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Alendronate

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Alendronate Quick Reference
Alendronate
IUPAC Name
Sodium [4-amino-1-hydroxy-1-(hydroxy-oxido-phosphoryl)- butyl]phosphonic acid trihydrate
Chemical Information
Empirical Formula C4H18NNaO10P2
Molecular Weight 325.124
General Drug Information
Classification Bisphosphonates
Schedule Legend
How Supplied Oral Tablets: 5mg, 10mg, 35mg, 40mg, 70mg

Solution: 70mg/75ml

Trade Names Fosamax
Pregnancy Category C
Breast Feeding No data available regarding the secretion of alendronate into breast milk. Caution should be used.
Generic Availability Generic not available
Patent Expiration Date Feb 06,2008
Administration Information
Route(s) Oral
Method(s) Take tablet or solution at least 30 minutes before consuming the first food, beverage, or medication of the day. Alendronate should be taken once a day (5mg, 10mg, 40mg formulations) or once a week (35mg and 70mg formulations) in the morning.
Pharmacokinetic Information
Absorption F = ~60%(coffee or orange juice can decrease F by~60%)
tmax = unavailable
Distribution Vd = ~28L
Protein binding =~78%
Metabolism None Known
Excretion T1/2 = >10 years
Urine

Contents

Brand/Trade Names of Drug

Fosamax

Generic Name of Drug

Alendronate (a LEN droe nate) Alendronate Pronunciation Click Here

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Description

Alendronate belongs to a class of medications known as bisphosphonates It is a second generation bisphosphonate which strengthens bones in addition to preventing bone loss. Alendronate inhibits osteoclast-mediated bone resorption. It also binds to the hydroxyapatite found in bone.[1]

Alendronate was approved by the FDA for the treatment and prevention of osteoporosis and for the treatment of Paget's disease.

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Mechanism of action

Bisphosphonates are antiresorptive agents. They prevent the transformation of calcium phosphate into hydroxyapatite. In addition, bisphosphonates inhibits osteoclast mediated bone reabsorption through an unknown mechanism. Current theories suggest that alendronate is incorporated into osteoclasts and disrupts the cellular ruffed border. As a result, active bone resorption is reduced. [2].

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Time Required for Therapeutic Response

  • Data not available.[1]

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Pharmacokinetics

Absorption

The bioavailability of alendronate is about 60%. Coadministration with food decreases the bioavailability of alendronate by about 40%. Coffee or orange juice can decrease the bioavailability of alendronate by about 60%.[1]

Distribution

Approximately 78% of the circulating drug is bounded to plasma protein. The volume of distribution is approximately 28L (exclusively contained within bone).[1]

Metabolism

None Known.[1]

Excretion

About 50% of alendronate is recovered in the urine. The terminal half-life (t1/2) of alendronate is >10 years.[1]

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Special Population Pharmacokinetics

  • Renal insufficiency

The accumulation of alendronate may be greater for patients with renal insufficiency. Alendronate is not recommended in patients with creatinine clearance less than 35ml/min (severe renal insufficiency).[1]

  • Hepatic insufficiency

There is no known evidence that alendronate is metabolized through the liver. No dosage adjustment is needed.[1]

  • Hemodialysis

Data not available.[1]

  • Geriatric

No dosage adjustment is needed.[1]

  • Pediatric

Alendronate is not indicated for use in children.[1]

  • Gender

No dosage adjustment is needed.[1]

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Indications

FDA Approved Indications

  • Treatment to increase bone mass in men with osteoporosis[4]
  • Treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids in a daily dosage equivalent to 7.5mg or greater of prednisone and who have low bone mineral density[5]

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Non-FDA Approved Indications

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Dosage

NOTE: * The safety of alendronate in treating and preventing osteoporosis has only been studied for up to 7 years of therapy.[1]

