Drug General Information (ID: DDIFIODNJV)
Drug Name			Torasemide		Drug Info		Tiludronic acid		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Diuretics				Bisphosphonates
Structure

Mechanism of Torasemide-Tiludronic acid Interaction (Severity Level: Moderate)
Increased risk of hypocalcemia Click to Show/Hide Mechanism Graph
Drug Name		Torasemide				Tiludronic acid
Mechanism		Hypocalcemia				Hypocalcemia
Key Mechanism Factor 1
		Factor Name		Hypocalcemia
		Factor Description		Hypocalcemia is a low level of calcium found in a blood test. It can cause symptoms such as tingling, muscle cramps and heart rhythm problems that can range from mild to life-threatening.
Mechanism Description		Increased risk of hypocalcemia by the combination of Torasemide and Tiludronic acid

Recommended Action
Management		Caution is advised if bisphosphonates are coadministered with loop diuretics. Renal function as well as serum calcium levels should be monitored during and after treatment, since the effects of bisphosphonates can continue for many weeks after discontinuation. Patients and clinicians should be alert to signs and symptoms of clinical hypocalcemia such as muscle spasm, carpopedal spasm, laryngeal spasm, tetany, convulsions, mental changes (irritability, depression, psychosis), increased intracranial pressure, papilledema, QT interval prolongation, and cardiac arrhythmias.

References
1	Product Information. Skelid (tilundronate). Sanofi Winthrop Pharmaceuticals, New York, NY.
2	Product Information. Zometa (zoledronic acid). Novartis Pharmaceuticals, East Hanover, NJ.