Tiludronic acid

Oral
Paget's disease of bone

CrCl	Dosage
<30	Not recommended.

Severe renal impairment; pregnancy.

Acute upper GI inflammation. Take with plenty of water, at least 2 hr before or after meals.

Dysphagia, nausea, vomiting, diarrhoea or constipation, asthenia, dizziness, headache, skin reactions, hypocalcaemia, hypophosphataemia, musculoskeletal pain, osteonecrosis of the jaw, ocular disturbances, oesophagitis, oesophageal and gastric ulcer.

Hypocalcaemia, acute renal failure. Treatment is supportive and symptomatic. Milk or antacids may be given to minimise absorption for oral overdosage. Dialysis unlikely to be helpful.

Bioavailability increased by indometacin when taken at same time. Increased risk of hypocalcaemia with aminoglycosides. Decreased bioavailability when aspirin taken 2 hr after tiludronic acid. Absorption reduced by antacids, calcium salts, magnesium-containing laxatives and iron.

Avoid food (particularly calcium-containing products) for 2 hr before and after tiludronic acid.

Description: Tiludronic acid inhibits bone resorption. It also prevents formation and dissolution of hydroxyapatite crystals, therefore may interfere with bone mineralisation.
Pharmacokinetics:
Absorption: Poorly absorbed from GI tract. Oral bioavailability: 6% (fasting).
Distribution: Protein-binding: 90%, mostly to albumin.
Metabolism: Not metabolised.
Excretion: Half excreted in urine; remainder sequestered to bone.

Store at 15-30°C (59-86°F).

Agents Affecting Bone Metabolism