Drug-drug Interactions

There are few reported cases of drug-drug interactions between osteoporosis therapy and ART. However, a number of factors are known to interfere with osteoporosis treatments; the main considerations are shown below. 

Table 1. Potential HIV drug interactions with drugs used for osteoporosis.1

Drug Interactions
alendronate Some food and beverages (including mineral water), calcium supplements, antacids and some oral medicinal products will interfere with the absorption of alendronate. Therefore, patients must wait at least 30 minutes after taking alendronate before they take any other oral medicinal product
risedronate Concomitant ingestion of medications containing polyvalent cations, e.g. calcium, magnesium, iron and aluminium, will interfere with the absorption of risedronate
ibandronate Ibandronate should not be mixed with calcium-containing solutions
Caution is advised when administering bisphosphonates with aminoglycosides as both can lower serum calcium levels for prolonged periods
zoledronate Caution is advised when administering with aminoglycosides
Caution is advised when administering with other potentially nephrotoxic drugs
raloxifene Should not be co-administered with cholestyramine
calcitonin Concomitant use of calcitonin and lithium may reduce plasma lithium concentrations and the dose of lithium may need to be adjusted
teriparatide Caution is advised in patients taking digitalis

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  1. The Electronic Medicines Compendium. Accessed 25 April 2017.
  2. Miacalcin [package insert]. Stein, Switzerland: Novartis Pharma Stein AG; 2009. Accessed 25 April 2017.