  • Treatment of osteoporosis in postmenopausal women[1]
    • Starting & Maintenance Dose:
      • One 70mg tablet once a week; or
      • One bottle of 70mg oral solution once a week; or
      • One 10mg tablet once a day
  • Treatment to increase bone mass in men with osteoporosis[1]
    • Starting & Maintenance Dose:
      • One 70mg tablet once a week; or
      • One bottle of 70mg oral solution once a week; or
      • One 10mg tablet once a day
  • Prevention of osteoporosis in postmenopausal women[1]
    • Starting & Maintenance Dose:
      • One 35mg tablet once a week; or
      • One 5mg tablet once a day
  • Treatment of glucocorticoid-induced osteoporosis in men and women[1]
    • Starting & Maintenance Dose:
      • One 5mg tablet once a day
      • One 10mg tablet once a day (ONLY For postmenopausal women not receiving estrogen)
  • Paget's disease of bone in men and women[1]
    • Starting & Maintenance Dose:
      • One 40mg tablet once a day for 6 months
  • Retreatment of Paget's disease[1]
    • Can consider retreating with alendronate with a six-month post-treatment evaluation.
  • Maximum Dosage Limits[1]
    • Adults: 10 mg/day PO or 70 mg/week PO for osteoporosis; 40 mg/day PO for Paget's disease
    • Elderly: 10 mg/day PO or 70 mg/week PO for osteoporosis; 40 mg/day PO for Paget's disease
    • Adolescents and children: Unknown; safety and efficacy has not been established in this population.
  • Dosage Adjustment[1]
    • Renal insufficiency: No adjustment is necessary if creatinine clearance is >35ml/min. The use of alendronate is not recommended in patients with creatinine clearance <= 35ml/min.
    • Hepatic insufficiency: No adjustment is necessary.
    • Hemodialysis: Unknown.
    • Geriatric: No adjustment is necessary.
    • Gender: No adjustment is necessary.

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Administration

  • Route: Oral[1]
  • Method:[1]
    • Take tablet or solution, at least 30 minutes before the first food, beverage or medication, once a day (5mg, 10mg and 40mg formulations) or once a week (35mg and 70mg formulations) in the morning.
    • Swallow the tablet with a full glass (8oz.) of plain water. (2oz. of plain water is sufficient for the liquid formulation)
    • Do not lie down for at least 30 minuties and until after the first food consumption.

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Monitoring Parameters

  • Serum alkaline phosphatase
  • Serum calcium
  • Serum creatinine and BUN (patients with renal insufficiency)
  • Bone mineral density

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Contraindications/Precautions

Contraindications

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Precautions

  • Musculoskeletal pain
  • Osteonecrosis of the jaw
  • Renal insufficiency
  • Glucocorticoid-induced osteoporosis (patients receiving less than 7.5mg of prednisone or equivalent)

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Pregnancy indications

  • Pregnancy category: Category C[1]
  • Teratogenicity: Animal reproduction studies have shown adverse effects on the fetus including slightly increased offspring mortality and growth retardation. Alendronate may be used during pregnancy if the potential benefits justify the potential risks to the fetus.[1]

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Breast-feeding indications

  • Secretion into breast milk: No data available. Alendronate may be used in nursing mother if the potential benefits to the mother justify the potential risks to the infant.[1]

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Drug-Drug Interactions

Alendronate Drug/Drug Interaction Chart
Severity Level Click here to see Severity Level Legend Increased Effect/Toxicity Decreased Effect
4 None Known None Known
3 aspirin[1] The risk of upper GI side effects is increased when alendronate is co-administered with ASA. Nonsteroidal antiinflammatory drugs (NSAIDs)[1] The risk of upper GI side effects is increased when alendronate is co-administered with NSAIDs. None Known
2 H2-blockers[1] The risk of upper GI side effects is increased when alendronate is co-administered with H2-blockers by affecting the bioavailability of alendronate.proton pump inhibitors (PPIs)[1] The risk of upper GI side effects is increased when alendronate is co-administered with PPIs by affecting the bioavailability of alendronate.loop diuretics[8][9] The risk of hypocalcemia is increased when IV alendronate is co-administered with loop diuretics. aluminum hydroxide[1] The absorption of alendronate is decreased when alendronate is co-administered with aluminum hydroxide.antacids[1] The absorption of alendronate is decreased when alendronate is co-administered with antacids.calcium carbonate[1] The absorption of alendronate is decreased when alendronate is co-administered with calcium carbonate.calcium salts[1] The absorption of alendronate is decreased when alendronate is co-administered with calcium salts.iron salts[1] The absorption of alendronate is decreased when alendronate is co-administered with iron salts.magnesium salts[1] The absorption of alendronate is decreased when alendronate is co-administered with magnesium salts.polysaccharide-iron complex[1] The absorption of alendronate is decreased when alendronate is co-administered with polysaccharide-iron complex.
1 None Known teriparatide[10][11] The anabolic activity of teriparatide is decreased when it is co-administered with alendronate.


