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Etidronate and Calcium (Didrocal) - Uses, Dose, Side effects, MOA

Etidronate is a medication primarily used to treat conditions involving abnormal bone development or breakdown, such as Paget's disease of bone or osteoporosis. It belongs to a class of medications known as bisphosphonates. Etidronate works by inhibiting the activity of cells called osteoclasts, which are responsible for breaking down bone tissue. By reducing osteoclast activity, etidronate helps to increase bone density and strength.

Calcium, on the other hand, is a mineral that is essential for various bodily functions, including the formation and maintenance of strong bones and teeth. It plays a crucial role in bone health, and an adequate intake of calcium is important for preventing conditions like osteoporosis.

Etidronate and Calcium (Didrocal) is a combination of a bisphosphonate (etidronate) and calcium. It is used in the treatment of postmenopausal and corticosteroid-induced osteoporosis.

Etidronate and Calcium (Didrocal) Uses:

Note: This is not approved in the US.

Corticosteroid-induced osteoporosis:
- Prevention of corticosteroid-induced osteoporosis
Postmenopausal osteoporosis:
- It is used for the treatment and prevention of established postmenopausal osteoporosis.

Etidronate and Calcium (Didrocal) Dose in Adults

Note:

When you're prescribed a 90-day treatment for bone problems, you'll take two different things, but not at the same time.
First, you'll take the white tablets with etidronate disodium.
Then, you'll take the blue, capsule-shaped tablets with calcium carbonate.
You'll do this for four cycles, which adds up to about a year.
If your bone health doesn't improve after this time, your doctor might stop the treatment.

Etidronate and Calcium (Didrocal) Dose in the treatment of Corticosteroid-induced osteoporosis and postmenopausal osteoporosis:

In the treatment of corticosteroid-induced osteoporosis and postmenopausal osteoporosis, the recommended doses are:

Etidronate disodium: Take 400 mg once daily for 14 days.
Followed by:
- Calcium carbonate: Take 1,250 mg (500 mg elemental calcium) once daily for 76 days.

So, first, you take etidronate disodium for 14 days, then switch to calcium carbonate for the next 76 days.

Use in Children:

Not indicated.

Etidronate and Calcium Pregnancy Category: C

The use of etidronate disodium and calcium carbonate in pregnant women is not recommended.
Animal studies have shown adverse effects, and the manufacturer advises against the use of this product during pregnancy.

Use of etidronate or calcium during lactation:

The manufacturer advises against the use of this product in nursing women due to potential risks to the nursing infant.
Calcium from calcium carbonate can be excreted into breast milk, and while the excretion of etidronate is not well understood, there is concern about potential adverse reactions in nursing infants.

Dose in Kidney Disease:

The manufacturer's instructions don't include dosage adjustments, so it's important to be cautious and keep a close eye on things while using this medication.
Also, the intravenous (IV) form of etidronate, when given directly into the vein, has been found to potentially harm the kidneys.

Dose in Liver disease:

The manufacturer's instructions don't include any specific dosage adjustments for people with liver problems.

Side Effects of Etidronate and Calcium (Didrocal):

Central Nervous System:
- Dizziness
- Headache
Gastrointestinal:
- Diarrhea
- Nausea
- Flatulence
- Constipation
- Dyspepsia
- Vomiting

Contraindications to Etidronate and Calcium (Didrocal):

If someone has a known allergy to etidronate disodium or any ingredient in the medication, or if they are experiencing osteomalacia (a condition where the bones become weak and soft), it's not safe to use etidronate or calcium carbonate therapy.
Before starting this treatment, it's important to resolve any ongoing osteomalacia with appropriate treatment.

Warnings and precautions

Bone fractures:

Patients taking bisphosphonates for osteoporosis treatment or prevention should be aware of the risk of atypical femur fractures (AFF).
These fractures can occur in the subtrochanteric femur (just below the hip joint) or the diaphyseal femur (long segment of the thigh bone).
Some patients may experience warning signs like prodromal pain weeks or months before the fracture.
Although it's uncertain if bisphosphonate therapy directly causes these fractures, most cases have been reported in patients taking bisphosphonates.
The risk may increase with long-term use (over 3 to 5 years), but generally, the benefits of therapy outweigh the risk of AFF within the first 5 years of treatment.
If patients experience thigh or groin pain while on bisphosphonates, they should be evaluated for a femur fracture.
In cases of femoral shaft fracture, it's advisable to consider interrupting bisphosphonate therapy and assess for fracture in the opposite limb.

