Fracta

Zoledronic Acid

Chemical

Injectable

Dosage form :

Vials

Doses :

4mg

Short Description:

The active substance in Fracta is zoledronic acid, which belongs to a group of substances called bisphosphonates. Fracta works by attaching itself to the bone and slowing down the rate of bone change.

Product Introduction

What Fracta is and what it is used for?

The active substance in Fracta is zoledronic acid, which belongs to a group of substances called bisphosphonates. Fracta works by attaching itself to the bone and slowing down the rate of bone

Change. It is used:

To prevent bone complications e.g. fractures, in adult patients with bone metastases (spread of cancer from the primary cancer site to the bone).
To reduce the amount of calcium in the blood in adult patients where it is too high due to the presence of a tumour. Tumours can accelerate normal bone change in such a way that the release of calcium from bone is increased. This condition is known as tumour-induced hypercalcaemia (TIH).

Before you are given Fracta

Follow carefully all instructions given to you by your doctor. Your doctor will carry out blood tests before you start treatment with Fracta and will check your response to treatment at regular intervals.

You should not be given Fracta:

If you are breast-feeding.
If you are allergic to zoledronic acid, another bisphosphonate (the group of substances to which Fracta belongs), or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Talk to your doctor before you are given Fracta:

If you have or have had a kidney problem.
If you have or have had pain, swelling or numbness of the jaw, a feeling of heaviness in the jaw or loosening of a tooth. Your doctor may recommend a dental examination before you start treatment with Fracta.
If you are having dental treatment or are due to undergo dental surgery, tell your dentist that you are being treated with Fracta and inform your doctor about your dental treatment.

While being treated with this Fracta, you should maintain good oral hygiene (including regular teeth brushing) and receive routine dental check-ups.

Contact your doctor and dentist immediately if you experience any problems with your mouth or teeth such as loose teeth, pain or swelling, or non-healing of sores or discharge, as these could be signs of a condition called osteonecrosis of the jaw.

Patients who are undergoing chemotherapy and/or radiotherapy, who are taking steroids, who are undergoing dental surgery, who do not receive routine dental care, who have gum disease, who are smokers, or who were previously treated with a bisphosphonate (used to treat or prevent bone disorders) may have a higher risk of developing osteonecrosis of the jaw.

Reduced levels of calcium in the blood (hypocalcaemia), sometimes leading to muscle cramps, dry skin, burning sensation, have been reported in patients treated with Fracta. Irregular heart beat (cardiac arrhythmia), seizures, spasm and twitching (tetany) have been reported as secondary to severe hypocalcaemia. In some instances the hypocalcaemia may be life-threatening. If any of these apply to you, tell your doctor straight away. If you have pre-existing hypocalcaemia, it must be corrected before initiating the first dose of Fracta. You will be given adequate calcium and vitamin D supplements.

Patients aged 65 years and over

Fracta can be given to people aged 65 years and over. There is no evidence to suggest that any extra precautions are needed.

Children and adolescents

Fracta is not recommended for use in adolescents and children below the age of 18 years.

Other medicines and Fracta

Please tell your doctor if you are taking or have recently taken or might take any other medicines, including medicines obtained without a prescription. It is especially important that you tell your doctor if you are also taking:

Aminoglycosides (medicines used to treat severe infections), calcitonin (a type of medicine used to treat post-menopausal osteoporosis and hypercalcaemia), loop diuretics (a type of medicine to treat high blood pressure or oedema) or other calcium-lowering medicines, since the combination of these with bisphosphonates may cause the calcium level in the blood to become too low.
Thalidomide (a medicine used to treat a certain type of blood cancer involving the bone) or any other medicines which may harm your kidneys.
Any other medicine that also contains Zoledronic Acid and is used to treat osteoporosis and other non-cancer diseases of the bone, or any other bisphosphonate, since the combined effects of these medicines taken together with Fracta are unknown.
Anti-angiogenic medicines (used to treat cancer), since the combination of these with Fracta has been associated with an increased risk of osteonecrosis of the jaw (ONJ).

Pregnancy ad breast-feeding

You should not be given Fracta if you are pregnant. Tell your doctor if you are or think that you may be pregnant. You must not be given Fracta if you are breast-feeding. Ask your doctor for advice before taking any medicine while you are pregnant or breast-feeding.

