Zoledronic acid
Accession Number
DB00399  (APRD01294, DB06286)
Small Molecule

Zoledronic acid, or CGP 42'446,8 is a third generation, nitrogen containing bisphosphonate similar to ibandronic acid, minodronic acid, and risedronic acid.5 Zoledronic acid is used to treat and prevent multiple forms of osteoporosis, hypercalcemia of malignancy, multiple myeloma, bone metastases from solid tumors, and Paget’s disease of bone.12,13,14 Zoledronic acid was first described in the literature in 1994.8

Zoledronic acid was granted FDA approval on 20 August 2001.12

  • (1-hydroxy-2-(1H-imidazol-1-yl)ethylidene)bisphosphonic acid
  • (1-hydroxy-2-imidazol-1-ylethylidene)diphosphonic acid
  • ácido zoledrónico
  • Anhydrous Zoledronic Acid
  • Zol
  • Zoledronate
  • Zoledronic acid
  • Zoledronic Acid Anhydrous
  • Zoledronic Acid, Anhydrous
External IDs
CGP 42446 / CGP-42446
Product Ingredients
IngredientUNIICASInChI Key
Zoledronate disodium7D7GS1SA24165800-07-7IEJZOPBVBXAOBH-UHFFFAOYSA-L
Zoledronate trisodiumARL915IH66165800-08-8HYMYRPXSMHJPGD-UHFFFAOYSA-A
Zoledronic acid hemipentahydrate1K9U67HDIDNot AvailableAZZILOGHCMYHQY-UHFFFAOYSA-N
Zoledronic acid monohydrate6XC1PAD3KF165800-06-6FUXFIVRTGHOMSO-UHFFFAOYSA-N
Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
AclastaSolutionIntravenousNovartis2005-08-22Not applicableCanada
AclastaInjection, solution5 mg/100mlIntravenousNovartis Europharm Limited2005-04-15Not applicableEu
AclastaInjection, solution5 mg/100mlIntravenousNovartis Europharm Limited2005-04-15Not applicableEu
Act Zoledronic AcidSolution5 mgIntravenousActavis Pharma CompanyNot applicableNot applicableCanada
Act Zoledronic Acid ConcentrateSolutionIntravenousActavis Pharma CompanyNot applicableNot applicableCanada
ReclastInjection, solution5 mg/100mLIntravenousNovartis Pharmaceuticals Corporation2007-04-01Not applicableUs
Zoledronic AcidInjection, solution0.04 mg/1mLIntravenousSagent Pharmaceuticals2015-09-01Not applicableUs
Zoledronic AcidInjection, solution4 mg/100mLIntravenousHospira, Inc.2017-10-19Not applicableUs
Zoledronic Acid - ASolutionIntravenousSandoz Canada IncorporatedNot applicableNot applicableCanada
Zoledronic Acid - ZSolutionIntravenousSandoz Canada Incorporated2014-01-15Not applicableCanada
Additional Data Available
  • Application Number
    Application Number

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  • Product Code
    Product Code

    A governmentally-recognized ID which uniquely identifies the product within its regulatory market.

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Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Jamp-zoledronic AcidSolution4 mgIntravenousJamp Pharma CorporationNot applicableNot applicableCanada
PMS-zoledronic AcidSolutionIntravenousPharmascience Inc2014-11-25Not applicableCanada
Taro-zoledronic AcidSolutionIntravenousTaro Pharmaceuticals, Inc.2014-04-02Not applicableCanada
Taro-zoledronic Acid ConcentrateSolutionIntravenousTaro Pharmaceuticals, Inc.2014-02-26Not applicableCanada
Val-zoledronic AcidSolutionIntravenousValeo Pharma Corp.Not applicableNot applicableCanada
Zoledronic AcidInjection, solution, concentrate4 mg/5mLIntravenousAmneal Agila, Llc2012-04-232017-12-31Us
Zoledronic AcidInjection4 mg/5mLIntravenousFresenius Kabi USA, LLC2014-09-04Not applicableUs
Zoledronic AcidInjection, solution, concentrate4 mg/5mLIntravenousGland Pharma Limited2013-09-20Not applicableUs
Zoledronic AcidSolution5 mg/100mLIntravenousAkorn2014-08-21Not applicableUs
Zoledronic acidInjection4 mg/5mLIntravenousBluePoint Laboratories2020-06-29Not applicableUs
Additional Data Available
  • Application Number
    Application Number

    A unique ID assigned by the FDA when a product is submitted for approval by the labeller.

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  • Product Code
    Product Code

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CAS number
Average: 272.0896
Monoisotopic: 271.996323708
Chemical Formula
InChI Key
[1-hydroxy-2-(1H-imidazol-1-yl)-1-phosphonoethyl]phosphonic acid



Zoledronic acid is indicated to treat hypercalcemia of malignancy, multiple myeloma, bone metastases from solid tumors, osteoporosis in men and postmenopausal women, glucocorticoid induced osteoporosis, and Paget's disease of bone in men and women.12,13,14 Zoledronic acid is also indicated for the prevention of osteoporosis in post menopausal women and glucocorticoid induced osteoporosis.12,13,14

Associated Conditions

Zoledronic acid is a third generation, nitrogen containing bisphosphonate that inhibits osteoclast function and prevents bone resorption.5 The therapeutic window is wide as patients are unlikely to suffer severe effects from overdoses and the duration of action is long.12,13,14 Patients should be counselled regarding the risk of electrolyte deficiencies, renal impairment, osteonecrosis of the jaw, atypical femoral fractures, bronchoconstriction, hepatic impairment, hypocalcemia, and embryo-fetal toxicity.12,13,14

