Alendronate for osteoporosis

Bone disorders such as sclerosis or decreased bone density have caused serious health problems for millions of people and have had a devastating impact on their quality of life. From childhood to old age, bone health is of particular importance. For this reason, many efforts are made in the field of prevention and treatment of these disorders. Alendronate is one of the effective and effective drugs in the field of preventing osteoporosis. In this article, we will first examine the mechanism of action and then the pharmaceutical forms, uses, precautions and contraindications of alendronate.

Alendronate dosage forms

Pharmaceutical forms of alendronate include tablets of 5 mg (generic), 10 mg, 35 mg, 40 mg and 70 mg (generic, Fosamax), effervescent tablet 70 mg (generic, Binosto), solution, oral It is 70 mg / 75 ml (generic, Fosamax). This medicine is also known as Osteophos.

Uses of alendronate tablets

Alendronate is used to prevent and treat certain types of osteoporosis (bone loss) in adults. Osteoporosis causes bones to become thinner and break more easily. Your chances of developing osteoporosis increase as you age, after menopause, or if you take corticosteroid medications (such as prednisone) for a long time. This medicine works by reducing bone resorption and helps maintain strong bones and reduce the risk of bone fractures. Alendronate belongs to a class of drugs called bisphosphonates.

Pharmacological effects and mechanism of action of alendronate drug

bisphosphonate; It binds to hydroxyapatite crystals in bone and prevents osteoclast-mediated bone resorption. It also reduces the release of minerals and the breakdown of collagen or matrix in the bone. Absorption with bioavailability of 0.64% for women and 0.59% for men, which is reduced by 60% with food. 78% protein-bound distribution and 50% excretion through urine and feces (unabsorbed drug).

Dosage of alendronate

Before taking alendronate, follow the directions carefully to make sure your body absorbs as much of the medicine as possible and to reduce the risk of damage to your esophagus. This medicine is usually taken once a week unless your doctor tells you otherwise. Pick a day of the week that best fits your schedule and take it on that day each week. Take this medicine orally after waking up during the day and before taking the first food, drink or other medicine.

Time to take alendronate tablets

Take this medication with a full glass (6-8 oz or 180-240 ml) of plain water. Never chew the regular pill and swallow it whole with water. Then remain completely upright (sitting, standing or walking) for at least 30 minutes and do not lie down until your first meal of the day. Note that alendronate is only effective when taken on an empty stomach. At least 30 minutes (preferably 1 to 2 hours) after taking the medicine, it is allowed to drink only water so that the medicine works well. Also, calcium or iron supplements, vitamins, antacids, coffee, tea, soft drinks, mineral water, calcium-enriched juices and food can reduce the absorption of alendronate.

How to take Alendronate (Osteophus)

1. The use of this drug is recommended for the treatment and prevention of osteoporosis in postmenopausal women. To prevent osteoporosis, take 5 mg (Fosamax) orally daily or 35 mg orally per week. In men, 10 mg daily or 70 mg (tablets and oral solution) once a week should be used to prevent osteoporosis.
2. This drug (only Fosamax) is recommended for the treatment of glucocorticoid-induced osteoporosis. The recommended dose is 10 mg orally per day in men and women, and 10 mg orally per day in postmenopausal women who are not undergoing hormone replacement therapy.
3. This drug (Fosamax only) is recommended for the treatment of Paget’s disease of bone. The dosage is 40 mg orally per day for 6 months.
4. Also, this medicine is used to treat Osteogenesis Imperfecta (orphan) in children over 4 years old.

Precautions

Patients, before using alendronate, if you are allergic to this drug or other bisphosphonates, avoid using it. In some cases, this medicine contains inactive substances that will cause sensitivity and allergic reactions after use. If you have a medical history including esophageal disorders (such as esophageal stricture or achalasia), difficulty swallowing, difficulty standing or standing for at least 30 minutes, low calcium levels, kidney problems, stomach or intestinal disorders (such as ulcers) and… Use with caution. Pregnant women should consult a doctor regarding the risks of using this medicine.

1. In some patients, the use of this drug causes local irritation of the mucous membrane of the upper digestive tract.
2. Take this medicine only with plain water (do not use with coffee, juice or even mineral water), sit or stand upright for at least 30 minutes after taking.
3. Hypocalcemia has been reported in some patients using bisphosphonates. Consider performing an ophthalmologic evaluation in patients with signs of ocular inflammation.
4. Osteonecrosis of the jaw can occur spontaneously and is generally associated with delayed healing after tooth extraction or local infection. Known risk factors include invasive dental procedures (eg, tooth extraction, dental implants, bone surgery), diagnosis of cancer, concomitant treatments (eg, chemotherapy, corticosteroids, angiogenesis inhibitors), poor oral hygiene, and comorbidities. The risk of osteonecrosis of the jaw may increase over time. Increase exposure to bisphosphonates.
5. risk of severe bone, joint, or muscle pain; Discontinue treatment in patients experiencing severe pain symptoms. Avoid use in patients with a history of these symptoms along with bisphosphonate therapy.
6. Use the effervescent tablet with caution in sodium-restricted patients (one tablet contains 603 mg of sodium, equivalent to approximately 1532 NaCl or salt).
7. The use of this drug in severe renal failure (CrCl <35 ml/min) is not recommended.
8. There is a possible increased risk of subtrochanteric and atypical femoral diaphyseal fractures, which may discontinue treatment after 3 to 5 years in patients at low fracture risk. After discontinuation, periodically reassess fracture risk. Consider periodic reassessment of the need for continued bisphosphonate therapy, especially if therapy lasts longer than 5 years. Patients with new hip or groin pain should be evaluated to rule out a femur fracture.