Driving and using machines

There have been very rare cases of drowsiness and sleepiness with the use of Fracta. You should therefore be careful when driving, using machinery or performing other tasks that need full attention.

Fracta contains Sodium

This medicinal product contains less than 1 mmol sodium (23 mg) per 5ml vial of Fracta, i.e., essentially “sodium free”. If your doctor uses a solution of common salt to dilute Fracta, the dose of sodium received would be larger.

How Fracta is given?

Fracta must only be given by healthcare professionals trained in administering bisphosphonates intravenously, i.e. through a vein.
Your doctor will recommend that you drink enough water before each treatment to help prevent dehydration.
Carefully follow all the other instructions given to you by your doctor, nurse or pharmacist.

How much Fracta is given

The usual single dose given is 4 mg.
If you have a kidney problem, your doctor will give you a lower dose depending on the severity of your kidney problem.

How often you will be given Fracta

If you are being treated for the prevention of bone complications due to bone metastases, you will be given one infusion of Fracta every three to four weeks.
If you are being treated to reduce the amount of calcium in your blood, you will normally only be given one infusion of Fracta.

How Fracta is given

Fracta is given as a drip (infusion) into a vein which should take at least 15 minutes and should be administered as a single intravenous solution in a separate infusion line.

Patients whose blood calcium levels are not too high will also be prescribed calcium and vitamin D supplements to be taken each day.

If you are given more Fracta than you should be

If you have received doses higher than those recommended, you must be carefully monitored by your doctor. This is because you may develop serum electrolyte abnormalities (e.g. abnormal levels of calcium, phosphorus and magnesium) and/or changes in kidney function, including severe kidney impairment. If your level of calcium falls too low, you may have to be given supplemental calcium by infusion.

How to prepare and administer Fracta

To prepare an infusion solution containing 4 mg zoledronic acid, further dilute the Fracta (5.0 ml) with 100 ml of calcium-free or other divalent cation-free infusion solution. If a lower dose of Fracta is required, first withdraw the appropriate volume as indicated below and then dilute it further with 100 ml of infusion solution. To avoid potential incompatibilities, the infusion solution used for dilution must be either 0.9% w/v sodium chloride or 5% w/v glucose solution.

Do not mix Fracta with calcium-containing or other divalent cation-containing solutions such as lactated Ringer’s solution.

Instructions for preparing reduced doses of Fracta: Withdraw the appropriate volume of the liquid concentrate, as follows:

4 ml for 3.5 mg dose
1 ml for 3.3 mg dose
8 ml for 3.0 mg dose

For single use only. Any unused solution should be discarded.

Only clear solution free from particles and discolouration should be used. Aseptic techniques must be followed during the preparation of the infusion.

Chemical and physical in-use stability has been demonstrated for up to 24 hours at 2°C to 8°C and for 3 hours at 25°C.

From a microbiological point of view, the diluted solution for infusion should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2°C 8°C when diluted with 100ml of 0.9% w/v sodium chloride solution or 5% w/v glucose solution.

The refrigerated solution should then be equilibrated to room temperature prior to administration.

The solution containing zoledronic acid is given as a single 15-minute intravenous infusion in a separate infusion line. The hydration status of patients must be assessed prior to and following administration of Fracta to ensure that they are adequately hydrated.

Studies with several types of infusion lines made from polyvinylchloride, polyethylene and polypropylene showed no incompatibility with Fracta.

Since no data are available on the compatibility of Fracta with other intravenously administered substances, Fracta must not be mixed with other medications/substances and should always be given through a separate infusion line.

Possible Side Effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. The most common ones are usually mild and will probably disappear after a short time.

Tell your doctor about any of the following serious side effects straight away.

Common (may affect up to 1 in 10 people):

Severe kidney impairment (will normally be determined by your doctor with certain specific blood tests).
Low level of calcium in the blood.

Uncommon (may affect up to 1 in 100 people):

Pain in the mouth, teeth and/or jaw, swelling or non-healing sores inside the mouth or jaw, discharge, numbness or a feeling of heaviness in the jaw, or loosening of a tooth. These could be signs of bone damage in the jaw (osteonecrosis). Tell your doctor and dentist immediately if you experience such symptoms while being treated with Fracta or after stopping treatment.
Irregular heart rhythm (atrial fibrillation) has been seen in patients receiving Fracta for postmenopausal osteoporosis. It is currently unclear whether Fracta causes this irregular heart rhythm but you should report it to your doctor if you experience such symptoms after you have received Fracta.
Severe allergic reaction: shortness of breath, swelling mainly of the face and throat.

