Which patient should not be prescribed alendronate Fosamax for osteoporosis?
Alendronic acid is a type of medicine called a bisphosphonate. Bisphosponates are prescribed to help your bones stay as strong as possible. Taking alendronic acid can help if you have, or are at risk of developing, osteoporosis. This is a condition that causes your bones to get weaker and be more likely to break. Show
Osteoporosis can happen for many reasons, but you are more likely to get it if:
Talk to your doctor if you are worried about the health of your bones because of the medicines you take, or changes to your hormone levels because of the menopause. Alendronic acid is only available on prescription. You can take it as a standard tablet, a soluble tablet that dissolves in water, or as a liquid that you drink. 2. Key facts
3. Who can and cannot take alendronic acidAlendronic acid can be taken by most adults aged 18 and over. It's sometimes prescribed for children with osteoporosis. Do not give it to children under the age of 18 unless it's prescribed by a doctor. Alendronic acid is not suitable for some people. To make sure it's safe for you, tell your doctor if you:
4. How and when to take alendronic acidFollow your doctor's instructions about how and when to take your medicine. Dosage and strengthThe usual dose of alendronic acid for adults is 70mg taken once a week. There is also a 10mg tablet you take once a day. You will usually take alendronic acid once a week:
Whether you take alendronic acid daily or weekly, you need to take your medicine at the same time each day or day of the week. If it's weekly, choose a day that suits your routine. How to take alendronic acidIt's important to follow the instructions for this medicine very carefully. If you do not, it may not work or it could irritate and damage your food pipe as you swallow it. The best time to take your medicine is usually 30 minutes before you have breakfast. Take it on an empty stomach, before you have anything to eat or drink (other than plain tap water) and before you take any other medicines that you swallow. Alendronic acid works best on an empty stomach because your body can absorb it properly. It's important to take alendronic acid while you're sitting up or standing. Try to stay upright for 30 minutes after taking your medicine – you can be sitting, standing or walking. 5. Side effectsLike all medicines, alendronic acid can cause side effects in some people, but many people have no side effects, or only minor ones. Common side effectsThese common side effects happen in more than 1 in 100 people. Talk to your doctor or pharmacist if they bother you or do not go away:
Serious side effectsSome people may have serious side effects when taking alendronic acid. These include heartburn (or heartburn that gets worse), problems or pain when swallowing, or chest pain. These may be signs of ulcers in your food pipe (oesophagus). If this happens, stop taking alendronic acid and speak to a doctor. Other serious side effects are rare, but call a doctor straight away if you have:
In rare cases, alendronic acid may cause a serious allergic reaction (anaphylaxis). Immediate action required: Call 999 or go to A&E now if:
You could be having a serious allergic reaction and may need immediate treatment in hospital. These are not all the side effects of alendronic acid. For a full list, see the leaflet inside your medicine packet. Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information. 6. How to cope with side effects of alendronic acidWhat to do about:
7. Pregnancy and breastfeedingAlendronic acid and pregnancyAlendronic acid is not recommended during pregnancy. This is because there has not been enough research into its safety. Alendronic acid and breastfeedingIt's generally OK to take alendronic acid while breastfeeding. This is because we only expect very small amounts to pass into breast milk. It may not be suitable in a very small number of cases. Check with your doctor about what's best for you and your baby. Non-urgent advice: Tell your doctor if you're:
For more information about how alendronic acid can affect you and your baby during pregnancy, find out more on the Best Use of Medicines in Pregnancy (BUMPS) website. 8. Cautions with other medicinesIf you've been prescribed alendronic acid, do not take other medicines that you have to take by mouth (orally) at the same time. This is because it enters the stomach, soaks up the alendronic acid and stops it working properly. If you do need to take another medicine by mouth, wait for at least 30 minutes. Some medicines can affect the way alendronic acid works. Tell your doctor if you're taking:
Also tell your doctor if you are having chemotherapy. Mixing alendronic acid with herbal remedies or supplementsThere's very little information about taking herbal remedies and supplements with alendronic acid. Important: Medicine safetyTell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. 9. Common questions about alendronic acidHow does alendronic acid work? Alendronic acid increases the amount of calcium in your bones (your bone mineral density). This makes your bones stronger and less likely to break. How long does it take to work? Alendronic acid usually starts to work after 1 month. However, it may take 6 to 12 months for the medicine to fully protect your bones. How good is it at preventing further broken bones? If you have osteoporosis, or you've recently broken a bone, you're at risk of future breaks (fractures). However, you can significantly reduce the chance of this happening by taking alendronic acid. If you're a woman in this "at risk" group, taking alendronic acid for at least 12 months can halve your chances of going on to fracture your wrist, hip or spine. How long will I take it for? You'll usually take alendronic acid long term, for at least 3 to 5 years. Your doctor will then review your ongoing need for it. If you're having long-term treatment with steroids, you'll usually take alendronic acid until