COMMON BRAND NAME(S):
Fosamax

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Uses: (1) Treatment of postmenopausal osteoporosis; (2) treatment of Paget's disease; (3) prevention of postmenopausal osteoporosis; (4) prevention of osteoporosis in people who take corticosteroid-type medicines; (5) once weekly prevention or treatment of osteoporosis; (6) treatment of osteoporosts m men.

Other (unlabeled) generally accepted uses: (1) approved in Canada in combination with hormone replacement therapy (estrogen or estrogen plus progesterone) to increase positive outcomes on increased bone mass; (2) may have a role in osteoporosis sometimes seen in HIV patients (antiretroviral induced); (3) could have a role intravenously in reflex sympathetic dystrophy syndrome (RSDS); (4) early research suggests a role in early treatment of osteonecrosis (avascular necrosis of bone); (5) prevents bone loss in women who stop hormone replacement therapy (HRT).

How This Drug Works: This medicine works at the brush border of the osteoclast cell (inhibiting enzymes in the mevalonate pathway). This prevents the cell from resorbing (gobbling up) bone while the osteoblast (bone-building cell) continues to work. The end result is bone-building and decreased fracture risk.

Available Dosage Forms and Strengths
Tablets - 5 mg, 10 mg, 35 mg, 40 mg, 70 mg

Recommended Dosage Ranges (Actual dose and schedule must be determined for each patient individually.)

Infants and Children: Efficacy and safety are not established.
18 to 65 rears of Age: Treatment of osteoporosis in women after menopause: 70 mg once a week OR 10 mg taken once daily.
Osteoporosis prevention in women after menopause: 35 mg once a week OR 5 mg once daily. I strongly recommend an appropriate amount of dietary calcium and/or calcium supplementation to ensure adequate calcium every day. Discuss the need for vitamin D with your doctor. Calcium and vitamin D are critical in osteoporosis prevention and treatment.
Osteoporosis TREATMENT in women after menopause or in men: 70 mg once a week for women (can also be considered for men) OR 10 mg once dailv. Calcium and vitamin D also should be added.
Prevention of glucocorticoid-induced osteoporosis: 5 mg daily in one study. Treatment of glucocorticoid-induced osteoporosis: 5 mg once daily. In postmenopausal women who are NOT taking estrogen, the dose for this indication is 10 mg once daily.
Paget's disease: 40 mg once daily for 6 months. Repeat treatment after a 6 month evaluation period may be possible if patients relapse (increased serum alkaline phosphatase).
Over 65 Years of Age: Same as in those 18 to 65 years old.

Conditions Requiring Dosing Adjustments

Liver Function: No changes needed.
Kidney Function: Lower doses for patients with kidney compromise. Patients with creatinine clearances less than 35 ml/min should not be given this medicine.

Dosing Instructions: TAKE THIS MEDICINE WITH 6 TO 8 OUNCES OF TAP WATER TO GET THE BEST RESULTS. DO NOT take this drug with food or other drugs. The therapeutic benefit will be decreased. Take it at least half an hour before the first food or liquids (other than plain tap water) of the day. Avoiding food or drink for more than 30 minutes lets more medicine get into your body to go to work. DO NOT lie down for 30 minutes (preferably an hour) after taking this drug (decreases risk of irritation of the esophagus). If you forget a dose: Take the medicine right away, unless it is nearly time for your next dose. If you are taking it once weekly, call your doctor. DO NOT double doses.

Usual Duration of Use: In Paget's disease, this medicine is used once daily for 6 months, with recheck after that. In treating osteoporosis after menopause, many doctors get a bone mineral density test (DEXA or PDEXA presently most widely used) to help decide to start therapy and then get a second test 2 years later or order certain laboratory tests to check results or outcome of therapy. Further study is needed to find the best dosing strategies in long-term (greater than 5 years) use of alendronate (cyclic or ongoing).

Please Note: The information contained on this page is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs or following any treatment or regimen. Only your doctor, nurse or pharmacist can provide you with advice on what is safe and effective for you.

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