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Drug-Food-Herb Interactions

Alendronate Drug/Food/Herb Interaction Chart
Severity Level Click here to see Severity Level Legend Increased Effect/Toxicity Decreased Effect
4 None Known None Known
3 None Known Food[1] The bioavailability of alendronate is decreased when co-administered with food.
2 None Knownn None Known
1 None Known None Known


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Adverse Reactions/Side Effects

Alendronate Adverse Reactions Chart[12]
Incidence Body System Adverse Reactions
> 10 % Endocrine & metabolic Hypocalcemia (transient, mild, 18%); hypophosphatemia (transient, mild, 10%)
1-10% CNS Headache (up to 3%)
GI Abdominal pain (1% to 7%), acid reflux (1% to 4%), dyspepsia (1% to 4%), nausea (1% to 4%), flatulence (up to 4%), diarrhea (1% to 3%), gastroesophageal reflux disease (1% to 3%), constipation (up to 3%), esophageal ulcer (up to 2%), abdominal distension (up to 1%), gastritis (up to 1%), vomiting (up to 1%), dysphagia (up to 1%), gastric ulcer (1%), melena (1%)
Neuromuscular & skeletal Arthralgia, limb pain, muscle cramp, myalgia, neck/shoulder pain, paresthesia, tremor
< 1% All Postmarketing, and/or case reports: Anastomotic ulcer, angioedema; bone, muscle, or joint pain (occasionally severe, considered incapacitating in rare cases); dizziness, duodenal ulcer, episcleritis, erythema, esophageal erosions, esophageal perforation, esophageal stricture, esophagitis, fever, flu-like syndrome, hypersensitivity reactions, hypocalcemia (symptomatic), joint swelling, lymphocytopenia, malaise, myalgia, oropharyngeal ulceration, osteonecrosis (jaw), peripheral edema, photosensitivity (rare), pruritus, rash, scleritis (rare), Stevens-Johnson syndrome, taste perversion, toxic epidermal necrolysis, urticaria, uveitis (rare), vertigo, weakness


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Overdosage Measures

Symptoms of overdose include hypocalcemia, hypophosphatemia, and upper GI adverse affects.

  • Treatment:
    • Give patient milk or antacids to bind alendronate.
    • Keep patient fully upright.[1]


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Product Information and Distribution

Alendronate Product Availability Information
Name Manufacturer Dosage Form Strength Quantity NDC Storage
Fosamax[1] Merck & Co. Oral Tablets 5 mg 30 00006-0925-31 15-30°C (59-86°F)
100 00006-0925-58
10 mg 30 00006-0936-31
100 00006-0936-58
31 00006-0936-72
1000 00006-0936-82
As ordered 00006-0936-00
7 CRTN 00006-0936-07
100 box 00006-0936-28
35 mg 1 blister pk 00006-0077-01
20 blister pk 00006-0077-21
4 blister pk 00006-0077-44
40 mg 30 00006-0212-31
As ordered 00006-0212-00
70 mg 4 blister pk 00006-0031-44
1 box 00006-0031-01
20 blister pk 00006-0031-21
Oral solution 70 mg/ 75 ml 4X75 ml bottle 00006-3833-34


  • Manufacturers/Distributors

Manufactured by: Merck & Co Inc, Whitehouse Station, United States

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Pharmacogenomic information

Alendronate Pharmacogenomic Information

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Patient Information

  • Take as directed.
  • Take tablet or solution, at least 30 minutes before the first food, beverage or medication in the morning.
  • Swallow the tablet with a full glass (8oz.) of plain water. (2oz. of plain water is sufficient for the liquid formulation)
  • Do not lie down for at least 30 minuties and until after the first food consumption.
  • Avoid OTC medications unless instructed by your physician.
  • Possible side effects include flatulence, bloating, nausea, acid regurgitation. Small frequent meals may help reducing the side effects.
  • Report acute headache or gastric pain, unresolved GI upset, or acid stomach.
  • Inform your doctor if you are or intend to become pregnant.