Mechanism of action

Bisphosphonates are taken into the bone where they bind to hydroxyapatite. Bone resorption by osteoclasts causes local acidification, releasing the bisphosphonate, which is taken into the osteoclast by fluid-phase endocytosis.6 Endocytic vesicles become acidified, releasing bisphosphonates into the cytosol of osteoclasts where they act.6

Osteoclasts mediate resorption of bone.7 When osteoclasts bind to bone they form podosomes, ring structures of F-actin.7 Etidronic acid also inhibits V-ATPases in the osteoclast, though the exact subunits are unknown, preventing F-actin from forming podosomes.11 Disruption of the podosomes causes osteoclasts to detach from bones, preventing bone resorption.7

Nitrogen containing bisphosphonates such as zoledronate are known to induce apoptosis of hematopoietic tumor cells by inhibiting the components of the mevalonate pathway farnesyl diphosphate synthase, farnesyl diphosphate, and geranylgeranyl diphosphate.10,9 These components are essential for post-translational prenylation of GTP-binding proteins like Rap1.10,9 The lack of prenylation of these proteins interferes with their function, and in the case of Rap1, leads to apoptosis.10,9 zoledronate also activated caspases which further contribute to apoptosis.10,9

AFarnesyl pyrophosphate synthase
AGeranylgeranyl pyrophosphate synthase
Additional Data Available
Adverse Effects

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Additional Data Available

Structured data covering drug contraindications. Each contraindication describes a scenario in which the drug is not to be used. Includes restrictions on co-administration, contraindicated populations, and more.

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Additional Data Available
Blackbox Warnings

Structured data representing warnings from the black box section of drug labels. These warnings cover important and dangerous risks, contraindications, or adverse effects.

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A 4mg intravenous dose reaches a Cmax of 370±78.5ng/mL, with a Tmax of 0.317±0.014h, and an AUC of 788±181ng*h/mL.4 A 5mg intravenous dose reaches a Cmax of 471±76.1ng/mL, with a Tmax of 0.368±0.005h, and an AUC of 917±226ng*h/mL.4

Volume of distribution
Not Available
Protein binding

Zoledronic acid is 23-53% protein bound in plasma.12,13,14


Zoledronic acid is not metabolized in vivio.12,13,14

Route of elimination

Zoledronic acid is 39 ± 16% eliminated in the urine as the unmetabolized parent drug.12,13,14

Half life

Zoledronic acid has a terminal elimination half life of 146 hours.12,13,14


Zoledronic acid has a renal clearance of 3.7 ± 2.0 L/h.12,13,14


Patients experiencing an overdose may present with renal impairment, hypocalcemia, hypophosphatemia, and hypomagnesemia.12,13,14 Overdose should be managed through intravenous administration of the insufficient ions.12,13,14

Affected organisms
  • Humans and other mammals
Zoledronate Action PathwayDrug action
Pharmacogenomic Effects/ADRs
Not Available


Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
AceclofenacThe risk or severity of gastrointestinal bleeding can be increased when Aceclofenac is combined with Zoledronic acid.
AcemetacinThe risk or severity of gastrointestinal bleeding can be increased when Acemetacin is combined with Zoledronic acid.
Acetylsalicylic acidThe risk or severity of gastrointestinal bleeding can be increased when Acetylsalicylic acid is combined with Zoledronic acid.
AcyclovirThe risk or severity of nephrotoxicity and hypocalcemia can be increased when Acyclovir is combined with Zoledronic acid.
AdefovirThe risk or severity of nephrotoxicity and hypocalcemia can be increased when Adefovir is combined with Zoledronic acid.
Adefovir dipivoxilThe risk or severity of nephrotoxicity and hypocalcemia can be increased when Adefovir dipivoxil is combined with Zoledronic acid.
AlclofenacThe risk or severity of gastrointestinal bleeding can be increased when Alclofenac is combined with Zoledronic acid.
Alendronic acidThe risk or severity of adverse effects can be increased when Zoledronic acid is combined with Alendronic acid.
AlmasilateThe serum concentration of Zoledronic acid can be decreased when it is combined with Almasilate.
AlminoprofenThe risk or severity of gastrointestinal bleeding can be increased when Alminoprofen is combined with Zoledronic acid.
Additional Data Available
  • Extended Description
    Extended Description

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  • Severity

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  • Evidence Level
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Food Interactions
No interactions found.


Synthesis Reference

Judith Aronhime, Revital Lifshitz-Liron, "Zoledronic acid crystal forms, zoledronate sodium salt crystal forms, amorphous zoledronate sodium salt, and processes for their preparation." U.S. Patent US20050054616, issued March 10, 2005.

