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Pharmacologic class: Bisphosphonate
Therapeutic class: Bone-resorption inhibitor
Pregnancy risk category C
Impedes bone resorption by inhibiting osteoclast activity, absorbing calcium phosphate crystal in bone, and directly blocking dissolution of hydroxyapatite crystal of bone
Tablets: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg
Indications and dosages
➣ Paget's disease of bone (men and women)
Adults: 40 mg P.O. daily for 6 months
➣ Prevention of osteoporosis in postmenopausal women
Adults: 5 mg P.O. daily or 35 mg P.O. once weekly for up to 7 years
➣ Glucocorticoid-induced osteoporosis in men and women
Adults: 5 mg P.O. daily. For postmenopausal women not receiving estrogen, recommended dosage is 10 mg P.O. once daily.
➣ Treatment of osteoporosis in postmenopausal women; treatment to increase bone mass in men with osteoporosis
Adults: 70-mg tablet or 70 mg oral solution P.O. weekly or 10-mg tablet P.O. daily
• Hypersensitivity to drug or its components
• Esophageal abnormalities such as stricture or achalasia that delay esophageal emptying
• Inability to stand or sit upright for 30 minutes
• Increased risk of aspiration (oral solution)
Use cautiously in:
• Severe renal insufficiency (creatinine clearance less than 35 ml/minute), esophageal disease, GI ulcers, gastritis, osteonecrosis of jaw
• pregnant or breastfeeding patients
• Give with 6 to 8 oz of water 30 minutes before first food, beverage, or medication of day.
• Don't give at bedtime or before patient arises for the day.
• Don't give food, other beverages, or oral drugs for at least 30 minutes after giving tablets.
• Keep patient upright for at least 30 minutes after giving dose to avoid serious esophageal irritation.
• Follow oral solution with at least 60 ml (2 oz) of water to facilitate gastric emptying.
• Be aware that patients should receive supplemental calcium and vitamin D if dietary intake is inadequate.
• Be aware that aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) may worsen GI upset. Discuss alternative analgesics with prescriber.
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, acid regurgitation, esophageal ulcer, flatulence, dyspepsia, abdominal distention, dysphagia
GU: urinary tract infection
Metabolic: hypomagnesemia, hypophosphatemia, hypokalemia, fluid overload
Musculoskeletal: bone or muscle pain
Skin: rash, redness, photosensitivity
Other: abnormal taste
Drug-drug. Antacids, calcium supplements: decreased alendronate absorption
NSAIDs, salicylates: increased risk of GI upset
Ranitidine: increased alendronate effect
Drug-diagnostic tests. Calcium, phosphate: decreased levels
Drug-food. Any food, caffeine (as in coffee, tea, cocoa), mineral water, orange juice: decreased drug absorption
• Monitor for signs and symptoms of GI irritation, including ulcers.
• Monitor blood pressure.
• Evaluate blood calcium and phosphate levels.
☞ Tell patient to immediately report serious vomiting, severe chest or abdominal pain, difficulty swallowing, or abdominal swelling.
• Instruct patient to take tablets first thing in the morning on an empty stomach, with 6 to 8 oz of water only.
• Instruct patient to follow oral solution with at least 60 ml (2 oz) of water.
• Tell patient not to lie down, eat, drink, or take other oral medications for 30 minutes after taking dose.
• Advise patient to take only those pain relievers suggested by prescriber. Inform him that some over-the-counter pain medications (such as aspirin and NSAIDs) may worsen drug's adverse effects.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.