Meta Information
ID:denosumab
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/calcium-supplements
Target name:
Calcium Supplements
Severity:
major
Interaction type:
requirement
Nature:
absolute
Description:
Denosumab potently inhibits bone resorption, which can lead to a rapid and severe drop in blood calcium levels (hypocalcemia). Adequate calcium intake is essential to maintain normal blood calcium levels during treatment.
Actionable advice:
You must take daily calcium supplements (at least 1000 mg) as prescribed by your doctor throughout your denosumab treatment.
Target id:
/intervention/vitamin_d3_systemic_disease
Target name:
Vitamin D Supplements
Severity:
major
Interaction type:
requirement
Nature:
absolute
Description:
Vitamin D is required for the proper absorption of calcium from the gut. Without adequate vitamin D, calcium supplementation will be ineffective, increasing the risk of denosumab-induced hypocalcemia.
Actionable advice:
You must take daily vitamin D supplements (at least 400 IU) as prescribed by your doctor throughout your denosumab treatment.
Target id:
/condition/hypocalcemia
Target name:
Pre-existing Low Blood Calcium (Hypocalcemia)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Denosumab can cause severe, life-threatening hypocalcemia. Starting treatment in a patient who already has low calcium levels is contraindicated and can lead to serious complications like seizures or cardiac arrhythmias.
Actionable advice:
Avoid denosumab completely if you have uncorrected low blood calcium; it must be treated and normalized first.
Target id:
/condition/renal-impairment
Target name:
Severe Kidney Disease (Renal Impairment)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Patients with severe kidney impairment (creatinine clearance <30 mL/min) or on dialysis have a significantly higher risk of developing severe hypocalcemia with denosumab due to impaired vitamin D metabolism.
Actionable advice:
Use with extreme caution and frequent calcium monitoring if you have severe kidney disease; discuss risks with your doctor.
Target id:
/procedure/invasive-dental-procedure
Target name:
Invasive Dental Procedures (e.g., tooth extraction, implants)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Denosumab increases the risk of a rare but serious condition called osteonecrosis of the jaw (ONJ), where the jawbone fails to heal after minor trauma like a tooth extraction.
Actionable advice:
Complete any necessary invasive dental work before starting denosumab and maintain excellent oral hygiene during treatment.
Target id:
/procedure/discontinuation-of-denosumab
Target name:
Stopping Denosumab Treatment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Abruptly stopping denosumab leads to a rapid reversal of its effects, a surge in bone resorption above baseline, and a significant loss of bone mineral density, which is associated with a high risk of multiple vertebral fractures.
Actionable advice:
Do not stop denosumab without a specific plan to transition to another antiresorptive therapy to prevent rebound bone loss.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Denosumab may cause fetal harm as the RANK/RANKL pathway is crucial for fetal immune system development and bone metabolism. It is contraindicated during pregnancy.
Actionable advice:
Avoid denosumab completely if you are pregnant or planning to become pregnant.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
It is not known if denosumab is excreted in human milk, but due to the potential for serious adverse reactions in nursing infants, it is not recommended.
Actionable advice:
Avoid denosumab while breastfeeding; discuss alternatives with your doctor.
Target id:
/biomarker/serum-calcium
Target name:
Serum Calcium Level Check (Pre-Dose)
Severity:
major
Interaction type:
requirement
Nature:
temporal
Temporal spacing:
Hours before target:
168
Hours after target:
0
Description:
It is critical to confirm that blood calcium levels are normal before administering denosumab to prevent inducing or worsening hypocalcemia.
Actionable advice:
Check your serum calcium level within the week prior to receiving your denosumab injection.
Target id:
/biomarker/serum-calcium
Target name:
Serum Calcium Level Check (Post-Dose)
Severity:
major
Interaction type:
requirement
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
336
Description:
Blood calcium levels can drop after a denosumab injection, typically reaching their lowest point around day 10. Monitoring is essential to detect and treat hypocalcemia, especially in high-risk patients.
Actionable advice:
Check your serum calcium level within 14 days after your injection, especially if you have kidney disease.
Target id:
/class/immunosuppressants
Target name:
Immunosuppressant Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Denosumab can affect immune function and may increase the risk of serious infections. Combining it with other immunosuppressive drugs (like corticosteroids or calcineurin inhibitors) could further elevate this risk.
Actionable advice:
Use with caution and monitor closely for signs of infection when taking with other immunosuppressants.
Target id:
/intervention/bisphosphonates
Target name:
Bisphosphonates (e.g., Alendronate, Zoledronic Acid)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Concomitant use of denosumab with bisphosphonates is not recommended as it could increase the risk of over-suppression of bone turnover, leading to adverse events like ONJ or atypical fractures, without added benefit.
Actionable advice:
Do not use denosumab concurrently with bisphosphonates or other antiresorptive therapies.
Target id:
/class/live-vaccines
Target name:
Live Attenuated Vaccines
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
As denosumab can modulate the immune system, there is a theoretical risk that it could reduce the efficacy of live vaccines or increase the risk of infection from the vaccine virus itself.
Actionable advice:
Avoid receiving live vaccines during treatment with denosumab.
Target id:
/condition/history-of-hypersensitivity-to-denosumab
Target name:
History of Allergic Reaction to Denosumab
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Prior hypersensitivity reactions, which can include anaphylaxis, rash, and urticaria, are an absolute contraindication to further use of the drug.
Actionable advice:
Avoid denosumab completely if you have a known allergy to it or its components.
Target id:
/condition/pre-existing-dermatitis-eczema
Target name:
Pre-existing Dermatitis or Eczema
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Description:
Denosumab can cause skin-related side effects, including dermatitis, rashes, and eczema. Individuals with a history of these conditions may be more susceptible or experience exacerbations.
Actionable advice:
Monitor your skin for new or worsening rashes while on denosumab and report them to your doctor.