General References
  1. Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S: Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007 Nov 1;357(18):1799-809. Epub 2007 Sep 17. [PubMed:17878149]
  2. Reid IR, Brown JP, Burckhardt P, Horowitz Z, Richardson P, Trechsel U, Widmer A, Devogelaer JP, Kaufman JM, Jaeger P, Body JJ, Brandi ML, Broell J, Di Micco R, Genazzani AR, Felsenberg D, Happ J, Hooper MJ, Ittner J, Leb G, Mallmin H, Murray T, Ortolani S, Rubinacci A, Saaf M, Samsioe G, Verbruggen L, Meunier PJ: Intravenous zoledronic acid in postmenopausal women with low bone mineral density. N Engl J Med. 2002 Feb 28;346(9):653-61. [PubMed:11870242]
  3. Durie BG, Katz M, Crowley J: Osteonecrosis of the jaw and bisphosphonates. N Engl J Med. 2005 Jul 7;353(1):99-102; discussion 99-102. [PubMed:16000365]
  4. Shiraki M, Tanaka S, Suzuki H, Ueda S, Nakamura T: Safety, pharmacokinetics, and changes in bone metabolism associated with zoledronic acid treatment in Japanese patients with primary osteoporosis. J Bone Miner Metab. 2017 Nov;35(6):675-684. doi: 10.1007/s00774-016-0806-3. Epub 2016 Dec 20. [PubMed:28000034]
  5. Cremers S, Drake MT, Ebetino FH, Bilezikian JP, Russell RGG: Pharmacology of bisphosphonates. Br J Clin Pharmacol. 2019 Jun;85(6):1052-1062. doi: 10.1111/bcp.13867. Epub 2019 Feb 28. [PubMed:30650219]
  6. Russell RG, Watts NB, Ebetino FH, Rogers MJ: Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int. 2008 Jun;19(6):733-59. doi: 10.1007/s00198-007-0540-8. [PubMed:18214569]
  7. Murakami H, Takahashi N, Tanaka S, Nakamura I, Udagawa N, Nakajo S, Nakaya K, Abe M, Yuda Y, Konno F, Barbier A, Suda T: Tiludronate inhibits protein tyrosine phosphatase activity in osteoclasts. Bone. 1997 May;20(5):399-404. [PubMed:9145236]
  8. Green JR, Muller K, Jaeggi KA: Preclinical pharmacology of CGP 42'446, a new, potent, heterocyclic bisphosphonate compound. J Bone Miner Res. 1994 May;9(5):745-51. doi: 10.1002/jbmr.5650090521. [PubMed:8053405]
  9. Ullen A, Schwarz S, Lennartsson L, Kalkner KM, Sandstrom P, Costa F, Lennernas B, Linder S, Nilsson S: Zoledronic acid induces caspase-dependent apoptosis in renal cancer cell lines. Scand J Urol Nephrol. 2009;43(2):98-103. doi: 10.1080/00365590802475904. [PubMed:19101859]
  10. Miwa A, Takezako N, Hayakawa H, Hayakawa M, Tominaga S, Yanagisawa K: YM-175 induces apoptosis of human native monocyte-lineage cells via inhibition of prenylation. Am J Hematol. 2012 Dec;87(12):1084-8. doi: 10.1002/ajh.23328. Epub 2012 Oct 9. [PubMed:23044853]
  11. Russell RG: Bisphosphonates: the first 40 years. Bone. 2011 Jul;49(1):2-19. doi: 10.1016/j.bone.2011.04.022. Epub 2011 May 1. [PubMed:21555003]
  12. FDA Approved Drug Products: Zometa Zoledronic Acid Intravenous Injection [Link]
  13. FDA Approved Drug Products: Reclast Zoledronic Acid Intravenous Injection [Link]
  14. FDA Approved Drug Products: Reclast Zoledronic Acid Injection [Link]
External Links
Human Metabolome Database
PubChem Compound
PubChem Substance
Therapeutic Targets Database
PDBe Ligand
RxList Drug Page
ATC Codes
M05BB08 — Zoledronic acid, calcium and colecalciferol, sequentialM05BA08 — Zoledronic acid
AHFS Codes
  • 92:24.00 — Bone Resorption Inhibitors
PDB Entries
1zw5 / 2e91 / 2f8c / 2f8z / 2f9k / 2q58 / 3ez3 / 3iba / 3ldw / 3n45
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Clinical Trials

