Prolia (denosumab) is a prescription drug used to treat osteoporosis and strengthen bones in certain people. This drug can interact with some other medications. For example, Prolia can interact with corticosteroids such as hydrocortisone.
Prolia is used in certain adults who have a high risk of bone fractures. It’s used to:
- treat osteoporosis in males* and postmenopausal females*
- treat osteoporosis caused by corticosteroid treatment
- strengthen bones in people receiving certain treatments for prostate or breast cancer
Prolia contains the active ingredient denosumab. The medication comes as a liquid solution that’s injected under your skin by a healthcare professional.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions. Keep reading to learn about Prolia’s possible interactions. And for more information about Prolia, including details about its uses, see this article.
* In this article, we use the terms “male” and “female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.
Before starting Prolia, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Prolia interacts with herbs or vitamins and supplements, see the “Are there other interactions with Prolia?” section below.)
If you have questions about what drugs should not be taken with Prolia or drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Prolia. Keep in mind that this table does not include all drugs that may interact with Prolia. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug group or drug name | Drug examples | What can happen |
| corticosteroids | • hydrocortisone injection (Solu-Cortef) • hydrocortisone tablet (Cortef) • methylprednisolone (Medrone, Solu-Medrone) • prednisone (Rayos) | can increase the risk of infection and jaw or dental problems |
| bisphosphonates | • alendronate (Fosamax) • risedronate (Actonel) | can increase the risk of low calcium levels and jaw or dental problems |
| immunosuppressants | • adalimumab (Humira) • cyclosporine (Neoral, others) • infliximab (Remicade) | can increase the risk of infection |
| drugs that lower calcium levels | • calcitonin • cinacalcet (Sensipar) • etelcalcetide (Parsabiv) | can cause low calcium levels |
Certain health conditions or other factors could increase your risk of harm from Prolia and cause your doctor to not prescribe this drug for you. These factors are known as contraindications. The list below includes contraindications of Prolia.
If you have a low level of calcium in your blood: If you have low blood calcium levels, your doctor will likely prescribe calcium supplements to correct this condition before prescribing Prolia for you. This is because Prolia can lower your calcium level even further. Very low calcium levels can cause severe problems that may need treatment in a hospital and can even be life threatening.*
If you’re pregnant: If you’re pregnant, your doctor likely will not prescribe Prolia for you. This drug can cause fetal harm if used during pregnancy. Ask your doctor about other treatments that may be better options for you. If you’re able to become pregnant, your doctor may order a pregnancy test to check that you’re not before you start Prolia treatment.
If you’ve had an allergic reaction: If you’ve had an allergic reaction to Prolia or any of its ingredients, your doctor likely will not prescribe Prolia for you. This is because receiving the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Before starting Prolia, talk with your doctor if any of the above factors apply to you. They can determine whether this treatment is safe for you.
* Prolia has a boxed warning about the risk of this side effect in certain people. See the boxed warning information at the start of this article to learn more.
Prolia is not known to interact with alcohol. If you have questions about consuming alcohol during Prolia treatment, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Prolia.
Interaction with corticosteroids
Prolia can interact with corticosteroids (also called steroids), which are drugs used to treat inflammation (swelling). Examples of corticosteroids include:
- hydrocortisone injection (Solu-Cortef)
- hydrocortisone tablet (Cortef)
- methylprednisolone (Medrone, Solu-Medrone)
- prednisone (Rayos)
What could happen
Prolia and corticosteroids can both increase your risk of infection, so your risk may be higher if you take these drugs together.
Prolia can also cause a rare side effect called osteonecrosis of the jaw, which can cause jaw pain and loosening of teeth. You may have a higher risk of this side effect if you take Prolia with corticosteroids.
If you have dental or oral health problems, or cancer, you may have a higher risk of osteonecrosis of the jaw if you take Prolia with corticosteroids.
What you can do
If you take Prolia with a corticosteroid, be sure to practice good oral hygiene, including regularly brushing and flossing your teeth. Tell your doctor right away if you have symptoms of dental or jaw problems. These can include pain or numbness in your jaw, infection in your mouth, and loosening of your teeth.
