Drug General Information (ID: DDIV0X82OA)
Drug Name			Pamidronic acid		Drug Info		Phenylbutazone		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinflammatory Agents				Analgesics
Structure

Mechanism of Pamidronic acid-Phenylbutazone Interaction (Severity Level: Moderate)
Increased risk of GI mucosal injury/bleeding risk Click to Show/Hide Mechanism Graph
Drug Name		Pamidronic acid				Phenylbutazone
Mechanism 1		GI mucosal injury/bleeding risk				GI mucosal injury/bleeding risk
Key Mechanism Factor 1
		Factor Name		Gastrointestinal toxicity
		Factor Description		The risk and severity of gastrointestinal toxicity, including inflammation, bleeding, ulceration, and perforation, increases when drugs with gastrointestinal mucosal irritant effects are combined.
Mechanism Description		Increased risk of GI mucosal injury/bleeding risk by the combination of Pamidronic acid and Phenylbutazone
Increased risk of nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Pamidronic acid				Phenylbutazone
Mechanism 2		Nephrotoxicity				Nephrotoxicity
Key Mechanism Factor 2
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Pamidronic acid and Phenylbutazone

Recommended Action
Management		Caution is advised if bisphosphonates are prescribed in combination with NSAIDs. Patients receiving oral bisphosphonates should be closely monitored for the development of gastrointestinal toxicity and advised to immediately report potential signs and symptoms such as severe abdominal pain, nausea, vomiting, diarrhea, loss of appetite, dizziness, lightheadedness, and/or black, tarry stools. Patients receiving intravenous formulations of bisphosphonates should have renal function and serum electrolytes closely monitored.

References
1	Product Information. Actonel (risedronate). Procter and Gamble Pharmaceuticals, Cincinnati, OH.
2	Product Information. Bonefos (clodronate). Rhone-Poulenc Rorer Canada Inc, Laval, QC.
3	Product Information. Didronel I.V. Infusion (etidronate). MGI Pharma Inc, Minnetonka, MN.