Drug reference
Treatment of postmenopausal osteoporosis ▶BY MOUTH ▶Adult (female): 10 mg daily, alternatively 70 mg once weekly. Treatment of osteoporosis in men ▶BY MOUTH ▶Adult (male): 10 mg daily. Prevention and treatment of corticosteroid-induced osteoporosis in postmenopausal women not receiving hormone replacement therapy ▶BY MOUTH ▶Adult (female): 10 mg daily.
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Abnormalities of oesophagus. hypocalcaemia. other factors which delay emptying (e.g. stricture or achalasia)
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Active gastro-intestinal bleeding. atypical femoral fractures. duodenitis. dysphagia. exclude other causes of osteoporosis. gastritis. history (within 1 year) of ulcers. surgery of the upper gastro-intestinal tract. symptomatic oesophageal disease. ulcers. upper gastro- intestinal disorders
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NICE decisions ▶Bisphosphonates for treating osteoporosis (updated July 2019) NICE TA464 This technology appraisal guidance should be applied clinically in conjunction with: . NICE guideline on osteoporosis (CG146), which defines who is eligible for osteoporotic fracture risk assessment. . NICE quality standard on osteoporosis (QS149), which defines the clinical intervention thresholds for the 10-year fracture probability of a major osteoporotic fracture, in those patients who have undergone fracture risk assessment. Alendronic acid is recommended as an option for treating osteoporosis in patients: . who are eligible for risk assessment as defined in the full NICE guideline and quality standard on osteoporosis, and . who have been assessed as being at higher risk of osteoporotic fragility fracture using the methods recommended in the full NICE guideline and quality standard on osteoporosis, and . when bisphosphonate treatment is appropriate, taking into account their risk of fracture, their risk of adverse effects from bisphosphonates, and their clinical circumstances and preferences. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta464 Scottish Medicines Consortium (SMC) decisions SMC No. 1137/16 The Scottish Medicines Consortium has advised (April 2016) that alendronic acid (Binosto ®) is accepted for restricted use within NHS Scotland for the treatment of postmenopausal osteoporosis where alendronic acid is the appropriate treatment choice, but the patient is unable to swallow tablets.
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→Appendix 1: bisphosphonates
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▶Common or very common Gastrointestinal disorders. joint swelling. vertigo ▶Uncommon Haemorrhage ▶Rare or very rare Femoral stress fracture. oropharyngeal ulceration. photosensitivity reaction. severe cutaneous adverse reactions (SCARs) SIDE-EFFECTS, FURTHER INFORMATION Severe oesophageal reactions (oesophagitis, oesophageal ulcers, oesophageal stricture and oesophageal erosions) have been reported; patients should be advised to stop taking the tablets and to seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.
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Avoid.
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Manufacturer advises avoid—no information available.
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Avoid if eGFR less than 35 mL/minute/1.73 m2.
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Correct disturbances of calcium and mineral metabolism (e.g. vitamin-D deficiency, hypocalcaemia) before starting treatment. Monitor serum-calcium concentration during treatment.
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Tablets should be swallowed whole and oral solution should be swallowed as a single 100 mL dose. Doses should be taken with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after administration.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral solution Oral solution ▶Alendronic acid (Non-proprietary) Alendronic acid 700 microgram per 1 ml Alendronic acid 70mg/100ml oral solution unit dose sugar free sugar-free | 4 unit dose P £28.58 DT = £28.58 Effervescent tablet ▶Binosto (Internis Pharmaceuticals Ltd) Alendronic acid (as Alendronate sodium) 70 mg Binosto 70mg effervescent tablets sugar-free | 4 tablet P £22.80 DT = £22.80 Tablet ▶Alendronic acid (Non-proprietary) Alendronic acid (as Alendronate sodium) 10 mg Alendronic acid 10mg tablets | 28 tablet P £7.00 DT = £2.61 Alendronic acid (as Alendronate sodium) 70 mg Alendronic acid 70mg tablets | 4 tablet P £22.80 DT = £0.92 ▶Fosamax Once Weekly (Merck Sharp & Dohme Ltd) Alendronic acid (as Alendronate sodium) 70 mg Fosamax Once Weekly 70mg tablets | 4 tablet P £22.80 DT = £0.92 Endocrine system
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Patients or their carers should be given advice on how to administer alendronic acid tablets and oral solution. Oesophageal reactions Patients (or their carers) should be advised to stop taking alendronic acid and to seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.
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10 mg daily, alternatively 70 mg once
First-line fragment. Read the complete Indications and Dose section above.
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10 mg daily.
First-line fragment. Read the complete Indications and Dose section above.
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10 mg daily.
First-line fragment. Read the complete Indications and Dose section above.
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