Drug Interaction Report

ADJUST DOSING INTERVAL: The bioavailability of tiludronate is increased 2 to 4 times in patients receiving concomitant indomethacin. The mechanism of the interaction is not known.

MANAGEMENT: The manufacturer recommends that indomethacin should not be taken within 2 hours before or 2 hours after 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.

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.