Drug Interaction Report

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: Food significantly decreases the bioavailability of alendronate, possibly to negligible levels.

MANAGEMENT: Alendronate should be administered with 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 alendronate.