Drug Interactions between Actonel with Calcium and etelcalcetide

MONITOR CLOSELY: Concomitant use of etelcalcetide with other medicines known to lower serum calcium may increase the risk of hypocalcemia. The proposed mechanism is additive reduction in serum calcium levels. Significant decreases in serum calcium may cause paraesthesias, myalgias, muscle spasms, seizures, QT interval prolongation, and ventricular arrhythmia. Etelcalcetide given alone may lead to severe hypocalcemia requiring concomitant treatment with therapies to increase serum calcium levels.

MANAGEMENT: Close monitoring of corrected serum calcium levels is recommended if etelcalcetide is used in combination with other medications known to lower serum calcium, such as denosumab, calcitonin, foscarnet, bisphosphonates, or loop diuretics. It is recommended that the patient's corrected serum calcium level should be measured within one week of initiation or dose adjustment of etelcalcetide and monitored approximately every 4 weeks. In addition, the manufacturer product labeling should be consulted for management guidelines in the event of a reduction in corrected serum calcium levels below the lower limit of the normal range and/or symptoms of hypocalcemia. Patients should also be advised to contact their health care professional if they experience symptoms of hypocalcemia, such as numbness or tingling in the fingers, toes, or around the mouth, muscle spasms, twitches or cramps, seizures, confusion, and irregular heartbeats.

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.