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.
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.
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
Adult: PO 400 mg/d with 68 oz of water x 3 mo
- Give with 68 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
, coughing, pharyngitis. Skin:
Hyperparathyroidism, vitamin D deficiency, Musculoskeletal:
Absorption decreased by calcium-
- or magnesium-containing antacids
Absorption increased by indomethacin.
Poorly absorbed from GI tract. Steady-State:
30 d. Metabolism:
Not metabolized. Elimination:
Primarily in urine. Half-Life:
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.