Zoledronic Acid (Zometa) Dispensation, Preparation, and Use

Purpose/ Applicability: 

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

Scope:

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.

Definition(s):

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

Equipment:

• 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

Procedure:

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