The FDA ( Food and Drug Administration ) has notified healthcare professionals and patients of an update to the drug label for Reclast ( Zoledronic acid; Europe: Aclasta ) regarding the risk of kidney failure. Cases of acute renal failure requiring dialysis or having a fatal outcome following Reclast use have been reported to FDA. The revised label states that Reclast is contraindicated in patients with creatinine clearance less than 35 mL/min or in patients with evidence of acute renal impairment. The label also recommends that healthcare professionals screen patients prior to administering Reclast in order to identify at-risk patients.

Risk factors for developing renal failure include underlying moderate to severe renal impairment, use of kidney-damaging or diuretic medications at the same time as Zoledronic Acid, or severe dehydration occurring before or after Reclast is given.
The risk of developing renal failure in patients with underlying renal impairment also increases with age.

These labeling changes are being made to the Reclast label only, although Zoledronic acid, also sold as Zometa, is approved for treatment of cancer-related indications. Renal toxicity is already addressed in the Warnings and Precautions section of the Zometa as well as in the Reclast label. Dose reductions for Zometa are provided for patients with renal impairment.

Recommendations

a) Reclast is contraindicated in patients with creatinine clearance less than 35 mL/min, or in patients with evidence of acute renal impairment;

b) Healthcare professionals should screen patients prior to administering Reclast in order to identify at-risk patients;

c) Healthcare professionals should also monitor renal function in patients who are receiving Reclast.

Source: FDA, 2011

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