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References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 1.39 1.40 Fosamax® (alendronate sodium) package insert. Whitehouse Station, NJ; Merck & Co.Inc; 2006 Nov.
  2. ↑ Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 5th Edition ed. New York, NY: The McGraw-Hill Companies, Inc 2002.
  3. ↑ Iwamoto J, Takeda T, Sato Y, Uzawa M.Comparison of the effect of alendronate on lumbar bone mineral density and bone turnover in men and postmenopausal women with osteoporosis. Clin Rheumatol. 2007 Feb;26(2):161-7.Epub 2006 Mar 25.
  4. ↑ Drake AJ 3rd, Brietzke SA, Aprill BS, Shakir KM.Effect of alendronate treatment on bone mineral density in male patients with osteoporosis.Endocr Pract. 1999 Jul-Aug;5(4):184-90.
  5. ↑ Sambrook PN, Kotowicz M, Nash P, Styles CB, Naganathan V, Henderson-Briffa KN, Eisman JA, Nicholson GC.Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium.J Bone Miner Res. 2003 May;18(5):919-24.
  6. ↑ Saunders Y, Ross JR, Broadley KE, Edmonds PM, Patel S; Steering Group.Systematic review of bisphosphonates for hypercalcaemia of malignancy.Palliat Med. 2004 Jul;18(5):418-31.
  7. ↑ Rizzoli R, Buchs B, Bonjour J-P. Effect of a single infusion of alendronate in malignant hypercalcemia; dose dependency and comparison with clodronate. Int J Cancer 1992;50:706—12.
  8. ↑ Zometa® (zoledronic acid) package insert. East Hanover, NJ: Novartis Pharma Stein AG;2004 Mar.
  9. ↑ Lasix® (furosemide) package insert. Bridgewater, NJ: Aventis Pharmaceuticals; 2004 Jan.
  10. ↑ Black DM, Greenspan SL, Ensrud KE, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 2003;349:1207—15.
  11. ↑ Finkelstein JS, Hayes A, Hunzelman JL, et al. The effects of parathyroid hormone, alendronate or both in men with osteoporosis. N Engl J Med 2003;349:1216—26.
  12. ↑ Lexi-Comp (2003). Drug Information Handbook. 11th Edition., APhA.