Clinical Trials
1CompletedBasic ScienceHealthy Postmenopausal Women1
1CompletedOtherRisk Factors for or a Diagnosis of Osteoporosis1
1CompletedTreatmentAdenocarcinoma, Prostate1
1CompletedTreatmentBone Metastases / Breast Cancer / Lung Cancers / Prostate Cancer1
1CompletedTreatmentBreast Cancer / Multiple Myeloma (MM)1
1CompletedTreatmentCLDN18.2-positive Adenocarcinoma of Esophagus / CLDN18.2-positive Adenocarcinoma of the Gastroesophageal Junction / CLDN18.2-positive Gastric Adenocarcinoma1
1CompletedTreatmentMetastatic Hormone Refractory Prostate Cancer1
1CompletedTreatmentMultiple Myeloma Bone Disease1
1CompletedTreatmentProstate Cancer1
1RecruitingTreatmentAcute Lymphoblastic Leukaemias (ALL) / Ewing's Sarcoma (ES) / Leukemia Acute Myeloid Leukemia (AML) / Lymphoma, Hodgkins / Myelodysplastic Syndrome / Myeloproliferative Syndromes / Neuroblastomas / Non-Hodgkin's Lymphoma (NHL) / Primitive Neuroectodermal Tumor / Rhabdomyosarcomas / Sarcoma, Osteogenic1
1RecruitingTreatmentHematopoietic Stem Cell Transplantation (HSCT)1
1RecruitingTreatmentSarcoma, Osteogenic / Tumors, Solid1
1TerminatedTreatmentCervical Cancers / Precancerous Conditions1
1TerminatedTreatmentMultiple Myeloma and Plasma Cell Neoplasm1
1, 2Active Not RecruitingTreatmentBone Metastases / Breast Cancer1
1, 2CompletedSupportive CareBreast Cancer / Hypercalcemia of Malignancy / Metastatic Cancers / Pain1
1, 2CompletedTreatmentMetastatic Cancers / Renal Cancers1
1, 2CompletedTreatmentMultiple Myeloma and Plasma Cell Neoplasm / Pain1
1, 2Not Yet RecruitingPreventionBariatric Surgery Candidate / Bone Loss / Bone Resorption1
1, 2TerminatedTreatmentGiant Cell Tumors of Bone1
1, 2WithdrawnNot AvailableSickle Cell Disease (SCD)1
2Active Not RecruitingPreventionBone Loss / Osteoporosis / Spinal Cord Injuries (SCI) / Spinal Cord Injury, Acute1
2Active Not RecruitingTreatmentOsteogenesis Imperfecta (OI)1
2CompletedPreventionBone Loss / Prostate Cancer1
2CompletedPreventionBreast Cancer1
2CompletedSupportive CareCentral Nervous System(CNS)Malignancies / Neoplasms, Brain / Osteoporosis1
2CompletedSupportive CareDuctal Carcinoma In Situ / Early Breast Cancer / Estrogen Receptor Positive Breast Cancer / Estrogen Receptor-Positive Breast Cancer / Progesterone Receptor Positive Breast Cancer / Progesterone Receptor-positive Breast Cancer / Stage II Breast Cancer / Stage IIIA Breast Cancer / Stage IIIB Breast Cancer / Stage IIIC Breast Cancer1
2CompletedSupportive CareHereditary Breast and Ovarian Cancer Syndrome / Hereditary Breast/Ovarian Cancer (brca1, brca2) / Osteoporosis / Ovarian Cancer / Ovarian Carcinoma1
2CompletedTreatmentAdenocarcinoma of the Prostate / Prostate Cancer1
2CompletedTreatmentAdenocarcinoma of the Prostate / Recurrent Prostate Cancer / Stage IV Prostate Cancer1
2CompletedTreatmentAgnogenic Myeloid Metaplasia / Myeloid Metaplasia1
2CompletedTreatmentBack Pain Lower Back1
2CompletedTreatmentBone Loss / Human Immunodeficiency Virus (HIV) Infections / Osteopenia / Osteoporosis1
2CompletedTreatmentBone Metastasis / Gastrointestinal Cancers1
2CompletedTreatmentBone Neoplasms / Breast Cancer / Prostate Cancer1
2CompletedTreatmentBreast Cancer4
2CompletedTreatmentBreast Cancer / Metastatic Bone Disease1
2CompletedTreatmentBreast Cancer / Multiple Myeloma (MM)1
2CompletedTreatmentDuctal Histologic Type / Locally Advanced Breast Cancer (LABC) / Without Her 2 Overexpression / Without Her2 Overexpression1
2CompletedTreatmentHormone-Refractory Prostate Cancer2
2CompletedTreatmentHutchinson-Gilford Progeria Syndrome1
2CompletedTreatmentHutchinson-Gilford Syndrome / Progeria1
2CompletedTreatmentLeukemias / Malignant Lymphomas / Myelodysplastic Syndromes / Osteoporosis / Ovarian Cancer1
2CompletedTreatmentLow Bone Mineral Density / Postmenopausal Osteoporosis (PMO)1
2CompletedTreatmentLung Cancer Non-Small Cell Cancer (NSCLC)1
2CompletedTreatmentMalignant Neoplasm of Nasopharynx1
2CompletedTreatmentMetastatic Cancers / Prostate Cancer2
2CompletedTreatmentMultiple Myeloma (MM)5
2CompletedTreatmentNeoplasms, Breast1
2CompletedTreatmentOsteogenesis Imperfecta (OI)2
2CompletedTreatmentProstate Cancer2
2CompletedTreatmentRenal Cancers / Renal Cell Adenocarcinoma1
2Enrolling by InvitationTreatmentProgeria1
2Not Yet RecruitingTreatmentBone Metastatic Non-small Cell Lung Cancer1
2Not Yet RecruitingTreatmentNeovascular Age-Related Macular Degeneration1
2RecruitingTreatmentAdenocarcinoma of the Pancreas / Recurrent Pancreatic Carcinoma / Stage I Pancreatic Cancer / Stage I Pancreatic Cancer AJCC v6 and v7 / Stage IA Pancreatic Cancer / Stage IA Pancreatic Cancer AJCC v6 and v7 / Stage IB Pancreatic Cancer / Stage IB Pancreatic Cancer AJCC v6 and v7 / Stage II Pancreatic Cancer / Stage II Pancreatic Cancer AJCC v6 and v7 / Stage IIA Pancreatic Cancer / Stage IIA Pancreatic Cancer AJCC v6 and v7 / Stage IIB Pancreatic Cancer / Stage IIB Pancreatic Cancer AJCC v6 and v7 / Stage III Pancreatic Cancer / Stage III Pancreatic Cancer AJCC v6 and v7 / Stage IV Pancreatic Cancer / Stage IV Pancreatic Cancer AJCC v6 and v71
2RecruitingTreatmentBone Metastases / Prostate Cancer1
2RecruitingTreatmentBone Metastasis / Gastrointestinal Cancers1
2RecruitingTreatmentIOP / Osteoporosis1
2RecruitingTreatmentNon-Squamous Non-Small Cell Lung Cancer1
2RecruitingTreatmentTriple Negative Breast Cancer (TNBC)1
2TerminatedDiagnosticLung Cancer Non-Small Cell Cancer (NSCLC) / Metastases / Small Cell Lung Cancer (SCLC)1
2TerminatedPreventionBone Loss1
2TerminatedPreventionMultiple Myeloma (MM)1
2TerminatedPreventionProstate Cancer1
2TerminatedTreatmentBreast Cancer1
2TerminatedTreatmentChronic Myeloid Leukemia (CML)1
2TerminatedTreatmentGiant Cell Tumors of Bone / Osteoclastoma1
2TerminatedTreatmentLung Cancer Non-Small Cell Cancer (NSCLC) / Malignant Pleural Effusions1
2TerminatedTreatmentCancer treatment / Metastatic Breast Cancer1
2TerminatedTreatmentPrimary Breast Cancer1
2TerminatedTreatmentRenal Cancers1
2TerminatedTreatmentUrologic Neoplasms1
2TerminatedTreatmentUterine Cervical Neoplasms1
2Unknown StatusPreventionOsteonecrosis1
2Unknown StatusTreatmentBreast Cancer / Breast Diseases / Neoplasms / Neoplasms by Site1
2Unknown StatusTreatmentComplex Regional Pain Syndromes (CRPS)1
2Unknown StatusTreatmentHepatocellular,Carcinoma1
2Unknown StatusTreatmentHuman Immunodeficiency Virus (HIV) Infections / Osteopenia / Osteoporosis1
2Unknown StatusTreatmentLung Cancers1
2WithdrawnTreatmentAcute Lymphoblastic Leukaemias (ALL) / Osteonecrosis / Osteoporosis1
2WithdrawnTreatmentPlasma Cell Myeloma1
2, 3CompletedPreventionBone Resorption / Heart Transplantation / Transplantation, Liver1
2, 3CompletedPreventionMetastatic Breast Cancer With Bone Involvement1
2, 3CompletedTreatmentBone Metastases / Metastatic Breast Cancer1
2, 3CompletedTreatmentDiabetes Complications / Neuropathic arthropathy1
2, 3CompletedTreatmentProstate Cancer1
2, 3RecruitingTreatmentProstate Cancer1
2, 3TerminatedTreatmentOsteoporosis1
2, 3Unknown StatusTreatmentBeta-Thalassemia / Transplantation, Bone Marrow1
2, 3Unknown StatusTreatmentBreast Cancer1
2, 3Unknown StatusTreatmentSarcoma, Osteogenic1
3Active Not RecruitingSupportive CareBreast Adenocarcinoma / DS Stage I Plasma Cell Myeloma / DS Stage II Plasma Cell Myeloma / Metastatic Malignant Neoplasm to the Bone / Musculoskeletal Complications / Pain / Urinary Complications1
3Active Not RecruitingSupportive CareBreast Cancer1
3Active Not RecruitingSupportive CareMetastatic Renal Cell Carcinoma1
3Active Not RecruitingSupportive CareOsteoporosis / Prostate Cancer1
3Active Not RecruitingTreatmentBreast Cancer2
3Active Not RecruitingTreatmentComplete Traumatic Spinal Cord Injury / Spinal Cord Injuries (SCI)1
3Active Not RecruitingTreatmentComplex Regional Pain Syndrome (CRPS) / Complex Regional Pain Syndrome - Type 1 / Complex Regional Pain Syndrome Type I1
3Active Not RecruitingTreatmentSarcomas1
3Active Not RecruitingTreatmentSolitary Osseous Plasmacytoma1
3Active Not RecruitingTreatmentTriple Negative Breast Cancer (TNBC)1
3CompletedPreventionBreast Cancer3
3CompletedPreventionLung Cancer Non-Small Cell Cancer (NSCLC)1
3CompletedPreventionLung Cancer Non-Small Cell Cancer (NSCLC) / Non Small Cell Lung Carcinoma (NSCLC)1
3CompletedPreventionNeoplasms, Breast / Osteoporosis1
3CompletedSupportive CareBone Metastases3
3CompletedSupportive CareBone Metastases / Malignancies / Malignancies, Hematologic / Multiple Myeloma (MM) / Multiple Myeloma Bone Lesions / Oncology1
