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Actonel with Calcium (calcium carbonate / risedronate) Disease Interactions

There are 10 disease interactions with Actonel with Calcium (calcium carbonate / risedronate):

Major

Bisphosphonate (Includes Actonel with Calcium) ↔ Onj

Severe Potential Hazard, Moderate plausibility

Applies to: Infection - Bacterial/Fungal/Protozoal/Viral

Osteonecrosis of the jaw (ONJ), which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients taking bisphosphonates. Known risk factors for osteonecrosis of the jaw include invasive dental procedures (e.g., tooth extraction, dental implants, boney surgery), diagnosis of cancer, concomitant therapies (e.g., chemotherapy, corticosteroids, angiogenesis inhibitors), poor oral hygiene, and co-morbid disorders (e.g., periodontal and/or other pre-existing dental disease, anemia, coagulopathy, infection, ill-fitting dentures). The manufacturers of bisphosphonates recommend discontinuation of bisphosphonate treatment for patients undergoing invasive dental procedures. Patients who develop osteonecrosis of the jaw while on bisphosphonate therapy should receive care by an oral surgeon. In these patients, extensive dental surgery to treat ONJ may exacerbate the condition. Discontinuation of bisphosphonate therapy should be considered based on individual benefit/risk assessment.

Major

Bisphosphonates (Includes Actonel with Calcium) ↔ Hypocalcemia

Severe Potential Hazard, High plausibility

Applies to: Hypocalcemia, Vitamin D Deficiency

The use of bisphosphonates is contraindicated for the treatment of osteoporosis in patients with hypocalcemia. These agents increase bone mineral density, a process that requires an adequate supply of calcium in the body. Following the initiation of therapy, a short-term reduction in serum calcium and phosphate levels usually occurs due to inhibition of bone resorption, especially in patients with Paget's disease, in whom the pretreatment rate of bone turnover may be greatly elevated. Hypocalcemia and other disturbances of mineral metabolism, such as vitamin D deficiency, should be treated prior to initiation of therapy. Appropriate intake of calcium and vitamin D should be ensured throughout the course of treatment.

References

  1. "Product Information. Fosamax (alendronate)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals, Cincinnati, OH.
  3. Schussheim DH, Jacobs TP, Silverberg SJ "Hypocalcemia associated with alendronate." Ann Intern Med 130 (1999): 329
  4. Lourwood DL "The pharmacology and therapeutic utility of bisphosphonates." Pharmacotherapy 18 (1998): 779-89
  5. Watts NB "Treatment of osteoporosis with bisphosphonates." Rheum Dis Clin North Am 20 (1994): 717-34
View all 5 references
Major

Bisphosphonates (Includes Actonel with Calcium) ↔ Upper Gi Mucosal Irritation

Severe Potential Hazard, High plausibility

Applies to: Duodenitis/Gastritis, Dyspepsia, Dysphagia, Esophageal Disease, Peptic Ulcer

Bisphosphonates may cause local irritation of the upper gastrointestinal mucosa. Esophagitis and esophageal ulcers and erosions, occasionally with bleeding, as well as gastric and duodenal ulcers, have been reported, primarily with alendronate. Because of their structural similarities, therapy with all bisphosphonates should be administered cautiously in patients with active upper gastrointestinal disorders. The usual precautions should be followed closely to minimize the risk of irritation (i.e. taking the medication with a full glass of water after arising for the day and remaining upright for at least 30 minutes afterwards and until the first food intake of the day). Therapy should be discontinued if dysphagia, odynophagia or retrosternal pain occurs. The manufacturer of alendronate considers its use to be contraindicated in patients with abnormalities of the esophagus that may delay esophageal emptying, such as stricture or achalasia.