PUBMED References

Efficacy Trial Articles

  1. Adachi JD, Saag KG, Delmas PD, Liberman UA, Emkey RD, Seeman E, Lane NE, Kaufman JM, Poubelle PE, Hawkins F, Correa-Rotter R, Menkes CJ, Rodriguez-Portales JA, Schnitzer TJ, Block JA, Wing J, McIlwain HH, Westhovens R, Brown J, Melo-Gomes JA, Gruber BL, Yanover MJ, Leite MO, Siminoski KG, Nevitt MC, Sharp JT, Malice MP, Dumortier T, Czachur M, Carofano W, Daifotis A.Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial.Arthritis Rheum. 2001 Jan;44(1):202-11.
  2. Ascott-Evans BH, Guanabens N, Kivinen S, Stuckey BG, Magaril CH, Vandormael K, Stych B, Melton ME.Alendronate prevents loss of bone density associated with discontinuation of hormone replacement therapy: a randomized controlled trial.Arch Intern Med. 2003 Apr 14;163(7):789-94.
  3. Bell NH, Bilezikian JP, Bone HG 3rd, Kaur A, Maragoto A, Santora AC; MK-063 Study Group.Alendronate increases bone mass and reduces bone markers in postmenopausal African-American women.J Clin Endocrinol Metab. 2002 Jun;87(6):2792-7.
  4. Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, Satterfield S, Wallace RB, Bauer DC, Palermo L, Wehren LE, Lombardi A, Santora AC, Cummings SR; FLEX Research Group.Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial.JAMA. 2006 Dec 27;296(24):2927-38.
  5. Chevrel G, Schott AM, Fontanges E, Charrin JE, Lina-Granade G, Duboeuf F, Garnero P, Arlot M, Raynal C, Meunier PJ.Effects of oral alendronate on BMD in adult patients with osteogenesis imperfecta: a 3-year randomized placebo-controlled trial.J Bone Miner Res. 2006 Feb;21(2):300-6. Epub 2005 Oct 24.
  6. Chow CC, Chan WB, Li JK, Chan NN, Chan MH, Ko GT, Lo KW, Cockram CS.Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism.J Clin Endocrinol Metab. 2003 Feb;88(2):581-7.
  7. Cranney A, Wells G, Willan A, Griffith L, Zytaruk N, Robinson V, Black D, Adachi J, Shea B, Tugwell P, Guyatt G; Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group.Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women.Endocr Rev. 2002 Aug;23(4):508-16.
  8. Ensrud KE, Barrett-Connor EL, Schwartz A, Santora AC, Bauer DC, Suryawanshi S, Feldstein A, Haskell WL, Hochberg MC, Torner JC, Lombardi A, Black DM; Fracture Intervention Trial Long-Term Extension Research Group.Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the Fracture Intervention Trial long-term extension.J Bone Miner Res. 2004 Aug;19(8):1259-69. Epub 2004 Mar 29.
  9. Greenspan SL, Schneider DL, McClung MR, Miller PD, Schnitzer TJ, Bonin R, Smith ME, DeLucca P, Gormley GJ, Melton ME.Alendronate improves bone mineral density in elderly women with osteoporosis residing in long-term care facilities. A randomized, double-blind, placebo-controlled trial.Ann Intern Med. 2002 May 21;136(10):742-6.
  10. Guaraldi G, Orlando G, Madeddu G, Vescini F, Ventura P, Campostrini S, Mura MS, Parise N, Caudarella R, Esposito R.Alendronate reduces bone resorption in HIV-associated osteopenia/osteoporosis.HIV Clin Trials. 2004 Sep-Oct;5(5):269-77.
  11. Kushida K, Shiraki M, Nakamura T, Kishimoto H, Morii H, Yamamoto K, Kaneda K, Fukunaga M, Inoue T, Nakashima M, Orimo H.Alendronate reduced vertebral fracture risk in postmenopausal Japanese women with osteoporosis: a 3-year follow-up study.J Bone Miner Metab. 2004;22(5):462-8. Erratum in: J Bone Miner Metab. 2005;23(1):95.
  12. Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J, Adami S, Weber K, Lorenc R, Pietschmann P, Vandormael K, Lombardi A.Alendronate for the treatment of osteoporosis in men.N Engl J Med. 2000 Aug 31;343(9):604-10.
  13. Recker R, Lips P, Felsenberg D, Lippuner K, Benhamou L, Hawkins F, Delmas PD, Rosen C, Emkey R, Salzmann G, He W, Santora AC.Alendronate with and without cholecalciferol for osteoporosis: results of a 15-week randomized controlled trial.Curr Med Res Opin. 2006 Sep;22(9):1745-55.
  14. Rizzoli R, Buchs B, Bonjour J-P. Effect of a single infusion of alendronate in malignant hypercalcemia; dose dependency and comparison with clodronate.Int J Cancer 1992;50:706—12.
  15. Sambrook PN, Kotowicz M, Nash P, Styles CB, Naganathan V, Henderson-Briffa KN, Eisman JA, Nicholson GC.Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium.J Bone Miner Res. 2003 May;18(5):919-24.
  16. Sawka AM, Papaioannou A, Adachi JD, Gafni A, Hanley DA, Thabane L.Does alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women.BMC Musculoskelet Disord. 2005 Jul 11;6:39.
  17. Weber TJ, Drezner MK.Effect of alendronate on bone mineral density in male idiopathic osteoporosis.Metabolism. 2001 Aug;50(8):912-5.
  18. Wiernikowski JT, Barr RD, Webber C, Guo CY, Wright M, Atkinson SA.Alendronate for steroid-induced osteopenia in children with acute lymphoblastic leukaemia or non-Hodgkin's lymphoma: results of a pilot study.J Oncol Pharm Pract. 2005 Jun;11(2):51-6.

