Etidronate Disease Interactions

The use of etidronate (for the treatment of Paget's disease or the treatment/prevention of heterotopic ossification) is contraindicated in patients with clinically overt osteomalacia. Etidronate can inhibit bone mineralization, which has resulted in osteomalacia and bone fractures in some patients. Accumulation of unmineralized osteoid is usually noticeable during prolonged, continuous use of high dosages (10 to 20 mg/kg/day) but may occur at lower dosages when use exceeds 6 months. The newer bisphosphonates (e.g., alendronate, pamidronate, risedronate, and tiludronate) do not cause mineralization defects and may be more appropriate for patients with osteomalacia, although clinical data may be lacking for the treatment of some conditions for which etidronate is used.

Etidronate administered orally may cause local irritation of the upper gastrointestinal mucosa. Its use is contraindicated in patients with esophageal abnormalities that delay esophageal emptying such as achalasia or strictures. Etidronate should be used with caution in patients with active upper gastrointestinal problems, such as Barrett's esophagus, dysphagia, gastritis, duodenitis, ulcers, etc, as cases of erosions, bleeding and perforation have been reported. Patients should be instructed to discontinue treatment immediately and seek medical attention if they develop dysphagia, retrosternal pain, or new or worsening heartburn.

Etidronate is eliminated intact by the kidney. There is no experience to specifically make recommendations in patients with impaired renal function. Etidronate dosage should be reduced when reductions in glomerular filtration rates are present. Patients with renal impairment should be closely monitored.