References

  1. Rimmer DE, Rawls DE "Improper alendronate administration and a case of pill esophagitis." Am J Gastroenterol 91 (1996): 2648-9
  2. "Product Information. Fosamax (alendronate)." Merck & Co, Inc, West Point, PA.
  3. Levine J, Nelson D "Esophageal stricture associated with alendronate therapy." Am J Med 102 (1997): 489-91
  4. Bauer DC, Black D, Ensrud K, Thompson D, Hochberg M, Nevitt M, Musliner T, Freedholm D "Upper gastrointestinal tract safety profile of alendronate - The Fracture Intervention Trial." Arch Intern Med 160 (2000): 517-25
  5. Lowe CE, Depew WT, Vanner SJ, Paterson WG, Meddings JB "Upper gastrointestinal toxicity of alendronate." Am J Gastroenterol 95 (2000): 634-40
  6. Cameron RB "Esophagitis dissecans superficialis and alendronate: case report." Gastrointest Endosc 46 (1997): 562-3
  7. Degroen PC, Lubbe DF, Hirsch LJ, Daifotis A, Stephenson W, Freedholm D, Pryortillotson S, Seleznick MJ, Pinkas H, Wang KK "Esophagitis associated with the use of alendronate." N Engl J Med 335 (1996): 1016-21
  8. Yue QY, Mortimer O "Alendronate - Risk for esophageal stricture." J Am Geriat Soc 46 (1998): 1581-2
  9. Wallace JL "Upper gastrointestinal ulceration with alendronate." Digest Dis Sci 44 (1999): 311-2
  10. Peter CP "Upper gastrointestinal ulceration with alendronate - Response." Digest Dis Sci 44 (1999): 312-3
  11. Nightingale SL "Important information regarding alendronate adverse reactions." JAMA 275 (1996): 1534
  12. Castell DO ""Pill esophagitis"--the case of alendronate." N Engl J Med 335 (1996): 1058-9
  13. Abdelmalek MF, Douglas DD "Alendronate-induced ulcerative esophagitis." Am J Gastroenterol 91 (1996): 1282-3
  14. Maconi G, Porro GB "Multiple ulcerative esophagitis caused by alendronate." Am J Gastroenterol 90 (1995): 1889-90
  15. Lourwood DL "The pharmacology and therapeutic utility of bisphosphonates." Pharmacotherapy 18 (1998): 779-89
  16. Colina RE, Smith M, Kikendall JW, Wong RK "A new probable increasing cause of esophageal ulceration: alendronate." Am J Gastroenterol 92 (1997): 704-6
  17. Liberman UA, Hirsch LJ "Esophagitis and alendronate." N Engl J Med 335 (1996): 1069-70
View all 17 references
Major

Calcium Salts (Includes Actonel with Calcium) ↔ Calcium- Phosphate Calcifications

Severe Potential Hazard, High plausibility

Applies to: Phosphate Imbalance

Elevated serum concentrations of calcium and phosphate can exceed the solubility level and result in calcium- phosphate precipitates that deposit in vascular and renal systems as well as other soft tissues of the body. Therapy with calcium should be administered with extreme caution in patients with hyperphosphatemia (hypoparathyroidism or severe renal impairment). Administration of oral calcium acetate or calcium carbonate, in addition to providing calcium, complexes phosphates within the GI tract. These complexes are eliminated in the feces. Clinical monitoring of serum calcium and phosphate concentrations is necessary.

References

  1. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Posture (calcium phosphate, triphasic)." Whitehall-Robbins, Madison, NJ.
Major

Calcium Salts (Includes Actonel with Calcium) ↔ Cardiac Contraction/Conduction

Severe Potential Hazard, High plausibility

Applies to: Arrhythmias

Calcium is involved in cardiac muscle contraction and electrical impulse conduction. Therapy with calcium salt formulations (particularly IV) should be administered cautiously to patients with cardiac disease. Patients receiving cardiac glycosides and concomitant IV calcium may experience arrhythmias. Therapy with IV calcium should be administered slowly and at reduced dosages in patients with cardiac disease.

