Classifications: regulator, bone metabolism (bisphosphonate);
Therapeutic: bone metabolism regulator

Prototype: Etidronate disodium
Pregnancy Category: C


240 mg tablets


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.


Treatment of Paget's disease.


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


  • 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.


Drug: Absorption decreased by calcium-, aluminum- or magnesium-containing antacids, aspirin. Absorption increased by indomethacin.


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

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