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Skelid
Class: Hormone/biphosphonates

 Action Inhibits normal and abnormal bone resorption.

 Indications Treatment of Paget’s disease of bone.

 Contraindications Standard considerations.

 Route/Dosage

ADULTS: PO 400 mg qd for 3 months.

 Interactions

Aspirin, calcium, aluminum- or magnesium-containing antacids: Decrease tiludronate bioavailability. Indomethacin: Increases tiludronate bioavailability.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Hypertension; syncope. CNS: Paresthesia; vertigo; somnolence; anxiety; nervousness; insomnia; involuntary muscle contractions. DERM: Rash; pruritis; sweating. GI: Diarrhea; nausea; constipation; vomiting; flatulence; abdominal pain; norexia; dry mouth; gastritis. META: Hyperparathyroidism. EENT: Cataract; conjunctivitis; glaucoma; rhinitis; sinusitis; pharyngitis. OTHER: Fatigue; asthenia; chest pain; edema; arthrosis; flushing.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Renal function impairment: Not recommended in patients with CrCl < 30 ml/min.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Have patient take drug on empty stomach 2 hr before or after meals.
  • Swallow tablet with 6–8 oz of plain water. Do not use beverages other than plain water (eg, mineral water).
  • Calcium or mineral supplements should be taken at least 2 hours before or after tiludronate.
  • Aluminum or magnesium-containing antacids, if needed, should be taken at least 2 hr after taking tiludronate.
  • Administer aspirin or indomethacin, if ordered, either 2 hr before or after tiludronate.
  • The 3 month course of treatment may be repeated in some patients following a 3 month tiludronate-free interval.
  • Store at controlled room temperature. Do not remove from foil strip until ready for administration.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note any hypersensitivity to biphosphonates and evidence of renal function impairment.
  • Record dates of any previous treatment with tiludronate.
  • Monitor patient for side effects.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypocalcemia

 Patient/Family Education

  • Instruct patient to take drug with 6–8 oz of plain water. Advise patient to not use any other beverage (eg, mineral water).
  • Instruct patient to avoid eating 2 hr before and 2 hr after taking medication since absorption of drug is reduced by food.
  • Instruct patient to maintain adequate intake of vitamin D and calcium.
  • Advise patient to take calcium or mineral supplements 2 hr before or 2 hr after tiludronate.
  • Advise patient to take aluminum- or magnesium-containing antacids at least 2 hr after tiludronate.
  • Advise patients taking aspirin or indomethacin to take these 2 hr before or after tiludronate.
  • Advise patient to not remove medication from foil strip until just before administration.

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