Contraindications for alendronate

1. Hypersensitivity
2. Hypocalcemia
3. Esophageal abnormalities that delay esophageal emptying, such as stenosis or achalasia
4. Inability to stand or stand for 30 minutes

Side effects of alendronate tablets

Stomach pain, constipation, diarrhea, gas or nausea are some of the side effects of Alendronate. If any of these effects persist or worsen, tell your doctor or pharmacist right away. Most people who use this drug do not experience serious side effects. Serious side effects of this drug include jaw or ear pain, swelling of joints, hands and ankles, increased bone inflammation, new or unusual hip, thigh and groin pain, black or tarry stools, vomiting similar to coffee grounds, etc. If you notice any of these very serious side effects, stop taking alendronate and talk to your doctor or pharmacist right away.

Side effects of daily dose of Alendronate (Osteophus)

1. stomach ache
2. Musculoskeletal (bone, muscle, or joint) pain
3. Acid reflux
4. flatulence
5. nausea
6. Indigestion
7. constipation
8. diarrhea
9. Headache
10. Esophageal ulcer
11. Vomit
12. dysphagia
13. Abdominal expansion

Side effects of the weekly dose of Alendronate (Osteophus)

1. stomach ache
2. Musculoskeletal pain
3. Indigestion
4. Acid reflux
5. nausea
6. Abdominal expansion
7. constipation
8. Flatulence
9. Gastritis
10. Muscular pain

Review of alendronate post-marketing reports

1. Gastrointestinal system: esophagitis, esophageal erosion, esophageal ulcer, esophageal stricture or perforation, oropharyngeal ulcer, gastric or duodenal ulcer
2. Musculoskeletal: bone, joint or muscle pain, joint swelling; Low energy subtrochanteric and femoral shaft fractures
3. Skin: Rash (sometimes with photosensitivity), pruritus, alopecia, severe skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis.
4. Special senses: uveitis, scleritis or episcleritis, cholesteatoma of external auditory canal (focal osteonecrosis)

Alendronate drug interactions

1. Category X interactions (avoid): parathyroid hormone
2. Reduction of alendronate effects by drugs: preparations containing polyvalent cations, proton pump inhibitors
3. Increased effects of alendronate by drugs: aminoglycosides, angiogenesis inhibitors (systemic), aspirin, non-steroidal anti-inflammatory drugs

Taking alendronate tablets during pregnancy and breastfeeding

Available data on use in pregnant women are insufficient to inform the drug-related risks of adverse maternal or fetal outcomes. It is also not known whether the medicine in the human breast affects the production of milk in a mild way, but the doctor should stop using the medicine considering the benefits and risks of use for the infant. Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for treatment and any potential effects of medication (alendronate) or underlying disease on the nursing infant.

Animal studies of alendronate (Osteophus) in pregnancy

1. In animal reproduction studies, daily oral administration to rats prior to mating until the end of pregnancy or lactation showed decreased postimplantation survival and decreased pup weight gain starting at doses equivalent to less than half the highest recommended clinical dose of 40 mg daily. (based on body surface) was done.
2. Oral administration to mice during organogenesis resulted in reduced fetal ossification starting at doses 3 times the daily clinical dose of 40 mg.
3. Delayed or failed delivery, prolonged labor, and maternal and fetal death in late pregnancy due to maternal hypocalcemia occurred at oral doses less than one-tenth of the daily clinical dose of 40 mg.
4. Bisphosphonates are incorporated into the bone matrix from which they are gradually released over several years. Based on the mechanism of action of bisphosphonates, there is a potential risk of fetal harm, mainly skeletal, if a woman becomes pregnant after completing bisphosphonate therapy.

Alendronate storage conditions

Alendronate should be stored at room temperature and away from light. It is also important to keep all medications out of the reach of children, as many forms of medication (such as weekly tablets and eye drops, creams, patches, and inhalers) are not child-resistant and can be easily opened by young children. . Unnecessary medications should be disposed of in specific ways to ensure that pets, children, and other people cannot ingest them.

A final word about alendronate

As we said in this article from Positive Sabz online pharmacy magazine, alendronate drug plays a very important role in human life as one of the basic solutions in the prevention and management of osteoporosis. This drug has been able to significantly reduce the risk of bone fractures and practically improve the quality of life of people with this disorder. The efficiency of alendronate as a main choice in the management of osteoporosis is very reasonable and justifiable, especially in people with multiple risk factors, including age, gender, and family history of bone disorders.

Site source: Medscape