Muscle, joint, or bone pain

While uncommon, some individuals may experience severe and occasionally debilitating bone, joint, or muscle pain while undergoing bisphosphonate treatment.
This pain can start suddenly or develop over several months.
If patients encounter severe symptoms, it's advisable to consider discontinuing the therapy.
Typically, symptoms improve once the treatment is stopped.
However, in some cases, the pain may return if the patient is rechallenged with the same drug or another bisphosphonate.
Therefore, it's recommended to avoid using bisphosphonates in patients with a history of these symptoms associated with bisphosphonate therapy.

Diarrhea:

Diarrhea is a common side effect of therapy with bisphosphonates and may happen more often when higher dosages are used.
It's important to be cautious when prescribing these medications to patients with gastrointestinal (GI) conditions that make them prone to diarrhea, such as ulcerative colitis, Crohn's disease, or irritable bowel syndrome.

Irritation of the gastrointestinal mucosa

Bisphosphonates can irritate the lining of the upper gastrointestinal tract, leading to conditions like esophagitis, dysphagia (difficulty swallowing), esophageal ulcers, erosions, and rarely, esophageal stricture (narrowing of the esophagus).
The risk of these conditions is higher in patients who are unable to follow dosing instructions properly.
It's important to be cautious when using bisphosphonates in patients with dysphagia, esophageal disorders, gastritis, duodenitis, or ulcers, as it may exacerbate their underlying condition.
If patients experience new or worsening symptoms, it's recommended to discontinue bisphosphonate use.

Hypocalcemia:

Hypocalcemia (low calcium levels) can occur with the use of bisphosphonates.
Before starting therapy with bisphosphonates, it's important to correct any existing hypocalcemia.
It's also crucial to ensure that patients are getting enough vitamin D and calcium from their diet or supplements.
This helps to maintain proper calcium levels in the body and reduces the risk of hypocalcemia during bisphosphonate treatment.

Ocular effects

Bisphosphonates can sometimes cause eye-related issues like conjunctivitis (pink eye), iritis, uveitis, scleritis, and episcleritis.
If patients experience complicated or severe inflammation in their eyes while taking bisphosphonates, it may be necessary to discontinue the therapy.
These patients should be referred for evaluation by an eye specialist (ophthalmologist) to manage their eye condition effectively.

Osteonecrosis in the jaw:

Bisphosphonate therapy has been linked to a condition called osteonecrosis of the jaw (ONJ), which is also known as medication-related osteonecrosis of the jaw (MRONJ).
This risk is especially noted in cancer patients receiving intravenous bisphosphonates and can also occur in patients with postmenopausal osteoporosis taking oral bisphosphonates.
Risk factors include cancer diagnosis, chemotherapy, radiation therapy, corticosteroids, anemia, infection, or existing dental problems.
The American Association of Maxillofacial Surgeons (AAOMS) suggests that patients with risk factors should have dental exams and preventive dentistry before starting chronic bisphosphonate therapy.
During treatment, invasive dental procedures should be avoided if possible.
While there's no clear evidence that stopping bisphosphonates reduces ONJ risk, clinical judgment should guide decisions about discontinuation before dental procedures.
The AAOMS recommends different approaches based on duration of bisphosphonate use and other medications taken.
Patients who develop ONJ during therapy should be managed by an oral surgeon.

Renal impairment:

Patients with renal impairment should use bisphosphonates cautiously.
If therapy is started, it's important to monitor their serum (blood) and urine calcium levels, along with other relevant parameters, to ensure their kidneys are functioning properly and to avoid any complications.

