Zoledronic Acid (Zometa) Dispensation, Preparation, and Use

Last Updated: 6/7/2023

Purpose/ Applicability: 

To provide a guideline for proper dispensation, preparation, and use of zoledronic acid for VTH services.  


This applies when zoledronic acid (Zometa) is dispensed to any of the VTH services for in-hospital use. Zoledronic acid – a bisphosphonate –  is a Table II hazardous drug on the NIOSH list and must be prepared and administered appropriately.


  • VTH: Veterinary Teaching Hospital
  • NIOSH: National Institute for Occupational Safety and Health
  • HD: Hazardous Drug


  • Equashield components
    • Size 13 vial top, LL transfer device (LL-2)
  • Zoledronic acid
  • Normal saline
  • 60 mL LL syringe
  • 10 mL Equashield syringe
  • Chemotherapy protective gloves
  • Syringe pump
  • Red biohazard bag


Pharmacy Procedure:

  • Patient prescription for zoledronic acid appears on the pharmacy worklist and the pharmacist authorizes the medication
  • To fill the prescription the Medication Dispensary staff will provide:
    • The 5 mL zoledronic acid vial (single use only)
    • A 50 mL vial of normal saline
    • A size 13 Equashield vial adaptor
    • A LL-2 adaptor
    • A 10 mL Equashield syringe
    • A 60 mL LL syringe

Service Procedure:

  • Upon receipt of the prescription, the service will return back to their ward and the medication will be given to the designated technician for administration of hazardous substances
  • While wearing chemotherapy protective gloves, the top of the zoledronic acid vial will be removed and replaced with a size 13 Equashield vial adaptor
  • The zoledronic acid will be drawn up into the 10 mL Equashield syringe and the LL-2 adaptor will be placed on the end of the syringe
  • The 50 mL vial of normal saline will be drawn up into the 60 mL LL syringe then the syringe will be attached to the opposite end of the LL-2 adaptor
  • The two syringes will be mixed together with the total volume being pushed into the 60 mL LL syringe
  • The Equashield syringe and LL-2 adaptor will be disposed of in a red biohazard bag
  • For administration, the syringe will be placed onto an appropriately calibrated syringe pump
  • Any persons coming into contact with the patient, the line, or the syringe/syringe pump must be wearing chemotherapy protective gloves.
  • After administration is complete, the 60 mL LL syringe and the line will be disposed of in a sharps container
  • A separate IV line should be used for administration; Do not administer with other intravenous agents.

Medication Specific Information

  • Zoledronic acid (Zometa) is a Table II HD – Reproductive toxicity
  • Zoledronic acid interacts with calcium and other divalent cations – avoid the use of LRS, etc.; Aminoglycosides ; Diuretics; Other nephrotoxic agents.
  • Following infusion, the manufacturer recommends a 10 mL NS flush.
  • The medication is single use only
    • Medication cannot be stored or kept for additional treatment and must be disposed of immediately after use
  • In the case of a medication spill :
    • On the patient – Wearing gloves, wipe fur down then follow with alcohol to deactivate the drug
    • In the wards – Wearing gloves, coat the area with alcohol to help with the deactivation of the drug, wipe up the liquid spill, coat area with alcohol a second time to remove any residue and wipe up

Keywordszometa, zoledronic acid, hazardous, NIOSH   Doc ID129213
OwnerJenny C.GroupUofI College of Veterinary Medicine Teaching Hospital
Created2023-06-20 10:44 CDTUpdated2023-06-20 10:52 CDT
SitesUniversity of Illinois College of Veterinary Medicine Teaching Hospital
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