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an inhibitor of bone resorption, administered orally as the disodium salt in treatment of Paget's disease of bone.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


(tye-loo-droe-nate) ,


(trade name)


Therapeutic: bone resorption inhibitors
Pharmacologic: biphosphonates
Pregnancy Category: C


Management of Paget’s disease of the bone in patients with:
  • Serum alkaline phosphatase ≥2 times the upper limit of normal,
  • Symptoms,
  • Risk for complications.


Inhibits resorption of bone by inhibiting osteoclast activity.

Therapeutic effects

Decreased progression of Paget’s disease.


Absorption: Rapidly but poorly absorbed following oral administration (6% bioavailability).
Distribution: Distributes to bone and soft tissue; subsequently is slowly released from bone.
Protein Binding: 90% protein binding.
Metabolism and Excretion: Excreted mostly in urine.
Half-life: 150 hr.

Time/action profile (blood levels)

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Contraindicated in: Hypersensitivity; Inability to stand/sit upright for at least 30 min; Severe renal impairment (CCr <30 mL/min).
Use Cautiously in: History of upper GI disorders; Invasive dental procedures, cancer, receiving chemotherapy or corticosteroids, poor oral hygeine, periodontal disease, dental disease, anemia, coagulopathy, infection, or poorly-fitting dentures (may ↑ risk of jaw osteonecrosis); Obstetric / Lactation / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • anxiety
  • drowsiness
  • fatigue
  • insomnia
  • nervousness
  • syncope
  • vertigo
  • weakness

Ear, Eye, Nose, Throat

  • cataracts
  • conjunctivitis
  • glaucoma
  • pharyngitis
  • rhinitis
  • sinusitis


  • bronchitis


  • chest pain
  • dependent edema
  • hypertension
  • peripheral edema


  • abdominal pain
  • anorexia
  • constipation
  • diarrhea
  • dry mouth
  • dysphagia
  • esophageal ulcer
  • esophagitis
  • flatulence
  • gastric ulcer
  • gastritis
  • nausea
  • tooth disorder
  • vomiting


  • urinary tract infection


  • flushing
  • increased sweating
  • pruritus
  • rash
  • skin disorder


  • hyperparathyroidism

Fluid and Electrolyte

  • hypocalcemia


  • musculoskeletal pain (most frequent)
  • arthrosis
  • involuntary muscle contractions
  • osteonecrosis (primarily of jaw)
  • pathological fractures


  • paresthesia


  • infection


Drug-Drug interaction

Absorption is decreased by concurrent administration of calcium supplements, aspirin, or aluminum- or magnesium-containing antacids.Bioavailability is ↑ by concurrent administration of indomethacin.Food ↓ absorption.


Oral (Adults) 400 mg/day taken with 8 oz of plain water only, for 3 mo.


Tablets: 400 mg

Nursing implications

Nursing assessment

  • Paget’s Disease: Assess for symptoms of Paget’s disease (bone pain, headache, decreased visual and auditory acuity, increased skull size).
  • Lab Test Considerations: Monitor alkaline phosphatase prior to and periodically during therapy. Tiluronate is indicated for patients with alkaline phosphatase 2 times the upper limit of normal.

Potential Nursing Diagnoses

Risk for injury (Indications)


  • Oral: Administer first thing in the morning with 6–8 oz plain water 30 min prior to other medications, beverages, or food.
    • Calcium supplements, aspirin, or indomethacin should not be taken for 2 hr before or 2 hr after tiludronate; antacids should not be taken for at least 2 hr following tiludronate.

Patient/Family Teaching

  • Instruct patient on the importance of taking exactly as directed, first thing in the morning, 30 min prior to other medications, beverages, or food. Waiting longer than 30 min will improve absorption. Tiluronate should be taken with 6–8 oz plain water (mineral water, orange juice, coffee, and other beverages decrease absorption). If a dose is missed, skip dose and resume the next morning; do not double doses or take later in the day. Do not discontinue without consulting health care professional.
    • Caution patients to remain upright for 30 min following dose to facilitate passage to stomach and minimize risk of esophageal irritation.
    • Advise patient to eat a balanced diet and consult health care professional about the need for supplemental calcium and vitamin D.
    • Encourage patient to participate in regular exercise and to modify behaviors that increase the risk of osteoporosis (stop smoking, reduce alcohol consumption).
    • Advise patient to inform health care professional of tiludronate therapy prior to dental surgery.
    • Advise female patient to notify health care professional if pregnancy is planned or suspected or if she is nursing.

Evaluation/Desired Outcomes

  • Decrease in the progression of Paget’s disease.
Drug Guide, © 2015 Farlex and Partners
References in periodicals archive ?
Bisphosphonates are mainly of two sub classes, non Nitrogen containing like Etidronate, Clodronate, Tiludronate and Nitrogen containing bisphosphonates Pamidronate, Nerid-ronate, Olpadronate, Alendronate, Ibandronate, Risedronate.
Patients taking alendronate (Fosamax[R]), risedronate (Actonel[R]), ibandronate (Boniva[R]), etidronate (Didronel[R]), or tiludronate (Skelid[R]) should carefully read and follow the directions on how to take the medication.
Currently available bisphosphonates include alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), etidronate (Didronel), pamidronate (Aredia), tiludronate (Skelid) and zoledronic acid (Reclast, Zometa).
Other bisphosphonates (etidronate, pamidronate, tiludronate).
The bisphosphonates approved by the FDA are alendronate (Fosamax, Fosamax plus D), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel, Actonel with calcium), tiludronate (Skelid), and zoledronic acid (Reclast, Zometa).
Bisphosphonate products approved by the FDA but not included in the safety review are etidronate (Didronel, by Procter & Gamble Pharmaceuticals), pamidronate (Aredia, by Novartis), and tiludronate (Skelid, by SanofiAventis US).
Bisphosphonates: The FDA has approved six bisphosphonates to prevent bone loss and fractures in postmenopausal women: alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel), tiludronate (Skelid), and zoleldronic acid (Reclast, Zometra).
In order of increasing potency, these are etidronate disodium, tiludronate disodium, pamidronate disodium, alendronate sodium and risedronate sodium.