Etidronate and Calcium: Drug Interaction

Risk Factor C (Monitor therapy)
Aminoglycosides	May enhance the hypocalcemic effect of Bisphosphonate Derivatives.
Amphetamines	Antacids may decrease the excretion of Amphetamines.
Angiogenesis Inhibitors (Systemic)	May enhance the adverse/toxic effect of Bisphosphonate Derivatives. Specifically, the risk for osteonecrosis of the jaw may be increased.
Antipsychotic Agents (Phenothiazines)	Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines).
Bromperidol	Antacids may decrease the absorption of Bromperidol.
Calcium Channel Blockers	Calcium Salts may diminish the therapeutic effect of Calcium Channel Blockers.
Captopril	Antacids may decrease the serum concentration of Captopril.
Cardiac Glycosides	Calcium Salts may enhance the arrhythmogenic effect of Cardiac Glycosides.
Cefpodoxime	Antacids may decrease the serum concentration of Cefpodoxime.
Cysteamine (Systemic)	Antacids may diminish the therapeutic effect of Cysteamine (Systemic).
Deferasirox	Bisphosphonate Derivatives may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased.
Dexmethylphenidate	Antacids may increase the absorption of Dexmethylphenidate. Specifically, antacids may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption.
Diacerein	Antacids may decrease the absorption of Diacerein.
DOBUTamine	Calcium Salts may diminish the therapeutic effect of DOBUTamine.
Methylphenidate	Antacids may increase the absorption of Methylphenidate. Specifically, antacids may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption.
Nonsteroidal Anti-Inflammatory Agents	May enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern.
Proton Pump Inhibitors	May diminish the therapeutic effect of Bisphosphonate Derivatives.
QuiNIDine	Antacids may decrease the excretion of QuiNIDine.
Rosuvastatin	Antacids may decrease the serum concentration of Rosuvastatin.
	Thiazide and Thiazide-Like Diuretics: May decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis.
Vitamin D Analogs	Calcium Salts may enhance the adverse/toxic effect of Vitamin D Analogs.
Risk Factor D (Consider therapy modification)
Acalabrutinib	Antacids may decrease the serum concentration of Acalabrutinib. Management: Separate administration of acalabrutinib from the administration of any antacids by at least 2 hours in order to minimize the potential for a significant interaction.
Allopurinol	Antacids may decrease the absorption of Allopurinol.
Alpha-Lipoic Acid	Calcium Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Calcium Salts.
Atazanavir	Antacids may decrease the absorption of Atazanavir.
Bictegravir	Calcium Salts may decrease the serum concentration of Bictegravir. Management: Bictegravir, emtricitabine, and tenofovir alafenamide can be administered with calcium salts under fed conditions, but coadministration with or 2 hours after a caclium salt is not recommended under fasting conditions.
Bisacodyl	Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur.
Bismuth Subcitrate	Antacids may diminish the therapeutic effect of Bismuth Subcitrate. Management: Avoid administration of antacids within 30 minutes of bismuth subcitrate (tripotassium bismuth dicitrate) administration.
Bisphosphonate Derivatives	Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid.
Bosutinib	Antacids may decrease the serum concentration of Bosutinib. Management: Administer antacids more than 2 hours before or after bosutinib.
Calcium Polystyrene Sulfonate	Antacids may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. The combined use of these two agents may result in metabolic alkalosis and/or loss of efficacy of the cation exchange resin. Management: To minimize this interaction, consider: a)separating doses by 2 or more hours; b)rectal administration of the exchange resin; or c)alternatives to antacids. Monitor for metabolic alkalosis and attenuation of CPS effects. Avoid magnesium hydroxide.
Cefditoren	Antacids may decrease the serum concentration of Cefditoren. Management: Concomitant use of cefditoren with antacids is not recommended. Consider alternative methods to control acid reflux (eg, diet modification) or alternative antimicrobial therapy. If antacid therapy can not be avoided, separate dosing by several hours.
Cefuroxime	Antacids may decrease the serum concentration of Cefuroxime. Management: Administer cefuroxime axetil at least 1 hour before or 2 hours after the administration of shortacting antacids.
Chloroquine	Antacids may decrease the serum concentration of Chloroquine. Management: Separate administration of antacids and chloroquine by at least 4 hours to minimize any potential negative impact of antacids on chloroquine bioavailability.
Corticosteroids (Oral)	Antacids may decrease the bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects.
Dabigatran Etexilate	Antacids may decrease the serum concentration of Dabigatran Etexilate. Management: Dabigatran etexilate Canadian product labeling recommends avoiding concomitant use with antacids for 24 hours after surgery. In other situations, administer dabigatran etexilate 2 hours prior to antacids. Monitor clinical response to dabigatran therapy.