3CompletedSupportive CareBreast Cancer / Lung Cancers / Metastatic Cancers / Pain / Prostate Cancer1
3CompletedSupportive CareBreast Cancer / Osteoporosis3
3CompletedSupportive CareHypercalcemia of Malignancy / Lung Cancers / Metastatic Cancers / Pain / Unspecified Adult Solid Tumor, Protocol Specific1
3CompletedSupportive CareOsteogenesis Imperfecta (OI)1
3CompletedTreatmentAvascular Necrosis of Femoral Head1
3CompletedTreatmentBone Loss / Breast Cancer1
3CompletedTreatmentBone Marrow Oedema1
3CompletedTreatmentBreast Cancer6
3CompletedTreatmentBreast Cancer With Bone Metastasis1
3CompletedTreatmentCrohn's Disease (CD) / Osteopenia / Osteoporosis1
3CompletedTreatmentEwing's Sarcoma (ES)1
3CompletedTreatmentFractures, Bone1
3CompletedTreatmentFunctional Outcomes / Prevention of BMD Loss After THR / Serum Markers of Bone Turnover1
3CompletedTreatmentHip Fracture / Osteoporosis1
3CompletedTreatmentMale Osteoporosis1
3CompletedTreatmentMalignant Lymphomas / Non-Hodgkin's Lymphoma (NHL)1
3CompletedTreatmentMetastatic Cancers / Prostate Cancer2
3CompletedTreatmentMultiple Myeloma and Plasma Cell Neoplasm2
3CompletedTreatmentNeoplasms, Breast1
3CompletedTreatmentOne to five years postmenopausal / Osteoporosis1
3CompletedTreatmentPaget's Disease of Bone2
3CompletedTreatmentPostmenopausal Osteoporosis (PMO)2
3CompletedTreatmentProstate Cancer4
3CompletedTreatmentTreatment of Bone Metastases1
3Not Yet RecruitingTreatmentIdiopathic Inflammatory Myopathies / Osteoporosis, Osteopenia1
3Not Yet RecruitingTreatmentVertebral Metastasis1
3RecruitingPreventionLung Cancer Non-Small Cell Cancer (NSCLC) / Lung Cancers1
3RecruitingTreatmentGiant Cell Tumors of Bone1
3RecruitingTreatmentOsteoarthritis, Hip1
3RecruitingTreatmentSecondary Osteoporosis1
3TerminatedPreventionRheumatoid Arthritis1
3TerminatedTreatmentAIS Grade A to D / Being Diagnosed With a Spinal Cord Injury Less Than 12 Weeks of Etiology Stable / Bone Demineralization Lesions in the Injured Marrow / Female or Male Between 18 and 45 Years / Level of Injury C5 L2 / No Osteoporosis / No Pregnancy1
3TerminatedTreatmentBone Neoplasms / Neoplasms Metastasis / Pain2
3TerminatedTreatmentBreast Cancer With Bone Metastasis1
3TerminatedTreatmentBreast Cancer / Neoplasms Metastasis1
3TerminatedTreatmentDisseminated Sclerosis / Osteoporosis1
3TerminatedTreatmentMultiple Myeloma (MM)2
3TerminatedTreatmentMultiple Myeloma Stage I1
3TerminatedTreatmentOsteoporosis / Thalassemia Majors (Beta-Thalassemia Major)1
3TerminatedTreatmentProstate Cancer3
3Unknown StatusTreatmentBreast Cancer / Hypercalcemia of Malignancy / Metastatic Cancers1
3Unknown StatusTreatmentBreast Cancer / Metastatic Cancers1
3WithdrawnSupportive CareBreast Cancer / Hypercalcemia of Malignancy / Metastatic Cancers / Pain1
4Active Not RecruitingPreventionBariatric Surgery Candidate1
4Active Not RecruitingPreventionOsteoporosis1
4Active Not RecruitingTreatmentBreast Cancer / Metastasis / Prostate Cancer1
4Active Not RecruitingTreatmentEarly Breast Cancer1
4Active Not RecruitingTreatmentOsteoporosis / Osteoporotic Fractures / Postmenopausal Osteoporosis (PMO)1
4Active Not RecruitingTreatmentOsteoporotic Fractures / Postmenopausal Osteoporosis (PMO)1
4Active Not RecruitingTreatmentPostmenopausal Osteoporosis (PMO)1
4CompletedPreventionBone Neoplasms1
4CompletedPreventionFracture Bone / Osteoporosis / Transplantation, Liver1
4CompletedPreventionMultiple Myeloma (MM)2
4CompletedPreventionOsteoarthritis, Hip1
4CompletedPreventionProstate Cancer1
4CompletedPreventionThalassaemic disorders1
4CompletedTreatmentBone Metastases / High NTX Level / Lung Cancer Non-Small Cell Cancer (NSCLC)1
4CompletedTreatmentBone Metastasis / Breast Cancer / Prostate Cancer1
4CompletedTreatmentBreast Cancer1
4CompletedTreatmentBreast Cancer With Metastatic Bone Disease1
4CompletedTreatmentBreast Cancer / Multiple Myeloma (MM) / Prostate Cancer1
4CompletedTreatmentComplications of Heart-lung Transplant / Osteopenia / Other Complications of Lung Transplant1
4CompletedTreatmentDisuse Osteoporosis1
4CompletedTreatmentFirst or Second Line HER2-negative Breast Cancer / Metastatic Disease Without Bone Metastasis1
4CompletedTreatmentHuman Immunodeficiency Virus (HIV) Infections1
4CompletedTreatmentHypocalcemia / Paget's Disease of the Bone1
4CompletedTreatmentLung Cancer Non-Small Cell Cancer (NSCLC) / Pleural Effusion, Malignant1
4CompletedTreatmentMalignancies / Neoplasms Metastasis / Pain1
4CompletedTreatmentMultiple Myeloma (MM)1
4CompletedTreatmentNeoplasms Metastasis1
4CompletedTreatmentNeoplasms Metastasis / Renal Cell Adenocarcinoma1
4CompletedTreatmentOsteoporosis, Osteopenia1
4CompletedTreatmentPaget's Disease of Bone1
4CompletedTreatmentPaget's Disease of the Bone1
4CompletedTreatmentPostmenopausal Osteoporosis (PMO)3
4CompletedTreatmentProstate Cancer6
4CompletedTreatmentProstate Cancer Patients With Bone Metastasis1
4CompletedTreatmentProstate Cancer With Bone Metastasis1
4CompletedTreatmentProstate Cancer With at Least One Bone Lesion in Patients Receiving Hormonal Therapy and Treatment With Bisphosphonates is Indicated1
4CompletedTreatmentRenal Osteodystrophy1
4Not Yet RecruitingTreatmentBone Metastasis / Lung Cancer Non-Small Cell Cancer (NSCLC)1
4Not Yet RecruitingTreatmentPostmenopausal Osteoporosis (PMO)1
4Not Yet RecruitingTreatmentSeropositive Muskuloskeletal Complaints1
4RecruitingPreventionBariatric Surgery Candidate / Bone Loss1
4RecruitingPreventionLung Cancer Metastatic / Tumor necrosis1
4RecruitingTreatmentMultiple Myeloma (MM)1
4RecruitingTreatmentOsteogenesis Imperfecta (OI)1
4RecruitingTreatmentOsteoporosis / Parkinson's Disease (PD) / Parkinsonism1
4RecruitingTreatmentOsteoporosis / Primary Hyperparathyroidism1
4TerminatedTreatmentPrimary Hormone Receptor Negative Breast Cancer in Premenopausal Women1
4TerminatedTreatmentStress Fracture Ankle / Stress Fracture Foot1
4Unknown StatusDiagnosticMetastatic Breast Cancer1
4Unknown StatusTreatmentBone Mineral Density / Bone Turnover Markers / Image Changes of Lumbar Fusion1
4Unknown StatusTreatmentMultiple Myeloma (MM)1
4WithdrawnTreatmentCystic Fibrosis (CF)1
4WithdrawnTreatmentMultiple Myeloma (MM)1
4WithdrawnTreatmentProsthetic Fixation After Cementless Total Hip Arthroplasty1
Not AvailableActive Not RecruitingTreatmentOsteonecrosis1
Not AvailableCompletedNot AvailableBone Density / Fracture Bone / Pain1
Not AvailableCompletedNot AvailableBone Metastasis / Metastatic Hormone Refractory Prostate Cancer1
Not AvailableCompletedNot AvailableBreast Cancer1
Not AvailableCompletedNot AvailableMultiple Disabilities / Osteoporosis1
Not AvailableCompletedNot AvailableMultiple Myeloma (MM)1
Not AvailableCompletedNot AvailablePostmenopausal Osteoporosis (PMO)1
Not AvailableCompletedPreventionBreast Cancer / Osteoporosis1
Not AvailableCompletedScreeningProstate Cancer1
Not AvailableCompletedSupportive CareBreast Cancer / Osteoporosis1
Not AvailableCompletedTreatmentBone Density / Prostatic Neoplasms1
Not AvailableCompletedTreatmentBone Loss / Fragility Fractures / Osteoporosis1
Not AvailableCompletedTreatmentHypercalcemia / Malignancies / Pain1
Not AvailableCompletedTreatmentOsteoporosis2
Not AvailableCompletedTreatmentPostmenopausal Osteoporosis (PMO)1
Not AvailableCompletedTreatmentProstate Cancer1
Not AvailableCompletedTreatmentImpaired kidney function1
Not AvailableEnrolling by InvitationNot AvailableAtypical Femoral Fractures / Bisphosphonate Therapy / Osteoporosis1
Not AvailableRecruitingNot AvailableBreast Cancer1
Not AvailableRecruitingNot AvailableLung Cancer Non-Small Cell Cancer (NSCLC)1
Not AvailableRecruitingTreatmentBone Loss / Neoplasms, Breast1
Not AvailableTerminatedTreatmentEstrogen Receptor Positive Breast Cancer / Estrogen Receptor-Positive Breast Cancer / Invasive Ductal Breast Carcinoma / Progesterone Receptor Positive Breast Cancer / Progesterone Receptor-positive Breast Cancer / Stage IA Breast Cancer / Stage IB Breast Cancer / Stage IIA Breast Cancer / Stage IIB Breast Cancer1
Not AvailableTerminatedTreatmentMultiple Myeloma (MM)1
Not AvailableUnknown StatusPreventionOsteoporosis / Transplantation, Liver1
Not AvailableUnknown StatusSupportive CareBreast Cancer / Hypercalcemia of Malignancy / Metastatic Cancers / Musculoskeletal Complications / Pain1
Not AvailableWithdrawnNot AvailableBreast Cancer1
Not AvailableWithdrawnDiagnosticMusculoskeletal Complications / Neoplasms, Malignant1
Not AvailableWithdrawnSupportive CareBone Marrow Transplant (BMT) / Hematopoietic Stem Cell Transplant (HSCT)1