your steroid treatment stops. Your doctor will then review whether you need to carry on. For other health problems, such as arthritis and diabetes, your doctor will usually assess your risk of broken bones every 3 to 5 years. This may include tests to check the strength (density) of your bones. Depending on the results, you'll either keep taking alendronic acid, take a break from it or stop taking it completely. How long do the effects last after I stop taking it? Once you stop taking alendronic acid, the effects of the medicine will gradually wear off. Your bones may continue to benefit for up to 5 years afterwards. The longer you take the medicine, the longer the effects will last. Is it safe to take long term? Alendronic acid is generally prescribed for a long time. While you're taking it, you're less likely to break a bone. In a very small number of people, taking alendronic acid for more than 2 years can increase their chances of getting a rare type of bone damage in their inner ear and certain types of breaks to their thigh bones. For this reason, your doctor will look at the benefits and risks of your treatment after 3 to 5 years and decide whether you should keep taking alendronic acid. This may involve some tests to check the strength (density) of your bones. The benefits of taking alendronic acid generally outweigh the risks. If you're concerned or have any questions, talk to your doctor or pharmacist. What happens if I do not take it? Missing the odd dose probably will not affect the health of your bones. But if you keep forgetting to take your alendronic acid, or you do not want to take it, for whatever reason, then speak to your doctor. There are other treatments that can help your bones. Any medicine can have side effects, but the benefits of alendronic acid usually far outweigh the risks. By not taking it, you're more likely to break a bone. Broken bones are painful and can have serious consequences. In older people, for example, a broken hip can mean a loss of mobility for some time, although there is every chance of full recovery. What can I do to keep my teeth healthy while taking it? It's important to take good care of your teeth while you're taking alendronic acid, because it might affect your jaw bone. It's a good idea to:
What happens if I need dental treatment? If you're having dental implants or having a tooth out while taking alendronic acid, there's a very small chance of damage to your jaw bone. For safety, tell your dentist that you're taking alendronic acid. They may recommend a different type of dental treatment. Will taking alendronic acid affect my arthritis? Some types of arthritis and arthritis medicines can increase your risk of developing osteoporosis. Taking alendronic acid reduces this risk. If you have arthritis and your doctor prescribes alendronic acid, let them know if the pain or swelling in your joints gets worse when you start taking this medicine. Will it affect my fertility? There's no evidence to suggest that taking alendronic acid will reduce fertility in either men or women. However, if you're trying to get pregnant, speak to a pharmacist or your doctor before taking alendronic acid. This is because most women will need to stop taking alendronic acid before getting pregnant. Will it affect my contraception? Alendronic acid does not affect any type of contraception including the contraceptive pill or emergency contraception. Can I drive or ride a bike? Alendronic acid may make you feel dizzy. It can also cause blurred vision, and bone, muscle or joint pain. If this happens to you, do not drive, cycle or use any machinery or tools until the effects have worn off. It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive. Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking alendronic acid. GOV.UK has more information on the law on drugs and driving. Is there any food or drink I need to avoid? Do not have anything to eat or drink before you take your alendronic acid first thing in the morning. You can drink tap water but this medicine must be taken on an empty stomach. Take your alendronic acid first thing in the morning, on an empty stomach. Do not have anything to eat or drink beforehand, other than plain tap water. It's important to follow the instructions carefully (the section has more detail), so that your medicine works properly. Do not take your medicine with mineral water. If it's not safe to drink your tap water for any reason, you can boil it and let it cool before drinking it. After taking your medicine, wait for 30 minutes. You can then eat and drink normally. Can I drink alcohol with it? Yes, you can drink alcohol while taking alendronic acid. However, drinking a lot of alcohol affects the strength of your bones and can increase your risk of breaks (fractures). Who should not take alendronate?You should not take alendronate if you have problems with your esophagus, or low levels of calcium in your blood. Do not take alendronate if you cannot sit upright or stand for at least 30 minutes after taking the medicine. Alendronate can cause serious problems in the stomach or esophagus.
What is contraindicated with alendronate?Alendronate is contraindicated in patients with abnormalities of the esophagus that delay esophageal emptying such as esophageal stricture or achalasia. Alendronate is contraindicated in patients who are at an increased risk of aspiration.
When should you not take alendronate?Never take alendronate at bedtime or before you wake up and get out of bed for the day. After you take alendronate, do not eat, drink, or take any other medications (including vitamins or antacids) for at least 30 minutes. Do not lie down for at least 30 minutes after you take alendronate.
Why should I not take Fosamax?There are concerns about the long-term safety of bisphosphonates (such as Fosamax) as long-term use has been associated with atypical femur fractures, osteonecrosis of the jaw, and esophageal cancer.
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