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Therapeutic Class Comparison Articles

  1. Cortet B, Bera-Louville A, Gauthier P, Gauthier A, Marchandise X, Delcambre B.Comparative efficacy and safety study of etidronate and alendronate in postmenopausal osteoporosis. effect of adding hormone replacement therapy.Joint Bone Spine. 2001 Oct;68(5):410-5.
  2. Giavaresi G, Fini M, Gnudi S, Aldini NN, Rocca M, Carpi A, Giardino R.Comparison of calcitonin, alendronate and fluorophosphate effects on ovariectomized rat bone.Biomed Pharmacother. 2001 Sep;55(7):397-403.
  3. Guanabens N, Pares A, Ros I, Alvarez L, Pons F, Caballeria L, Monegal A, Martinez de Osaba MJ, Roca M, Peris P, Rodes J.Alendronate is more effective than etidronate for increasing bone mass in osteopenic patients with primary biliary cirrhosis.Am J Gastroenterol. 2003 Oct;98(10):2268-74.
  4. Lanza F, Schwartz H, Sahba B, Malaty HM, Musliner T, Reyes R, Quan H, Graham DY.An endoscopic comparison of the effects of alendronate and risedronate on upper gastrointestinal mucosae.Am J Gastroenterol. 2000 Nov;95(11):3112-7.
  5. Rosen CJ, Hochberg MC, Bonnick SL, McClung M, Miller P, Broy S, Kagan R, Chen E, Petruschke RA, Thompson DE, de Papp AE; Fosamax Actonel Comparison Trial Investigators.Treatment with once-weekly alendronate 70 mg compared with once-weekly risedronate 35 mg in women with postmenopausal osteoporosis: a randomized double-blind study.J Bone Miner Res. 2005 Jan;20(1):141-51. Epub 2004 Sep 29.
  6. Sambrook PN, Geusens P, Ribot C, Solimano JA, Ferrer-Barriendos J, Gaines K, Verbruggen N, Melton ME.Alendronate produces greater effects than raloxifene on bone density and bone turnover in postmenopausal women with low bone density: results of EFFECT (Efficacy of FOSAMAX versus EVISTA Comparison Trial) International.J Intern Med. 2004 Apr;255(4):503-11.
  7. Walsh JP, Ward LC, Stewart GO, Will RK, Criddle RA, Prince RL, Stuckey BG, Dhaliwal SS, Bhagat CI, Retallack RW, Kent GN, Drury PJ, Vasikaran S, Gutteridge DH.A randomized clinical trial comparing oral alendronate and intravenous pamidronate for the treatment of Paget's disease of bone.Bone. 2004 Apr;34(4):747-54.

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Pharmacokinetics Articles

  1. Cremers SC, van Hogezand R, Banffer D, den Hartigh J, Vermeij P, Papapoulos SE, Hamdy NA.Absorption of the oral bisphosphonate alendronate in osteoporotic patients with Crohn's disease.Osteoporos Int. 2005 Dec;16(12):1727-30. Epub 2005 Jun 15.
  2. Stepensky D, Golomb G, Hoffman A.Pharmacokinetic and pharmacodynamic evaluation of intermittent versus continuous alendronate administration in rats.J Pharm Sci. 2002 Feb;91(2):508-16.

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Drug Interaction Articles

  1. Antoniucci DM, Sellmeyer DE, Bilezikian JP, Palermo L, Ensrud KE, Greenspan SL, Black DM.Elevations in Serum and Urinary Calcium with Parathyroid Hormone (1-84) with and without Alendronate for Osteoporosis.J Clin Endocrinol Metab. 2006 Dec 12.
  2. Black DM, Greenspan SL, Ensrud KE, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 2003;349:1207—15.
  3. Finkelstein JS, Hayes A, Hunzelman JL, et al. The effects of parathyroid hormone, alendronate or both in men with osteoporosis. N Engl J Med 2003;349:1216—26.
  4. Gomez-Garcia L, Esbrit P, Carreno L, Sabando P, Garcia-Flores M, Martinez ME.Alendronate interacts with the inhibitory effect of 1,25(OH)2D3 on parathyroid hormone-related protein expression in human osteoblastic cells.J Bone Miner Res. 2003 Jan;18(1):78-87.

