast cancer patients, a female patient received a single 48-mg dose of zoledronic acid in error. Two days after the overdose, the patient experienced a single episode of hyperthermia (38°C), which resolved after treatment. All other evaluations were normal, and the patient was discharged seven days after the overdose.
A patient with non-Hodgkin’s lymphoma received zoledronic acid 4 mg daily on four successive days for a total dose of 16 mg. The patient developed paresthesia and abnormal liver function tests with increased GGT (nearly 100U/L, each value unknown). The outcome of this case is not known.
In controlled clinical trials, administration of Zometa 4 mg as an intravenous infusion over 5 minutes has been shown to increase the risk of renal toxicity compared to the same dose administered as a 15-minute intravenous infusion. In controlled clinical trials, Zometa 8 mg has been shown to be associated with an increased risk of renal toxicity compared to Zometa 4 mg, even when given as a 15-minute intravenous infusion, and was not associated with added benefit in patients with hypercalcemia of malignancy [see Dosage And Administration (2.4)]."
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