Drug General Information (ID: DDIFV2I7P1)
Drug Name			Zoledronic acid		Drug Info		Alpelisib		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Bone Density Conservation Agents				Pi3K Inhibitors
Structure

Mechanism of Zoledronic acid-Alpelisib Interaction (Severity Level: Moderate)
Increased risk of other adverse reactions (Unspecific) Click to Show/Hide Mechanism Graph
Drug Name		Zoledronic acid				Alpelisib
Mechanism		Increase the risk of osteonecrosis of the jaw combined with alpelisib				Alpelisib
Key Mechanism Factor 1
		Factor Name		Adverse reactions
		Factor Description		An adverse reaction is an unexpected negative reaction to a medication or treatment that happens even when it's used correctly.
Mechanism Description		Increased risk of adverse reactions by the combination of Zoledronic acid and Alpelisib

Recommended Action
Management		Caution is advised when alpelisib is used simultaneously or sequentially with bisphosphonates or denosumab. Treatment should not be initiated in patients with ongoing ONJ from previous or concurrent treatment with bisphosphonates or denosumab. A routine oral examination should be performed by the prescriber prior to initiation of alpelisib treatment. For patients requiring invasive dental procedures, clinical judgment and risk-benefit assessment should guide the management plan of each patient based on their clinical circumstances. Patients should be advised to seek medical attention if they experience signs and symptoms of ONJ, such as: pain in the mouth, teeth, or jaw swelling or sores inside the mouth numbness or a feeling of heaviness in the jaw loosening of a tooth or exposure of bone in the jaw. Standard medical management should be initiated in patients who develop ONJ.

References
1	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
2	Product Information. Piqray (alpelisib). Novartis Pharmaceuticals, East Hanover, NJ.