Rare (may affect up to 1 in 1,000 people):

As a consequence of low calcium values: irregular heart beat (cardiac arrhythmia; secondary to hypocalcaemia).
A kidney function disorder called Fanconi syndrome (will normally be determined by your doctor with certain urine tests).

Very rare (may affect up to 1 in 10,000 people):

As a consequence of low calcium values: seizures, numbness and tetany (secondary to hypocalcaemia).
Talk to your doctor if you have ear pain, discharge from the ear, and/or an ear infection. These could be signs of bone damage in the ear.
Osteonecrosis has also very rarely been seen occurring with other bones than the jaw, especially the hip or thigh. Tell your doctor immediately if you experience symptoms such as new onset or worsening of aches, pain or stiffness while being treated with Fracta or after stopping treatment.

Tell your doctor about any of the following side effects as soon as possible:

Very common (may affect more than 1 in 10 people):

Low level of phosphate in the blood.

Common (may affect up to 1 in 10 people):

Headache and a flu-like syndrome consisting of fever, fatigue, weakness, drowsiness, chills and bone, joint and/or muscle ache. In most cases no specific treatment is required and the symptoms disappear after a short time (couple of hours or days).
Gastrointestinal reactions such as nausea and vomiting as well as loss of appetite.
Low level of red blood cells (anaemia).

Uncommon (may affect up to 1 in 100 people):

Hypersensitivity reactions.
Low blood pressure.
Chest pain.
Skin reactions (redness and swelling) at the infusion site, rash, itching.
High blood pressure, shortness of breath, dizziness, anxiety, sleep disturbances, taste disturbances, trembling, tingling or numbness of the hands or feet, diarrhoea, constipation, abdominal pain, dry mouth.
Low counts of white blood cells and blood platelets.
Low level of magnesium and potassium in the blood. Your doctor will monitor this and take any necessary measures.
Weight increase.
Increased sweating.
Blurred vision, tearing of the eye, eye sensitivity to light.
Sudden coldness with fainting, limpness or collapse.
Difficulty in breathing with wheezing or coughing.

Rare (may affect up to 1 in 1,000 people):

Slow heartbeat.
Unusual fracture of the thigh bone particularly in patients on long-term treatment for osteoporosis may occur rarely. Contact your doctor if you experience pain, weakness or discomfort in your thigh, hip or groin as this may be an early indication of a possible fracture of the thigh bone.
Interstitial lung disease (inflammation of the tissue around the air sacks of the lungs).
Flu-like symptoms including arthritis and joint swelling.
Painful redness and/or swelling of the eye

Very rare (may affect up to 1 in 10,000 people):

Fainting due to low blood pressure.
Severe bone, joint and/or muscle pain, occasionally incapacitating.

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet.

How to store Fracta

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and vial.

The expiry date refers to the last day of that month.

Store between 15° – 30°C. Keep vial in outer carton in order to protect from light.
If not used immediately after dilution with infusion media, for microbiological integrity, the solution should be refrigerated at 2°C-8°C. the refrigerated solution should then be equilibrated to room temperature prior to administration. The total time between dilution, storage in the refrigerator and end of administration must not exceed 24 hours.
Discard unused portion.
Do not throw away any medicines via wastewater. Ask your pharmacist how to throw

away medicines you no longer use. These measures will help protect the environment.

Further information

What Fracta contains?

Fracta contains the active ingredient Zoledronic Acid (as monohydrate).

One vial contains 4 mg zoledronic acid.

The other ingredients are mannitol, Tri sodium citrate anhydrous, sodium hydroxide, Citric acid anhydrous and water for injection.

Fracta

Zoledronic Acid

Category:

Chemical

Injectable

Dosage form :

Vials

Doses :

4mg

Short Description:

The active substance in Fracta is zoledronic acid, which belongs to a group of substances called bisphosphonates. Fracta works by attaching itself to the bone and slowing down the rate of bone change.

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