5 Prolia Interactions To Be Aware Of

Prolia (denosumab) is an injectable medication that treats osteoporosis in adults at high risk of bone fractures. You’ll typically receive a Prolia injection once every 6 months. Since it isn’t a daily medication, Prolia doesn’t directly interact with most medications. But there are some medications that can worsen Prolia side effects or make them more likely to occur. Here’s what you should know about five types of Prolia interactions.

1. COVID-19 vaccines

There isn’t a direct interaction between Prolia and COVID-19 vaccines. In fact, since Prolia can weaken your immune system, it’s important to receive any recommended vaccines to help protect you from illness. But experts do recommend waiting 4 to 7 days between receiving Prolia and getting a COVID-19 vaccine. This separation helps reduce the chance of severe injection site reactions that can happen if they’re both injected around the same time.

Talk to your prescriber or pharmacist about any vaccines you should receive before starting Prolia and throughout treatment. They can work around your Prolia doses if needed to help to keep you safe. 

2. Bisphosphonates

Bisphosphonates are another type of medication that treats osteoporosis. Examples include:

• Fosamax (alendronate)

• Actonel (risedronate)

• Boniva (ibandronate)

• Reclast (zoledronic acid)

In most cases, you’ll only receive Prolia if you’re unable to tolerate a bisphosphonate or it isn’t a safe option for you. But you shouldn’t take both medications at the same time. Doing so can increase the risk of fractures and other side effects. And the combination doesn’t offer any additional benefits, since these medications work in a similar way.

Good to know: Combining Prolia and bisphosphonates isn’t recommended. Typically, you’ll only take one osteoporosis medication at a time. But in some cases, your prescriber may recommend combining Prolia with Forteo (teriparatide), a different type of osteoporosis treatment. Talk to your healthcare team about your treatment options — they’ll recommend the best medications for your specific situation. 

3. Medications that can lower calcium levels

Hypocalcemia (low calcium levels) is a possible Prolia side effect. This can raise the risk of bone fractures over time.

If you’re also taking other medications that can cause low calcium levels, this side effect may be more likely. Examples include:

• Proton pump inhibitors, such as Prilosec (omeprazole)

• Some antiseizure medications, such as phenytoin and carbamazepine

• Loop diuretics, such as Lasix (furosemide)

• Some chemotherapy medications, such as cisplatin

• Corticosteroids, such as dexamethasone

• Some antiretroviral medications, such as Sustiva (efavirenz)

You may still be able to take these medications while you’re receiving Prolia. But your prescriber will likely keep a closer eye on your calcium levels. They may also recommend calcium and vitamin D supplements. But be sure to let your prescriber know if you develop any symptoms of low calcium levels, such as tingling or muscle cramps in your hands or feet. 

4. Medications that can raise your risk of infection

Prolia can weaken your immune system. This can raise your risk of mild and serious infections. If you take other medications that weaken your immune system, your risk of infection may go up. Examples include:

• Corticosteroids

• Some biologic medications, such as Humira (adalimumab)

• Chemotherapy

• Organ transplant medications, such as Neoral (cyclosporine, modified)

This doesn't mean you can't take these medications with Prolia. But your prescriber may monitor you more closely for signs of infection, such as fever, cough, or unusual skin changes. Be sure to let them know right away if you notice these or other infection symptoms.

5. Medications that can raise cholesterol levels

Prolia can raise your cholesterol levels. High cholesterol can increase your risk for heart problems, such as a heart attack or stroke. Taking Prolia with other medications that can increase cholesterol could worsen this side effect. Examples include:

• Claravis (isotretinoin)

• Some diuretics

• Beta blockers, such as Tenormin (atenolol)

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as Farxiga (dapagliflozin)

• Corticosteroids

• Danazol

• Some antiretroviral medications

• Some antipsychotics and antidepressants, such as Zyprexa (olanzapine) and Effexor (venlafaxine)

As with other potential Prolia interactions, in most cases you can still take these medications together. But your prescriber will likely check your cholesterol levels regularly to watch for this side effect. So be sure to stay on top of your regular appointments. You may also consider increasing your fiber intake, along with other steps to help keep your cholesterol levels down.

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Written by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

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