Dasatinib	Antacids may decrease the serum concentration of Dasatinib. Management: Simultaneous administration of dasatinib and antacids should be avoided. Administer antacids 2 hours before or 2 hours after dasatinib.
Deferiprone	Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours.
Delavirdine	Antacids may decrease the serum concentration of Delavirdine. Management: Separate doses of delavirdine and antacids by at least 1 hour. Monitor for decreased delavirdine therapeutic effects with this combination.
Dolutegravir	Calcium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral calcium. Administer dolutegravir/rilpivirine at least 4 hours before or 6 hours after oral calcium salts. Alternatively, dolutegravir and oral calcium can be taken together with food.
Eltrombopag	Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product.
Elvitegravir	Antacids may decrease the serum concentration of Elvitegravir. Management: Separate administration of antacids and elvitegravir-containing products by at least 2 hours in order to minimize the risk for an interaction.
Erdafitinib	Serum Phosphate Level-Altering Agents may diminish the therapeutic effect of Erdafitinib. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21).
Erlotinib	Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction.
Estramustine	Calcium Salts may decrease the absorption of Estramustine.
Fosinopril	Antacids may decrease the serum concentration of Fosinopril. Management: The US and Canadian fosinopril manufacturer labels recommend separating the doses of antacids and fosinopril by 2 hours.
Gefitinib	Antacids may decrease the serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or after administration of an antacid, and closely monitor clinical response to gefitinib.
Hyoscyamine	Antacids may decrease the serum concentration of Hyoscyamine. Management: Administer immediate release hyoscyamine before meals and antacids after meals when these agents are given in combination.
Salts	Iron Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Isomaltoside; Iron Sucrose.
Itraconazole	Antacids may increase the serum concentration of Itraconazole. Antacids may decrease the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any antacids. Exposure to Tolsura brand itraconazole may be increased by antacids; consider itraconazole dose reduction.
Ketoconazole (Systemic)	Antacids may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer oral ketoconazole at least 2 hours prior to use of any antacid product. Monitor patients closely for signs of inadequate clinical response to ketoconazole.
Lanthanum	Antacids may diminish the therapeutic effect of Lanthanum.
Ledipasvir	Antacids may decrease the serum concentration of Ledipasvir. Management: Separate the administration of ledipasvir and antacids by 4 hours.
Mesalamine	Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction.
Methenamine	Antacids may diminish the therapeutic effect of Methenamine.
Multivitamins/Fluoride (with ADE)	May increase the serum concentration of Calcium Salts. Calcium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). More specifically, calcium salts may impair the absorption of fluoride. Management: Avoid eating or drinking dairy products or consuming vitamins or supplements with calcium salts one hour before or after of the administration of fluoride.
Multivitamins/Minerals (with ADEK, Folate, Iron)	Antacids may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, antacids may decrease the absorption of orally administered iron. Management: Separate dosing of oral ironcontaining multivitamin preparations and antacids by as much time as possible in order to minimize impact on therapeutic efficacy of the iron preparation.
Mycophenolate	Antacids may decrease the absorption of Mycophenolate. Management: Separate doses of mycophenolate and antacids by at least 2 hours. Monitor for reduced effects of mycophenolate if taken concomitant with antacids.
Neratinib	Antacids may decrease the serum concentration of Neratinib. Specifically, antacids may reduce neratinib absorption. Management: Separate the administration of neratinib and antacids by giving neratinib at least 3 hours after the antacid.
Nilotinib	Antacids may decrease the serum concentration of Nilotinib. Management: Separate the administration of nilotinib and any antacid by at least 2 hours whenever possible in order to minimize the risk of a significant interaction.
PAZOPanib	Antacids may decrease the serum concentration of PAZOPanib. Management: Avoid the use of antacids in combination with pazopanib whenever possible. Separate doses by several hours if antacid treatment is considered necessary. The impact of dose separation has not been investigated.
PenicillAMINE	Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour.
Phosphate Supplements	Antacids may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Separating administer of oral phosphate supplements from antacid administration by as long as possible may minimize the interaction. Exceptions: Sodium Glycerophosphate Pentahydrate.
