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Drug Interactions between Actonel with Calcium and tiludronate

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

calcium carbonate tiludronate

Applies to: Actonel with Calcium (calcium carbonate / risedronate) and tiludronate

ADJUST DOSING INTERVAL: Products containing aluminum, calcium, magnesium and other polyvalent cations such as antacids or vitamin with mineral supplements are likely to interfere with the gastrointestinal absorption of oral bisphosphonates. For example, the bioavailability of tiludronate has been shown to decrease 80% during simultaneous administration with calcium, and 60% when aluminum- or magnesium-containing antacids were administered one hour before tiludronate.

MANAGEMENT: Antacids or other oral medications containing aluminum, calcium, magnesium and other polyvalent cations should be administered at least 2 hours before or 2 hours after the bisphosphonate dose.

References (6)
  1. (2001) "Product Information. Fosamax (alendronate)." Merck & Co., Inc
  2. Darcy PF (1995) "Nutrient-drug interactions." Adverse Drug React Toxicol Rev, 14, p. 233-54
  3. "Product Information. Skelid (tiludronate)." Sanofi Winthrop Pharmaceuticals
  4. (2001) "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals
  5. (2001) "Product Information. Bonefos (clodronate)." Rhone-Poulenc Rorer Canada Inc
  6. (2005) "Product Information. Boniva (ibandronate)." Roche Laboratories

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Moderate

calcium carbonate risedronate

Applies to: Actonel with Calcium (calcium carbonate / risedronate) and Actonel with Calcium (calcium carbonate / risedronate)

ADJUST DOSING INTERVAL: Products containing aluminum, calcium, magnesium and other polyvalent cations such as antacids or vitamin with mineral supplements are likely to interfere with the gastrointestinal absorption of oral bisphosphonates. For example, the bioavailability of tiludronate has been shown to decrease 80% during simultaneous administration with calcium, and 60% when aluminum- or magnesium-containing antacids were administered one hour before tiludronate.

MANAGEMENT: Antacids or other oral medications containing aluminum, calcium, magnesium and other polyvalent cations should be administered at least 30 minutes after the bisphosphonate dose.

References (6)
  1. (2001) "Product Information. Fosamax (alendronate)." Merck & Co., Inc
  2. Darcy PF (1995) "Nutrient-drug interactions." Adverse Drug React Toxicol Rev, 14, p. 233-54
  3. "Product Information. Skelid (tiludronate)." Sanofi Winthrop Pharmaceuticals
  4. (2001) "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals
  5. (2001) "Product Information. Bonefos (clodronate)." Rhone-Poulenc Rorer Canada Inc
  6. (2005) "Product Information. Boniva (ibandronate)." Roche Laboratories

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Drug and food interactions

Moderate

calcium carbonate food

Applies to: Actonel with Calcium (calcium carbonate / risedronate)

ADJUST DOSING INTERVAL: Administration with food may increase the absorption of calcium. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption.

MANAGEMENT: Calcium may be administered with food to increase absorption. Consider withholding calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic acid.

References (6)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  3. Cerner Multum, Inc. "Australian Product Information."
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
  5. Mangels AR (2014) "Bone nutrients for vegetarians." Am J Clin Nutr, 100, epub
  6. Davies NT (1979) "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc, 38, p. 121-8

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Moderate

tiludronate food

Applies to: tiludronate

ADJUST DOSING INTERVAL: Food significantly decreases the bioavailability of tiludronate. The manufacturer reports up to a 90% decrease in bioavailability when administered with or 2 hours after a standard breakfast. Clinical efficacy, however, was demonstrated when tiludronate was taken 2 hours before or after meals.

MANAGEMENT: Tiludronate should be administered with 6 to 8 ounces of plain water at least 2 hours before or 2 hours after food.

References (1)
  1. "Product Information. Skelid (tiludronate)." Sanofi Winthrop Pharmaceuticals

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Moderate

risedronate food

Applies to: Actonel with Calcium (calcium carbonate / risedronate)

ADJUST DOSING INTERVAL: Food significantly decreases the bioavailability of risedronate, possibly to negligible levels.

MANAGEMENT: Risedronate should be administered with 180 to 240 mL (6 to 8 ounces) of plain water, at least 30 minutes before the first food, beverage, or medication of the day. Patients should remain upright for at least 30 minutes following administration of risedronate.

References (1)
  1. (2001) "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Bone resorption inhibitors

Therapeutic duplication

The recommended maximum number of medicines in the 'bone resorption inhibitors' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'bone resorption inhibitors' category:

  • Actonel with Calcium (calcium carbonate/risedronate)
  • tiludronate

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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