Drug General Information (ID: DDI1IJQF0H)
Drug Name			Zoledronic acid		Drug Info		Vancomycin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Bone Density Conservation Agents				Antiinfective Agents
Structure

Mechanism of Zoledronic acid-Vancomycin Interaction (Severity Level: Moderate)
Increased risk of nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Zoledronic acid				Vancomycin
Mechanism		Nephrotoxicity				Nephrotoxicity
Key Mechanism Factor 1
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Zoledronic acid and Vancomycin

Recommended Action
Management		Caution is advised if pamidronate, zoledronic acid, or other intravenous formulations of bisphosphonates must be used in patients who have recently received or are receiving treatment with other potentially nephrotoxic agents (e.g., aminoglycosides, polypeptide and polymyxin antibiotics, vancomycin, amphotericin B, adefovir, cidofovir, tenofovir, foscarnet, cisplatin, gallium nitrate, lithium, mesalamine, certain immunosuppressants, intravenous pentamidine, high intravenous dosages of methotrexate, high dosages of nonsteroidal anti-inflammatory agents). Renal function and serum electrolytes should be monitored. Patients should have serum creatinine assessed prior to each treatment, and treatment should be withheld for renal deterioration.

References
1	Banerjee D, Asif A, Striker L, Preston RA, Bourgoignie JJ, Roth D "Short-term, high-dose pamidronate-induced acute tubular necrosis: The postulated mechanisms of bisphosphonate nephrotoxicity." Am J Kidney Dis 41 (2003): E18. [PMID: 12778436]
2	Chang JT, Green L, Beitz J "Renal failure with the use of zoledronic acid." N Engl J Med 349 (2003): 1676-9 discussion 1676-9. [PMID: 14573746]
3	Janssen Van Doorn K, Neyns B, Van Der Niepen P, Verbeelen D "Pamidronate-related nephrotoxicity (tubulointerstitial nephritis) in a patient with osteolytic bone metastases." Nephron 89 (2001): 467-8. [PMID: 11721169]
4	Kanis JA, Preston CJ, Yates AJ, Percival RC, Mundy KI, Russell RG "Effects of intravenous diphosphonates on renal function." Lancet 1 (1983): 1328. [PMID: 6134112]
5	Lockridge L, Papac RJ, Perazella MA "Pamidronate-associated nephrotoxicity in a patient with Langerhans's histiocytosis." Am J Kidney Dis 40 (2002): E2. [PMID: 12087588]
6	Markowitz GS, Fine PL, Stack JI, et al. "Toxic acute tubular necrosis following treatment with zoledronate (Zometa)." Kidney Int 64 (2003): 281-289. [PMID: 12787420]
7	Osullivan TL, Akbari A, Cadnapaphornchai P "Acute renal failure associated with the administration of parenteral etidronate." Ren Fail 16 (1994): 767-73. [PMID: 7899588]
8	Product Information. Aredia (pamidronate). Novartis Pharmaceuticals, East Hanover, NJ.
9	Product Information. Boniva (ibandronate). Roche Laboratories, Nutley, NJ.
10	Product Information. Ostac (clodronate). Hoffmann-La Roche Limited, Mississauga, IA.
11	Product Information. Zometa (zoledronic acid). Novartis Pharmaceuticals, East Hanover, NJ.
12	Zazgornik J, Grafinger P, Biesenbach G, Hubmann R, Fridrik M "Acute renal failure and alendronate." Nephrol Dial Transplant 12 (1997): 2797-8. [PMID: 9430905]