If you take Prolia with a corticosteroid, also tell your doctor right away if you have any symptoms of infection. These can include fever, cough, burning sensation when urinating, and skin swelling, warmth, discoloration, sores, or rash.
If you have questions about taking Prolia with a corticosteroid, talk with your doctor or pharmacist.
Interaction with bisphosphonates
Prolia can interact with bisphosphonates, which are drugs used to treat osteoporosis. Examples of bisphosphonates include:
- alendronate (Fosamax)
- risedronate (Actonel)
What could happen
Prolia and bisphosphonates can both cause low calcium levels. They can also both cause a rare side effect called osteonecrosis of the jaw. This side effect can cause jaw pain and loosening of teeth. So you may have a higher risk of these side effects if you take these drugs together.
If you have CKD, you may have a higher risk of low calcium levels if you take Prolia with a bisphosphate.
If you have dental or oral health problems, or cancer, you may have a higher risk of osteonecrosis of the jaw if you take Prolia with a bisphosphonate.
What you can do
If you take Prolia with a bisphosphonate, be sure to take your daily calcium and vitamin D supplement as prescribed by your doctor. This will help prevent low calcium levels. (Vitamin D helps your body absorb calcium.)
Also be sure to practice good oral hygiene, including regularly brushing and flossing your teeth. Tell your doctor right away if you have symptoms of dental or jaw problems. These can include pain or numbness in your jaw, infection in your mouth, and loosening of your teeth.
Interaction with immunosuppressants
Prolia can interact with immunosuppressant drugs, which weaken your immune system. They’re used to treat certain autoimmune conditions, such as rheumatoid arthritis. (Autoimmune conditions are caused by your immune system mistakenly attacking healthy tissues in your body.) Immunosuppressants are also used to help prevent rejection of organ transplants. Examples of immunosuppressant medications include:
- adalimumab (Humira)
- cyclosporine (Neoral, others)
- infliximab (Remicade)
What could happen
Prolia and immunosuppressants can both increase your risk of infection, so your risk may be higher if you take them together.
What you can do
If you take Prolia with an immunosuppressant, tell your doctor right away if you have any symptoms of infection. These can include fever, cough, burning sensation when urinating, and skin swelling, warmth, discoloration, sores, or rash.
Prolia may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Prolia.
Does Prolia interact with supplements?
Before starting Prolia, talk with your doctor and pharmacist about any herbs or vitamins and supplements you take. Sharing this information with them may help you avoid possible interactions. Talk with them if you have questions about any interactions that may affect you.
Prolia and herbs
There are currently no reports of Prolia interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future. For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products during treatment with Prolia.
Prolia and vitamins and minerals
There are currently no reports of Prolia interacting with vitamins or minerals. But this doesn’t mean that vitamin or mineral interactions won’t be recognized in the future. For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products during treatment with Prolia.
Keep in mind that your doctor will usually prescribe daily calcium and vitamin D supplements while you’re taking Prolia. These supplements help prevent a low calcium level, which is a possible side effect of Prolia.
Does Prolia interact with food?
There are currently no reports of Prolia interacting with food. If you have questions about eating certain foods during your treatment with Prolia, talk with your doctor.
Does Prolia interact with vaccines?
There are currently no reports of Prolia interacting with vaccines. If you have questions about getting certain vaccines during your Prolia treatment, talk with your doctor.
Does Prolia interact with lab tests?
There are currently no reports of Prolia interacting with lab tests. If you have questions about having certain lab tests during your treatment with Prolia, talk with the healthcare professional ordering the test.
Does Prolia interact with cannabis or CBD?There are currently no reports of Prolia interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Prolia.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may increase the risk of interactions with Prolia. Before starting Prolia, talk with your doctor about your health history. They’ll determine whether this drug is right for you. Health conditions or other factors that might interact with Prolia include:
Low calcium level: Prolia can lower the level of calcium in your blood.* If your calcium level is already low, your doctor will prescribe calcium supplements to correct it before you start Prolia. For more information, see the section above, called “When should I avoid Prolia?”
During Prolia treatment, you should take a daily calcium and vitamin D supplement to help prevent low calcium levels. Talk with your doctor about this.