References

  1. "Product Information. Posture (calcium phosphate, triphasic)." Whitehall-Robbins, Madison, NJ.
  2. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
Major

Calcium Salts (Includes Actonel with Calcium) ↔ Malabsorption

Severe Potential Hazard, High plausibility

Applies to: Achlorhydria, Malabsorption Syndrome

Calcium is absorbed from the intestinal tract by active transport and passive diffusion. Malabsorption syndromes (celiac disease, GI resection), deficiency of vitamin D, parathyroid hormone, or calcitonin, or an alkaline gastric pH (achlorhydria, carbonate or phosphate salts) can decrease the absorption of oral formulations of calcium. Calcium is available in oral and parenteral formulations.

References

  1. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Posture (calcium phosphate, triphasic)." Whitehall-Robbins, Madison, NJ.
Major

Calcium Salts (Includes Actonel with Calcium) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Absorption of oral calcium formulations may be altered and elimination of calcium by the kidney decreased with renal impairment. Hyperphosphatemia occurs during renal failure. Calcium acetate or calcium carbonate, in addition to providing calcium, complexes phosphates within the GI tract. Calcium carbonate can partially correct metabolic acidosis associated with chronic renal failure. Clinical monitoring of renal function and serum calcium and phosphate concentrations is necessary.

References

  1. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Posture (calcium phosphate, triphasic)." Whitehall-Robbins, Madison, NJ.
Major

Calcium Salts (Includes Actonel with Calcium) ↔ Sarcoidosis

Severe Potential Hazard, High plausibility

Applies to: Sarcoidosis

Hypercalciuria, with or without hypercalcemia, may occasionally occur in patients with sarcoidosis. Elevated calcium levels may result from increased intestinal absorption of calcium, which is related to the extrarenal production of vitamin D by mononuclear phagocytes present within the sarcoid granuloma. Therapy with calcium salts should be administered cautiously and only if necessary in patients with sarcoidosis.

References

  1. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  2. "Product Information. Posture (calcium phosphate, triphasic)." Whitehall-Robbins, Madison, NJ.
  3. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
Moderate

Bisphosphonates (Includes Actonel with Calcium) ↔ Asthma

Moderate Potential Hazard, Moderate plausibility

Applies to: Asthma

There have been reports of bronchoconstriction in aspirin-sensitive patients receiving bisphosphonates. Use of these agents in asthmatic and in aspirin-sensitive patients should be used with caution.

Moderate

Risedronate (Includes Actonel with Calcium) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Risedronate is primarily eliminated by the kidney. The renal clearance of the drug is decreased in patients with impaired renal function. Risedronate is not recommended for use in patients with creatinine clearance less than 30 mL/min due to a lack of clinical experience in this setting. No dosage adjustment is necessary in patients with mild to moderate renal impairment (CrCl >= 30 mL/min).

References

  1. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals, Cincinnati, OH.
  2. Mitchell DY, Eusebio RA, SaccoGibson NA, Pallone KA, Kelly SC, Nesbitt JD, Brezovic CP, Thompson GA, Powell JH "Dose-proportional pharmacokinetics of risedronate on single-dose oral administration to healthy volunteers." J Clin Pharmacol 40 (2000): 258-65
  3. Mitchell DY, StPeter JV, Eusebio RA, Pallone KA, Kelly SC, Russell DA, Nesbitt JD, Thompson GA, Powell JH "Effect of renal function on risedronate pharmacokinetics after a single oral dose." Br J Clin Pharmacol 49 (2000): 215-22

Actonel with Calcium (calcium carbonate / risedronate) drug Interactions

There are 488 drug interactions with Actonel with Calcium (calcium carbonate / risedronate)

Actonel with Calcium (calcium carbonate / risedronate) alcohol/food Interactions

There are 2 alcohol/food interactions with Actonel with Calcium (calcium carbonate / risedronate)

More about Actonel with Calcium (calcium carbonate / risedronate)

Related treatment guides

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
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 information available.

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Further information

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