Phosphate Supplements	Calcium Salts may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate and calcium administration. Administering oral phosphate supplements as far apart from the administration of an oral calcium salt as possible may be able to minimize the significance of the interaction. Exceptions: Sodium Glycerophosphate Pentahydrate.
Polyvalent Cation Containing Products	May decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate.
Potassium Phosphate	Antacids may decrease the serum concentration of Potassium Phosphate. Management: Consider separating administration of antacids and oral potassium phosphate by at least 2 hours to decrease risk of a significant interaction.
Quinolones	Antacids may decrease the absorption of Quinolones. Of concern only with oral administration of quinolones. Management: Avoid concurrent administration of quinolones and antacids to minimize the impact of this interaction. Recommendations for optimal dose separation vary by specific quinolone. Exceptions: LevoFLOXacin (Oral Inhalation).
Quinolones	Calcium Salts may decrease the absorption of Quinolones. Of concern only with oral administration of both agents. Exceptions: LevoFLOXacin (Oral Inhalation); Moxifloxacin (Systemic).
Raltegravir	Calcium Carbonate may decrease the serum concentration of Raltegravir.
Rilpivirine	Antacids may decrease the serum concentration of Rilpivirine. Management: Administer antacids at least 2 hours before or 4 hours after rilpivirine. Administer antacids at least 6 hours before or 4 hours after the rilpivirine/dolutegravir combination product.
Riociguat	Antacids may decrease the serum concentration of Riociguat. Management: Separate the administration of antacids and riociguat by at least 1 hour in order to minimize any potential interaction.
Sodium Polystyrene Sulfonate	Antacids may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. The combined use of these two agents may result in metabolic alkalosis and/or loss of efficacy of the exchange resin. Management: To minimize this interaction, consider: a)separating doses by 2 or more hours; b)rectal administration of the exchange resin; or c)alternatives to antacids. Monitor for metabolic alkalosis and attenuation of SPS effects. Avoid magnesium hydroxide.
Sotalol	Antacids may decrease the serum concentration of Sotalol. Management: Avoid simultaneous administration of sotalol and antacids. Administer antacids 2 hours after sotalol.
Strontium Ranelate	Calcium Salts may decrease the serum concentration of Strontium Ranelate. Management: Separate administration of strontium ranelate and oral calcium salts by at least 2 hours in order to minimize this interaction.
Sulpiride	Antacids may decrease the serum concentration of Sulpiride. Management: Separate administration of antacids and sulpiride by at least 2 hours in order to minimize the impact of antacids on sulpiride absorption.
Tetracyclines	Antacids may decrease the absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Exceptions: Eravacycline.
Tetracyclines	Calcium Salts may decrease the serum concentration of Tetracyclines. Management: If coadministration of oral calcium with oral tetracyclines can not be avoided, consider separating administration of each agent by several hours. Exceptions: Eravacycline.
Thyroid Products	Calcium Salts may diminish the therapeutic effect of Thyroid Products. Management: Separate the doses of the thyroid product and the oral calcium supplement by at least 4 hours.
Trientine	Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour.
Velpatasvir	Antacids may decrease the serum concentration of Velpatasvir. Management: Separate administration of velpatasvir and antacids by at least 4 hours.
Risk Factor X (Avoid combination)
Baloxavir Marboxil	Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil.
Calcium Acetate	Calcium Salts may enhance the adverse/toxic effect of Calcium Acetate.

Monitoring parameters:

Bone Mineral Density Evaluation

BMD should be checked 1 to 2 years after starting treatment.
After the initial evaluation, BMD should be assessed every 1 to 2 years thereafter.
Less frequent evaluations may be considered if BMD remains stable over time.

Monitoring Calcium Levels

Serum and urine calcium levels should be monitored regularly.
This is particularly important for patients with renal impairment or a history of kidney stones (nephrolithiasis).

Additional Laboratory Tests

Serum 25-hydroxyvitamin D (25(OH)D) levels should be measured periodically.
Phosphorus levels should also be monitored as part of routine laboratory testing.

Dental Examination and Preventive Dentistry

Patients at risk for osteonecrosis of the jaw should undergo a dental examination and preventive dentistry before starting bisphosphonate therapy.
This is especially crucial for cancer patients, those who are immunosuppressed, or those who have undergone head/neck radiotherapy.

How to administer Etidronate and Calcium (Didrocal)?

Etidronate Tablets