* Prolia has a boxed warning about the risk of this side effect in certain people. See the boxed warning information at the start of this article to learn more.
Thyroid or parathyroid surgery: If you’ve had surgery on your thyroid or parathyroid gland, you may have an increased risk of low calcium levels with Prolia. Your doctor may monitor you more closely during your Prolia treatment.
Trouble absorbing minerals: If you have malabsorption syndrome, you may have an increased risk of low calcium levels with Prolia. Talk with your doctor about whether Prolia is right for you.
Chronic kidney disease (CKD): If you have CKD, talk with your doctor about whether Prolia is right for you. Prolia has a boxed warning for the risk of seriously low calcium levels in people with CKD. For more information, see the boxed warning at the start of this article.
Dental or oral health problems: Prolia can cause a rare side effect called osteonecrosis of the jaw. This can lead to jaw pain and loosening of teeth. If you have dental or oral health problems, you may have a higher risk of this side effect. Your doctor may recommend seeing a dentist before you start Prolia treatment. If you need any dental work while taking Prolia, be sure to tell your dentist that you’re taking this medication.
Cancer: If you have cancer, you may have a higher risk of jaw or dental problems with Prolia. This is especially true if you’ve had or are currently receiving certain cancer treatments such as chemotherapy (traditional drugs used to treat cancer).
Pregnancy: Prolia treatment is not safe during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor about other treatment options. If you’re able to become pregnant, you should use birth control while receiving Prolia injections and for at least 5 months after your last dose.
Breastfeeding: It’s not known whether Prolia treatment is safe while breastfeeding. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Prolia or any of its ingredients, your doctor will likely not prescribe Prolia for you. This is because receiving the drug could cause another allergic reaction. Ask your doctor about other treatments that may be better options for you.
Find answers to some frequently asked questions about Prolia and possible interactions.
Can you take Prolia while on antibiotics?
Yes, it should be safe to take Prolia while taking antibiotics. There are no known interactions between these drugs.
Prolia is used to treat osteoporosis and to strengthen bones in certain adults. Antibiotics are used to treat bacterial infections. People with osteoporosis or weak bones who take Prolia may have an increased risk of infection. So it’s not uncommon for doctors to prescribe these drugs together.
However, keep in mind that during Prolia treatment you should also take daily calcium and vitamin D supplements. And calcium supplements can interact with certain antibiotics. Examples include fluoroquinolones, such as ciprofloxacin (Cipro), and tetracyclines, such as doxycycline (Vibramycin, others).
Taking calcium supplements at the same time of day as these antibiotics can stop the antibiotic from being absorbed into your body correctly. This could make the antibiotic less effective at treating the infection.
If you’re prescribed a course of antibiotics while receiving Prolia, ask your doctor or pharmacist if your calcium supplement can affect the antibiotic. To prevent an interaction, they may recommend taking your calcium supplement at a different time of day than the antibiotic.
If you have other questions about taking Prolia and antibiotics together, talk with your doctor or pharmacist.
Is there an interaction between Prolia and statins?
No. There are no known interactions between Prolia and statins.
Prolia is prescribed to treat osteoporosis and strengthen bones in certain adults. Statins are prescribed to lower high cholesterol and triglycerides, and to reduce the risk of heart attack and stroke in certain adults. Examples of statins include atorvastatin (Lipitor) and simvastatin (Zocor).
It’s not uncommon for doctors to prescribe these drugs together.
If you have questions about taking Prolia with a statin drug, talk with your doctor or pharmacist.
Taking certain steps can help you avoid interactions with Prolia. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- whether you drink alcohol or use cannabis
- other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a
medication list . - what to do if you start taking a new drug during your Prolia treatment
It’s also important to understand Prolia’s
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Taking Prolia exactly as prescribed can also help prevent interactions.
If you still have questions about Prolia and its possible interactions, talk with your doctor. Questions you may want to ask include:
- Do I need to stop Prolia treatment if I have surgery?
- Is it safe to take over-the counter pain relievers during Prolia treatment?
- Should I tell you if I change my diet or lifestyle while receiving Prolia?
To learn more about Prolia, see these articles:
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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.