Interactions between Tiludronate and Vert-Select DHA
1 drug interaction and 10 additional warnings found for the following 2 drugs:
- tiludronate
- Vert-Select DHA (multivitamin, prenatal)
Drug interactions
Moderate drug interactions
Moderate:
multivitamins, prenatal tiludronate
Applies to: Vert-Select DHA (multivitamin, prenatal) 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)
- (2001) "Product Information. Fosamax (alendronate)." Merck & Co., Inc
- Darcy PF (1995) "Nutrient-drug interactions." Adverse Drug React Toxicol Rev, 14, p. 233-54
- "Product Information. Skelid (tiludronate)." Sanofi Winthrop Pharmaceuticals
- (2001) "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals
- (2001) "Product Information. Bonefos (clodronate)." Rhone-Poulenc Rorer Canada Inc
- (2005) "Product Information. Boniva (ibandronate)." Roche Laboratories
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
multivitamins, prenatal Food/Lifestyle
Applies to: Vert-Select DHA (multivitamin, prenatal)
Adjust dosing interval
Concomitant use of some oral medications may reduce the bioavailability of orally administered iron, and vice versa. Food taken in conjunction with oral iron supplements may reduce the bioavailability of the iron. However, in many patients intolerable gastrointestinal side effects occur necessitating administration with food.
Management
Ideally, iron products should be taken on an empty stomach (i.e., at least 1 hour before or 2 hours after meals), but if this is not possible, administer with meals and monitor the patient more closely for a subtherapeutic effect. Some studies suggest administration of iron with ascorbic acid may enhance bioavailability. In addition, administration of oral iron products and some oral medications should be separated whenever the bioavailability of either agent may be decreased. Consult the product labeling for specific separation times and monitor clinical responses as appropriate.
References (2)
- "Product Information. Feosol (ferrous sulfate)." SmithKline Beecham
- (2021) "Product Information. Accrufer (ferric maltol)." Shield Therapeutics
Moderate:
tiludronate Food/Lifestyle
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)
- "Product Information. Skelid (tiludronate)." Sanofi Winthrop Pharmaceuticals
Disease interactions
8 potential interactions Applies to: 8 conditions, including Vitamin D Deficiency, Indigestion, Gastritis/Duodenitis, Hypocalcemia, and Peptic Ulcer.
Dysphagia
Major:
tiludronate
Tiludronate has a major potential interaction with Dysphagia.
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.
Esophageal Disease
Major:
tiludronate
Tiludronate has a major potential interaction with Esophageal Disease.
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.
Gastritis/Duodenitis
Major:
tiludronate
Tiludronate has a major potential interaction with Gastritis/Duodenitis.
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.
Hypocalcemia
Major:
tiludronate
Tiludronate has a major potential interaction with Hypocalcemia.
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.
Indigestion
Major:
tiludronate
Tiludronate has a major potential interaction with Indigestion.
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.
Peptic Ulcer
Major:
tiludronate
Tiludronate has a major potential interaction with 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.
Renal Dysfunction
Moderate:
tiludronate
Tiludronate has a moderate potential interaction with Renal Dysfunction.
Tiludronate is primarily eliminated by the kidney. The plasma half-life of the drug is prolonged in patients with impaired renal function. Tiludronate 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).
Vitamin D Deficiency
Major:
tiludronate
Tiludronate has a major potential interaction with 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.
More resources
tiludronate
A total of 113 drugs are known to interact with tiludronate.
- Tiludronate is in the drug class bisphosphonates.
- Tiludronate is used to treat Paget's Disease.
Vert-Select DHA
A total of 172 drugs are known to interact with Vert-Select DHA.
- Vert-select dha is used to treat Vitamin/Mineral Supplementation during Pregnancy/Lactation.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
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