TILUDRONATE DISODIUM
| TILUDRONATE DISODIUM (til-u'dro-nate) Skelid Classifications: regulator, bone metabolism (bisphosphonate); Therapeutic: bone metabolism regulator Prototype: Etidronate disodium Pregnancy Category: C |
Availability
240 mg tablets
Action
Mechanism of action of this diphosphate is to inhibit osteoclastic activity, which leads to resorption of the bone matrix. Acts primarily by inhibiting normal or abnormal bone resorption, thus reducing bone formation.
Therapeutic Effect
Reduces bone formation and effectiveness indicated by decreasing levels of alkaline phosphatase.
Uses
Treatment of Paget's disease.
Contraindications
Hypersensitivity to diphosphonates (e.g., alendronate, etidronate, pamidronate, tiludronate); severe kidney failure (Clcr <30 mL/min); pregnancy (category C), lactation.
Cautious Use
Hypocalcemia, renal impairment; active UGI problems (e.g., gastritis, dysphagia, ulcer, esophageal disease); vitamin D deficiency; CHF. Safety and efficacy in children are not established.
Route & Dosage
| Paget's Disease Adult: PO 400 mg/d with 6–8 oz of water x 3 mo |
Administration
Oral- Give with 6–8 oz of plain water 2 h before or after food.
- Do not give within 2 h of drugs containing calcium, aspirin, or indomethacin. Give aluminum- or magnesium-containing antacids no sooner than 2 h after tiludronate.
- Store in manufacturer's packaging at 15°–30° C (59°–86° F).
Adverse Effects (≥1%)
Body as a Whole: Pain, flu-like syndrome, edema. CNS: Headache, dizziness, paresthesias. CV: Chest pain. GI: Nausea, diarrhea, dyspepsia, vomiting, flatulence. Special Senses: Cataract, conjunctivitis, glaucoma. Respiratory: Rhinitis, sinusitis, coughing, pharyngitis. Skin: Rash. Metabolic: Hyperparathyroidism, vitamin D deficiency, Musculoskeletal: Arthralgia, arthrosis.Interactions
Drug: Absorption decreased by calcium-, aluminum- or magnesium-containing antacids, aspirin. Absorption increased by indomethacin.Pharmacokinetics
Absorption: Poorly absorbed from GI tract. Steady-State: 30 d. Metabolism: Not metabolized. Elimination: Primarily in urine. Half-Life: 150 h.Nursing Implications
Assessment & Drug Effects
- Monitor for S&S of upper GI dysfunction or ulceration.
- Lab tests: Periodic serum calcium and serum phosphate.
Patient & Family Education
- Do not remove tablets from foil strips until time to be taken.
- Wait at least 2 h after taking tiludronate to take aluminum- and magnesium-containing antacids.
- Consult physician to determine appropriate daily intake of vitamin D and calcium.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug