TILUDRONATE DISODIUM
(til-u'dro-nate)
Skelid
Classifications: regulator, bone metabolism (bisphosphonate)
Prototype: Etidronate disodium
Pregnancy Category: C

Availability

240 mg tablets

Actions

Mechanism of action of this diphosphate is to inhibit osteoclastic activity, which leads to resorption of the bone matrix.

Therapeutic Effects

Acts primarily by inhibiting normal or abnormal bone resorption, thus reducing bone formation. 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 (Cl_cr <30 mL/min).

Cautious Use

Hypocalcemia, active UGI problems (e.g., gastritis, dysphagia, ulcer, esophageal disease); CHF. Pregnancy (category C), lactation. Safety and efficacy in children are not established.

Route & Dosage

Paget's Disease
Adult: PO 400 mg/d with 6–8 oz of water times 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 excreted 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.
Do not breast feed while taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug