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| Risk Dimension | Evidence Quality | Severity if Realized | Practical Impact | |---|---|---|---| | Absorption interference (oral, same-time dosing) | Indirect/mechanistic | Moderate (reduced efficacy) | High: fixable with timing | | Direct chelation (glutathione binds alendronate) | None documented | Low | Low | | Pharmacodynamic antagonism (bone) | None documented | Potentially none or positive | Low | | Hepatic CYP interaction | Not applicable | None | None | | Renal clearance competition (IV glutathione) | Theoretical only | Unknown | Moderate precaution warranted | The dominant clinical concern is absorption interference, and it is entirely preventable with correct timing

Neurotrauma 36 , 4353 (2018)

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