Category: Joint & Cartilage Support

Species: Horses

Active Ingredients: tiludronate disodium

prescription required

What is Tildren®?

Tildren® is a bisphosphonate drug for intravenous infusion in horses.


Tildren® is indicated for the control of clinical signs associated with navicular syndrome in horses. Navicular syndrome is the most common cause of chronic forelimb lameness in performance horses. It is a degenerative process instigated by mechanical forces.

Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.


  • Restores balance to the process of bone remodeling
  • Decreases mineral loss and slows the rate of bone turnover
  • Alleviates pain induced by abnormal osteolysis

How It Works

About Navicular Syndrome

Navicular syndrome is the most common cause of chronic forelimb lameness in performance horses. Horses suffering from navicular syndrome feel pain in the heel, caused by degenerative bone lesions of the navicular bone. Clinical signs can vary, but are typically associated with a gait change or lameness, often aggravated when walking on hard ground or trotting circles.

Cause for Pain

Horses suffering from navicular syndrome feel pain in the palmar, or heel, region of the foot. They show gait abnormalities associated with degenerative lesions of the navicular bone.

Clinical Signs and Diagnosis

Clinical signs associated with navicular syndrome can vary but are typically indicated by a gait change or lameness which is aggravated when walking on hard ground or trotting circles.

If you suspect your horse may have navicular syndrome, please contact your veterinarian.

To diagnose navicular syndrome, the following methods may be used:

ns diagnosis

Podcast: Navicular Syndrome Update

From initial diagnosis to hoof care and bisphosphonate use, find out the newest information about this debilitating condition.
Recorded at Ask TheHorse Live

how circlesTildren® (tiludronate disodium) Reduces Bone Resorption

The active ingredient in Tildren® is tiludronate disodium, a bisphosphate that achieves its effect by regulating osteoclasts in areas of excessive activity. Following IV infusion, Tildren® travels through the blood stream and binds to the mineral matrix of the bone. The acidity of the remodeling environment causes the release of Tildren® from the bone matrix to the resorption space. This leads to improved bone remodeling, decreased mineral loss and alleviation of pain induced by abnormal osteolysis.

Learn More About How Tildren® Works

  1. Tildren® binds preferentially to the mineral phase of the bone at remodeling sites.
  2. Acidification breaks the bond.
  3. Tildren® is taken into the osteoclast by endocytosis.

how graph bmProduct Efficacy

Tildren® (tiludronate disodium) given at 1mg/kg IV, in conjunction with corrective shoeing, proved to be more effective in controlling clinical signs associated with navicular syndrome when evaluated at two months post-treatment compared to corrective shoeing alone.1

1 Freedom of Information Summary. NADA #141-420. Approved February 13, 2014.



Tildren® (tiludronate disodium) will be administered to your horse through an intravenous infusion. It is administered over a 90-minute period.

Tildren® is most effective when used in conjunction with corrective farriery and a controlled exercise program. Visit with your veterinarian to learn more about management and care after Tildren® has been given.

treatment horse bmProduct Safety

In a controlled 6-month open use field study1, Tildren® (tiludronate disodium) was evaluated under strict conditions. Horses were observed for four hours following infusion and adverse events were recorded.

The most common observations were clinical signs associated with colic, which are defined as outlined below. While colic may occur, clinical signs and incidence vary and may be intermittent.

Clinical signs that were considered to be indicative of colic:

Pawing, getting up and down, pacing, restlessness, rolling, trying to roll, looking or biting at side, stretching out/straining, kicking at belly/walls, repeatedly shifting weight behind.

1 Freedom of Information Summary. NADA #141-420. Approved February 13, 2014.
TILUDRONATE, Bibliography May 2016, Studies: 2003 to 2016, Source: PubMed

Dosing and Administration

Tildren® is administered through a single intravenous infusion of 1mg/kg (0.45mg/lb) in 0.9% Sodium Chloride, and is given slowly and evenly over 90 minutes. Of the administered dose, 30-50% of the tiludronate disodium distributes to the bone within 12 hours of dosing.

Bone concentrations are higher than plasma concentrations as early as 12 hours post-administration. The drug is slowly, but continuously, released in relation to the bone remodeling process and concentrations are still present at 6 months, but lower than at 3 months, in the bone.

Weight Range (lbs)Volume of Reconstituted
Tildren Solution (20 mg/mL)
Added to the Infusion Bag
550 -770 lbs15 mL
771 - 990 lbs20 mL
991 - 1,210 lbs25 mL*
1,211 - 1,430 lbs30 mL
(25 mL* + 5 mL from additional vial)
1,431 - 1,650 lbs35 mL
(25 mL* + 10 mL from additional vial)
1,651 - 1,875 lbs40 mL
(25 mL* + 15 mL from additional vial)

*1 vial = 25 mL

Pack Sizes

List No.Pack SizeCase Size

Do not use in horses with impaired renal function or with a history of renal disease. NSAIDs should not be used concurrently with TILDREN® . Concurrent use of NSAIDs with TILDREN® may increase the risk of renal toxicity and acute renal failure. Horses should be observed closely for 4 hours post-infusion for the development of clinical signs consistent with colic or other adverse reactions.

Caution should be used when administering TILDREN® to horses with conditions affecting mineral or electrolyte homeostasis (e.g. HYPP, hypocalcemia) and conditions which may be exacerbated by hypocalcemia (e.g. cardiac disease). The safe use of TILDREN® has not been evaluated in horses less than 4 years of age, in pregnant or lactating mares, or in breeding horses. See package insert for full prescribing information.