Names and pronunciation
(al-en-drone′ate) Binosto, Fosamax, Fosamax plus D, Fosavance
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Individual generic drug information
Extracted information for alendronate only.
(al-en-drone′ate) Binosto, Fosamax, Fosamax plus D, Fosavance
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Func. class.: Bone-resorption inhibitor
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Chem. class.: Bisphosphonate
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Do not confuse: Fosamax/Flomax
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ACTION: Decreases rate of bone resorption and may directly block disso- lution of hydroxyapatite crystals of bone; inhibits osteoclast activity
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USES: Treatment and prevention of osteoporosis in postmenopausal women, treatment of osteoporosis in men, Paget’s disease, treatment of corticosteroid- induced osteoporosis in postmenopausal women not receiving estrogen and in men who are on continuing corticoste- roid treatment with low bone mass
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Extracted information for alendronate only.
CONTRAINDICATIONS: Hyper- sensitivity to bisphosphonates, delayed esophageal emptying, inability to sit or stand for 30 min, hypocalcemia, preg- nancy, breastfeeding, children, CCr <35 mL/min Precautions: Esophageal disease, ulcers, gastritis, poor dental health, increased esophageal cancer risk
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SIDE EFFECTS RESP: Asthma exacerbation CV: Atrial fibrillation INTEG: Rash, photosensitivity CNS: Headache GI: Abdominal pain, constipation, nau- sea, vomiting, esophageal ulceration, acid reflux, dyspepsia, esophageal perfo- ration, diarrhea, esophageal cancer META: Hypophosphatemia, hypocalce- mia MS: Bone pain, osteonecrosis of the jaw, bone fractures
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INTERACTIONS Increase: GI adverse reactions—NSAIDs, salicylates, H2 blockers, proton pump inhibitors, gastric mucosal agents; moni- tor for GI reactions Decrease: absorption—antacids, cal- cium supplements; give alendronate at least 30-60 min before other products Drug/Food Decrease: absorption when used with caffeine, orange juice, food; take food at least 30 min after alendronate Drug/Lab Test Decrease: calcium, phosphate
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Extracted information for alendronate only.
DOSAGE AND ROUTES Osteoporosis in postmenopausal women • Adult and geriatric: PO 10 mg/day or 70 mg/wk Paget’s disease • Adult and geriatric: PO 40 mg/day × 6 mo; consider retreatment for relapse Prevention of osteoporosis in post- menopausal women (excluding Binosto and oral solution) Adult/postmenopausal female: PO 5 mg/day or 35 mg/wk Glucocorticoid-induced osteopo rosis in those receiving gluco corticosteroids • Adult: PO 5 mg/day; those not receiv- ing estrogen 10 mg/day Androgen deprivation therapy/osteo- porosis prevention Adult: PO 70 mg weekly Renal dose • Adult: PO CCr ≤35 mL/min, not recom- mended
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Available forms: Tablets 5, 10, 35, 40, 70 mg; tablets 70 mg with 2800 IU vitamin D3, 70 mg with 5600 IU vitamin D3; oral sol 70 mg/75 mL; effervescent tablet 70 mg
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Administer: • For 6 mo to be effective for Paget’s disease • Store in cool environment, out of di- rect sunlight • Tablet: take with 8 oz of water 30 min before first food, beverage, or medica- tion of the day • Do not lie down for ≥30 min after dose; do not take at bedtime or before rising • Liquid: use oral syringe or calibrated A device; give in AM with ≥2 oz of water ≥30 min before food, beverage, or medication • Effervescent tablet: Dissolve in 4 oz of water, after 5 min, stir and drink
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Extracted information for alendronate only.
Assess: • Hormonal status of women before treatment, history of fractures • For osteoporosis: bone density test before and during treatment • For Paget’s disease: increased skull size, bone pain, headache; decreased vision, hearing; alkaline phosphatase levels, baseline and periodically, 2× upper limit of normal is indicative of Paget’s disease • For hypercalcemia: paresthesia, twitching, laryngospasm; Chvostek’s, Trousseau’s signs; monitor calcium, vita- min D baseline and during treatment, correct prior to use • Dental status: regular dental exams should be performed; dental extractions (cover with antiinfectives before procedure) • MS pain: may occur in a few days or years later, symptoms usually resolve af- ter discontinuing
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Evaluate: • Therapeutic response: increased bone mass, absence of fractures
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To remain upright for 30 min after dose to prevent esophageal irritation; if dose is missed, skip dose, do not double doses or take later in day; to take in AM before food, other meds; to take with 6-8 oz of water only (no mineral water) • To take calcium, vitamin D if in- structed by health care provider • To use sunscreen, protective clothing to prevent photosensitivity • To avoid smoking, alcohol intake, which increase osteoporosis • To perform weight-bearing exercise to increase bone density • To maintain good oral hygiene, to use antiinfectives before dental procedures as directed by prescriber • Pregnancy/breastfeeding: to inform prescriber if pregnancy is planned or suspected; that cautious use is advised in breastfeeding
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Extracted information for alendronate only.
PHARMACOKINETICS Protein binding 78%, rapidly cleared from circulation, taken up mainly by bones, eliminated primarily through kidneys, bound to bone, half-life >10 yr
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Filter the extracted dose blocks for this individual drug.
Osteoporosis in postmenopausal women
• Adult and geriatric: PO 10 mg/day or 70 mg/wk Paget’s disease
Candidate age grouping · source page 47
Osteoporosis in postmenopausal women
• Adult and geriatric: PO 40 mg/day × 6 mo; consider retreatment for relapse Prevention of osteoporosis in post- menopausal women (excluding Binosto and oral solution) Adult/postmenopausal female: PO 5 mg/day or 35 mg/wk Glucocorticoid-induced osteopo rosis in those receiving gluco corticosteroids
Candidate age grouping · source page 47