  • Novartis pharmaceuticals corp
  • Novartis AG
Dosage forms
Injection, solutionIntravenous5 mg/100ml
SolutionIntravenous4 mg
InjectionIntravenous4 mg/5mL
InjectionIntravenous4 mg/100mL
InjectionIntravenous5 mg/100mL
Injection, solutionIntravenous0.04 mg/1mL
Injection, solutionIntravenous0.05 mg/1mL
Injection, solution, concentrateIntravenous0.8 mg/1mL
KitIntravenous4 mg/5mL
SolutionIntravenous4 mg/100mL
SolutionIntravenous5 mg/100mL
SolutionIntravenous5 mg
Injection, solutionIntravenous4 mg/100ml
Injection, solution, concentrateIntravenous4 mg/5ml
Injection, solutionIntravenous5 mg
Injection, solution, concentrateIntravenous4 mg/100mL
Powder, for solutionIntravenous
Unit descriptionCostUnit
Zometa 4 mg/5ml Concentrate 5ml Vial1095.69USD vial
Reclast 5 mg/100ml Solution13.39USD ml
Reclast 5 mg/100 ml solution12.88USD ml
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
Patent NumberPediatric ExtensionApprovedExpires (estimated)
Additional Data Available
  • Filed On
    Filed On

    The date on which a patent was filed with the relevant government.

