Maintaining Postmenopausal Health
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Patients should be instructed that the expected benefits of alendronate may only be obtained when each tablet is swallowed with plain water immediately upon arising for the day and at least 30 minutes before the first food, beverage, or medication of the day.71 Even dosing with orange juice or coffee has been shown to markedly reduce the absorption of alendronate. To facilitate delivery to the stomach, and thus reduce the potential for esophageal irritation, patients should swallow alendronate with a full glass of water (6–8 ounces) 30 minutes before the first food of the day and avoid lying down for at least 30 minutes after taking the tablet.71
Alendronate is indicated for both the prevention and treatment of osteoporosis in postmenopausal women and for the treatment of Paget’s disease of bone.71 When used for the treatment of osteoporosis, alendronate increases bone mass and prevents fractures, including those of the hip, wrist, and spine (vertebral compression fractures).71 When used for the prevention of osteoporosis, alendronate may be considered for postmenopausal women who are at risk of developing osteoporosis and for whom the desired clinical outcome is to maintain bone mass and to reduce the risk of future fracture. Bone loss is particularly rapid in postmenopausal women younger than age 60.71 Since risk factors are often associated with the development of postmenopausal osteoporosis (eg, early menopause, moderately low bone mass, thin body build, family history, Caucasian or Asian race), such risk factors should be considered when choosing this therapy.71
Alendronate is contraindicated in patients with hypocalcemia or abnormalities of the esophagus which delay esophageal emptying, or who are unable to stand or sit upright for 30 minutes. It is also contraindicated in women known to be hypersensitive to alendronate or other constituents of the tablets.
The recommended dosage depends on the indication. For osteoporosis prevention in postmenopausal women, administer 5 mg daily; for osteoporosis treatment, administer 10 mg daily; and for treatment of Paget’s disease, administer 40 mg per day for 6 months.
Patients should be advised that the risk of severe esophageal adverse experiences increases if the complete dosing instructions are not followed. Patients should not chew or suck on the tablet because of a potential for oropharyngeal ulceration.71 In addition, patients should be specifically instructed not to take alendronate at bedtime or before arising for the day. If they develop symptoms of esophageal disease (such as difficulty or pain swallowing, retrosternal pain, or new or worsening heartburn), patients should be instructed to stop taking alendronate and consult their physician.
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