Alendronate

Alendronate Brand Names- Binosto | Fosamax

What is Alendronate

Alendronate is an oral second-generation bisphosphonate; weekly or daily regimens are available for selected conditions.

Treatment with alendronate is associated with significant increases in bone mineral density (BMD) and reduces the risk for radiographic vertebral and non-vertebral fractures (e.g., hip fractures) in postmenopausal women.

Bisphosphonates such as alendronate are generally considered to be first-line therapy for the treatment of osteoporosis in postmenopausal women.

Bisphosphonates are effective in men with osteoporosis to increase bone density and reduce the risk for vertebral fracture; however, study data are less robust in men regarding reductions in nonvertebral fracture.

For osteoporosis prevention, the second and third-generation bisphosphonates appear to offer similar benefits across the class to increase bone mineral density; the balance of costs, benefits, and harms of treating osteopenic patients with bisphosphonates is most favorable when the estimated risk for fracture is high.

Alendronate is also effective and indicated for osteoporosis in patients receiving chronic corticosteroid treatment.

Alendronate also treats Paget’s disease; guidelines for Paget’s disease include alendronate as an alternative to zoledronic acid for these patients, as alendronate is known to stabilize osteolytic lesions; however, the effect of alendronate may not be as durable as with zoledronic acid and retreatment may be required between 2 and 6 years.

As with other bisphosphonates, alendronate has been investigated for hypercalcemia of malignancy and for adjuvant therapy in selected cancer patients to reduce the risk of osteopenia and related skeletal events; more study is needed.

Alendronate was first FDA-approved in 1995.

Indications & Dosage

  • hypercalcemia
  • osteoporosis
  • osteoporosis prophylaxis
  • Paget’s disease

For the treatment of osteoporosis

once-weekly regimen for postmenopausal osteoporosis or osteoporosis in men

Side Effects

  1. abdominal pain
  2. alopecia
  3. angioedema
  4. arthralgia
  5. asthenia
  6. atrial fibrillation
  7. bone fractures
  8. bone pain
  9. conjunctivitis
  10. constipation
  11. diarrhea
  12. dizziness
  13. dysgeusia
  14. dyspepsia
  15. dysphagia
  16. erythema
  17. esophageal stricture
  18. esophageal ulceration
  19. esophagitis
  20. fever
  21. flatulence
  22. gastritis
  23. gastroesophageal reflux
  24. GI bleeding
  25. GI perforation
  26. headache
  27. hypocalcemia
  28. hypophosphatemia
  29. lymphopenia
  30. malaise
  31. melena
  32. muscle cramps
  33. musculoskeletal pain
  34. myalgia
  35. nausea
  36. ocular inflammation
  37. ocular pain
  38. oral ulceration
  39. osteonecrosis
  40. peptic ulcer
  41. peripheral edema
  42. photosensitivity
  43. pruritus
  44. pyrosis (heartburn)
  45. rash
  46. Stevens-Johnson syndrome
  47. toxic epidermal necrolysis
  48. urticaria
  49. uveitis
  50. vertigo
  51. visual impairment
  52. vomiting

Monitoring Parameters

  • serum 25(OH)hydroxyvitamin D concentrations
  • serum alkaline phosphatase
  • serum calcium
  • serum creatinine/BUN
  • serum phosphate

Contraindications

  • achalasia
  • anemia
  • breast-feeding
  • cardiac disease
  • chemotherapy
  • children
  • coagulopathy
  • corticosteroid therapy
  • dental disease
  • dental work
  • dysphagia
  • esophageal stricture
  • esophagitis
  • gastritis
  • gastroesophageal reflux disease (GERD)
  • geriatric
  • GI disease
  • GI perforation
  • heart failure
  • hiatal hernia
  • hypertension
  • hypocalcemia
  • inability to stand or sit upright
  • infants
  • infection
  • neonates
  • phosphonate hypersensitivity
  • pregnancy
  • renal failure
  • renal impairment
  • sodium restriction
  • sunlight (UV) exposure
  • vitamin D deficiency

Interactions

  • Acetaminophen; Aspirin, ASA; Caffeine
  • Aluminum Hydroxide
  • Aluminum Hydroxide; Magnesium Carbonate
  • Aluminum Hydroxide; Magnesium Hydroxide
  • Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
  • Aluminum Hydroxide; Magnesium Trisilicate
  • Amlodipine; Celecoxib
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Bumetanide
  • Calcium
  • Calcium Acetate
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Calcium Chloride
  • Calcium Gluconate
  • Calcium; Vitamin D
  • Celecoxib
  • Chromium
  • Deferasirox
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Esomeprazole; Naproxen
  • Ethacrynic Acid
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Flurbiprofen
  • food
  • Furosemide
  • H2-blockers
  • Hetastarch; Dextrose; Electrolytes
  • Hydrocodone; Ibuprofen
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Indomethacin
  • Iron
  • Iron Salts
  • Iron Sucrose, Sucroferric Oxyhydroxide
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Lanthanum Carbonate
  • Levothyroxine
  • Levothyroxine; Liothyronine (Porcine)
  • Levothyroxine; Liothyronine (Synthetic)
  • Loop diuretics
  • Magnesium
  • Magnesium Citrate
  • Magnesium Salts
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nonsteroidal antiinflammatory drugs
  • Omeprazole; Sodium Bicarbonate
  • Oxaprozin
  • Parathyroid Hormone
  • Piroxicam
  • Polycarbophil
  • Polysaccharide-Iron Complex
  • Proton pump inhibitors
  • Rofecoxib
  • Sodium Bicarbonate
  • Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
  • Sucralfate
  • Sulindac
  • Tolmetin
  • Torsemide
  • Valdecoxib
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