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Adverse Effects Articles

  1. Aki S, Eskiyurt N, Akarirmak U, Tuzun F, Eryavuz M, Alper S, Arpacioglu O, Atalay F, Kavuncu V, Kokino S, Kuru O, Nas K, Ozerbil O, Savas G, Sendur OF, Soy D, Akyuz G; Turkish Osteoporosis Society.Gastrointestinal side effect profile due to the use of alendronate in the treatment of osteoporosis.Yonsei Med J. 2003 Dec 30;44(6):961-7.
  2. Baker DE.Alendronate and risedronate: what you need to know about their upper gastrointestinal tract toxicity.Rev Gastroenterol Disord. 2002;2(1):20-33.
  3. Bauer DC, Black D, Ensrud K, Thompson D, Hochberg M, Nevitt M, Musliner T, Freedholm D.Upper gastrointestinal tract safety profile of alendronate: the fracture intervention trial.Arch Intern Med. 2000 Feb 28;160(4):517-25.
  4. Coleman CI, Perkerson KA, Lewis A.Alendronate-induced auditory hallucinations and visual disturbances.Pharmacotherapy. 2004 Jun;24(6):799-802.
  5. Graham DY, Malaty HM.Alendronate and naproxen are synergistic for development of gastric ulcers.Arch Intern Med. 2001 Jan 8;161(1):107-10. Erratum in: Arch Intern Med 2001 Aug 13-27;161(15):1862.
  6. Greenspan S, Field-Munves E, Tonino R, Smith M, Petruschke R, Wang L, Yates J, de Papp AE, Palmisano J.Tolerability of once-weekly alendronate in patients with osteoporosis: a randomized, double-blind, placebo-controlled study.Mayo Clin Proc. 2002 Oct;77(10):1044-52.
  7. Lanza F, Sahba B, Schwartz H, Winograd S, Torosis J, Quan H, Reyes R, Musliner T, Daifotis A, Leung A.Lanza F, Sahba B, Schwartz H, Winograd S, Torosis J, Quan H, Reyes R, Musliner T, Daifotis A, Leung A.The upper GI safety and tolerability of oral alendronate at a dose of 70 milligrams once weekly: a placebo-controlled endoscopy study.Am J Gastroenterol. 2002 Jan;97(1):58-64.
  8. Maalouf NM, Heller HJ, Odvina CV, Kim PJ, Sakhaee K.Bisphosphonate-induced hypocalcemia: report of 3 cases and review of literature.Endocr Pract. 2006 Jan-Feb;12(1):48-53.
  9. Marshall JK, Rainsford KD, James C, Hunt RH.A randomized controlled trial to assess alendronate-associated injury of the upper gastrointestinal tract.Aliment Pharmacol Ther. 2000 Nov;14(11):1451-7.
  10. Yanik B, Turkay C, Atalar H.Hepatotoxicity induced by alendronate therapy.Osteoporos Int. 2007 Jan 17.

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Compliance Articles

  1. Segal E, Tamir A, Ish-Shalom S.Compliance of osteoporotic patients with different treatment regimens.Isr Med Assoc J. 2003 Dec;5(12):859-62.

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Pharmacoeconomic articles

  1. Brecht JG, Kruse HP, Mohrke W, Oestreich A, Huppertz E.Health-economic comparison of three recommended drugs for the treatment of osteoporosis.Int J Clin Pharmacol Res. 2004;24(1):1-10.
  2. Buckley LM, Hillner BE.A cost effectiveness analysis of calcium and vitamin D supplementation, etidronate, and alendronate in the prevention of vertebral fractures in women treated with glucocorticoids.J Rheumatol. 2003 Jan;30(1):132-8.
  3. Christensen PM, Brixen K, Gyrd-Hansen D, Kristiansen IS.Cost-effectiveness of alendronate in the prevention of osteoporotic fractures in Danish women.Basic Clin Pharmacol Toxicol. 2005 May;96(5):387-96.
  4. Johnell O, Jonsson B, Jonsson L, Black D.Cost effectiveness of alendronate (fosamax) for the treatment of osteoporosis and prevention of fractures.Pharmacoeconomics. 2003;21(5):305-14.
  5. Stevenson M, Lloyd Jones M, De Nigris E, Brewer N, Davis S, Oakley J.A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis.Health Technol Assess. 2005 Jun;9(22):1-160.

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External Links

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