    Learn more


Experimental Properties
water solubilitySparingly solubleFDA Label
Predicted Properties
Water Solubility3.27 mg/mLALOGPS
pKa (Strongest Acidic)0.66ChemAxon
pKa (Strongest Basic)6.67ChemAxon
Physiological Charge-2ChemAxon
Hydrogen Acceptor Count8ChemAxon
Hydrogen Donor Count5ChemAxon
Polar Surface Area153.11 Å2ChemAxon
Rotatable Bond Count4ChemAxon
Refractivity52.16 m3·mol-1ChemAxon
Polarizability20.1 Å3ChemAxon
Number of Rings1ChemAxon
Rule of FiveYesChemAxon
Ghose FilterNoChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleNoChemAxon
Predicted ADMET features
Human Intestinal Absorption-0.9723
Blood Brain Barrier+0.825
Caco-2 permeable-0.6418
P-glycoprotein substrateNon-substrate0.5602
P-glycoprotein inhibitor INon-inhibitor0.943
P-glycoprotein inhibitor IINon-inhibitor0.9961
Renal organic cation transporterNon-inhibitor0.9366
CYP450 2C9 substrateNon-substrate0.8319
CYP450 2D6 substrateNon-substrate0.8201
CYP450 3A4 substrateNon-substrate0.7551
CYP450 1A2 substrateNon-inhibitor0.8531
CYP450 2C9 inhibitorNon-inhibitor0.8576
CYP450 2D6 inhibitorNon-inhibitor0.8935
CYP450 2C19 inhibitorNon-inhibitor0.8319
CYP450 3A4 inhibitorNon-inhibitor0.9334
CYP450 inhibitory promiscuityLow CYP Inhibitory Promiscuity0.9904
Ames testNon AMES toxic0.5596
BiodegradationNot ready biodegradable0.5431
Rat acute toxicity2.3342 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.8515
hERG inhibition (predictor II)Non-inhibitor0.8616
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)


Mass Spec (NIST)
Not Available
SpectrumSpectrum TypeSplash Key
Predicted GC-MS Spectrum - GC-MSPredicted GC-MSNot Available
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSNot Available
MS/MS Spectrum - DI-ESI-qTof , NegativeLC-MS/MSNot Available


This compound belongs to the class of organic compounds known as bisphosphonates. These are organic compounds containing two phosphonate groups linked together through a carbon atoms.
Organic compounds
Super Class
Organic acids and derivatives
Organic phosphonic acids and derivatives
Sub Class
Direct Parent
Alternative Parents
N-substituted imidazoles / Organic phosphonic acids / Heteroaromatic compounds / Azacyclic compounds / Organopnictogen compounds / Organophosphorus compounds / Organooxygen compounds / Organonitrogen compounds / Organic oxides / Hydrocarbon derivatives
Bisphosphonate / N-substituted imidazole / Azole / Imidazole / Organophosphonic acid / Heteroaromatic compound / Azacycle / Organoheterocyclic compound / Organic nitrogen compound / Organophosphorus compound
Molecular Framework
Aromatic heteromonocyclic compounds
External Descriptors
imidazoles, 1,1-bis(phosphonic acid) (CHEBI:46557)


Pharmacological action
General Function
Poly(a) rna binding
Specific Function
Key enzyme in isoprenoid biosynthesis which catalyzes the formation of farnesyl diphosphate (FPP), a precursor for several classes of essential metabolites including sterols, dolichols, carotenoids...
Gene Name
Uniprot ID
Uniprot Name
Farnesyl pyrophosphate synthase
Molecular Weight
48275.03 Da
  1. Dunford JE, Thompson K, Coxon FP, Luckman SP, Hahn FM, Poulter CD, Ebetino FH, Rogers MJ: Structure-activity relationships for inhibition of farnesyl diphosphate synthase in vitro and inhibition of bone resorption in vivo by nitrogen-containing bisphosphonates. J Pharmacol Exp Ther. 2001 Feb;296(2):235-42. [PubMed:11160603]
  2. Glickman JF, Schmid A: Farnesyl pyrophosphate synthase: real-time kinetics and inhibition by nitrogen-containing bisphosphonates in a scintillation assay. Assay Drug Dev Technol. 2007 Apr;5(2):205-14. [PubMed:17477829]
  3. Guo RT, Cao R, Liang PH, Ko TP, Chang TH, Hudock MP, Jeng WY, Chen CK, Zhang Y, Song Y, Kuo CJ, Yin F, Oldfield E, Wang AH: Bisphosphonates target multiple sites in both cis- and trans-prenyltransferases. Proc Natl Acad Sci U S A. 2007 Jun 12;104(24):10022-7. Epub 2007 May 29. [PubMed:17535895]
  4. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [PubMed:11752352]
Pharmacological action
General Function
Metal ion binding
Specific Function
Catalyzes the trans-addition of the three molecules of IPP onto DMAPP to form geranylgeranyl pyrophosphate, an important precursor of carotenoids and geranylated proteins.
Gene Name
Uniprot ID
Uniprot Name
Geranylgeranyl pyrophosphate synthase
Molecular Weight
34870.625 Da
  1. Guo RT, Cao R, Liang PH, Ko TP, Chang TH, Hudock MP, Jeng WY, Chen CK, Zhang Y, Song Y, Kuo CJ, Yin F, Oldfield E, Wang AH: Bisphosphonates target multiple sites in both cis- and trans-prenyltransferases. Proc Natl Acad Sci U S A. 2007 Jun 12;104(24):10022-7. Epub 2007 May 29. [PubMed:17535895]
Small molecule
Pharmacological action
  1. Jahnke W, Henry C: An in vitro assay to measure targeted drug delivery to bone mineral. ChemMedChem. 2010 May 3;5(5):770-6. doi: 10.1002/cmdc.201000016. [PubMed:20209564]
  2. Nancollas GH, Tang R, Phipps RJ, Henneman Z, Gulde S, Wu W, Mangood A, Russell RG, Ebetino FH: Novel insights into actions of bisphosphonates on bone: differences in interactions with hydroxyapatite. Bone. 2006 May;38(5):617-27. Epub 2005 Jul 20. [PubMed:16046206]
  3. Cremers S, Drake MT, Ebetino FH, Bilezikian JP, Russell RGG: Pharmacology of bisphosphonates. Br J Clin Pharmacol. 2019 Jun;85(6):1052-1062. doi: 10.1111/bcp.13867. Epub 2019 Feb 28. [PubMed:30650219]


Pharmacological action
General Function
Transporter activity
Specific Function
Mediates export of organic anions and drugs from the cytoplasm. Mediates ATP-dependent transport of glutathione and glutathione conjugates, leukotriene C4, estradiol-17-beta-o-glucuronide, methotre...
Gene Name
Uniprot ID
Uniprot Name
Multidrug resistance-associated protein 1
Molecular Weight
171589.5 Da
  1. Yildiz M, Celik-Ozenci C, Akan S, Akan I, Sati L, Demir R, Savas B, Ozben T, Samur M, Ozdogan M, Artac M, Bozcuk H: Zoledronic acid is synergic with vinblastine to induce apoptosis in a multidrug resistance protein-1 dependent way: an in vitro study. Cell Biol Int. 2006 Mar;30(3):278-82. Epub 2006 Feb 2. [PubMed:16458542]

Drug created on June 13, 2005 07:24 / Updated on July 03, 2020 22:12

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