Alendronic acid, like other bisphosphonates for oral administration, can cause local irritation of the mucosa of the upper gastrointestinal tract. In this regard, it is necessary to use Alendronate with caution in patients with problems of the upper gastrointestinal tract (such as Barrett's esophagus, dysphagia, other diseases of the esophagus, gastritis, duodenitis, or ulcers).
Patients taking alendronic acid are noted to have such side effects reactions like esophagitis, oesophageal ulcer and erosion of the esophagus, sometimes with bleeding, occasionally leading to the occurrence of strictures or perforation of the esophagus. In some cases, these adverse events can be severe and require hospitalization.
Therefore, doctors should closely monitor any symptoms, indicating a possible response from the esophagus. Patients should to warn about the need to stop taking Alendronate and consult a doctor in the occurrence of dysphagia, pain when swallowing or behind the sternum, the appearance or intensification of heartburn.
The risk of severe adverse events on the part of the esophagus is higher in patients who disobey the recommendations for taking the drug: you can not take a horizontal position after using the drug and / or take it without squeezing, according to recommendations, a full glass of water (170 - 230 ml), and / or continue to take it when symptoms of esophageal irritation appear. Patients who can not follow the dosing instructions due to mental illness should Take Alendronate treatment under appropriate control.
If you miss a regular weekly dose of the drug should take 1 tablet of Alendronate on the next day, in the morning. It is not recommended to take 2 tablets in 1 day. In the future, you should return to taking Alendronate once a week, on the same day of the week that was chosen for taking the drug from the beginning.
In the presence of hypocalcemia, the level of calcium in the blood should be normalized before treatment with Alendronate. Other disorders of mineral metabolism (eg, vitamin deficiency D) should also be eliminated. In patients with these disorders during treatment with Alendronate, it is necessary to control the content calcium in the serum and symptoms of hypocalcemia. Due to alendronic acid increases the content of mineral substances in the bone tissue, there may be a slight asymptomatic decrease in the concentration, calcium and phosphates in the blood serum, especially with Paget's bone disease, with initially significantly increased metabolic rate of bone tissue, as well as in patients receiving glucocorticoids, which is accompanied by a possible decrease in absorption calcium. It is especially important to ensure adequate intake of calcium and vitamin D in these patients. In rare cases, hypocalcemia can be severe, usually in patients with predisposition to this complication (hypoparathyroidism, vitamin D deficiency, calcium malabsorption).
Stomatology.
In patients taking bisphosphonates, including alendronic acid, there were cases of local osteonecrosis of the jaw associated mainly with previous tooth extraction and / or local infection (including osteomyelitis), often with slow recovery. In most cases, local osteonecrosis of the jaw against the background of bisphosphonate reception occurs in cancer patients receiving bisphosphonates intravenously. Risk factors for local osteonecrosis of the jaw include invasive dental procedures (for example, tooth extraction, dental, implants, bone surgery), oncological disease, concomitant therapy (eg chemotherapy, radiation therapy, corticosteroids), poor oral hygiene, concomitant pathologies for example, periodontal disease and / or other diseases teeth / anemia, coagulopathy, infection, improperly seated dentures) and smoking. In patients for whom invasive dental procedures are necessary, discontinuing bisphosphonate treatment may reduce the risk of osteonecrosis of the jaw.When preparing a treatment plan for each patient, it is necessary to follow the clinical judgment of the attending physician. and / or a dental surgeon, taken on the basis of an individual benefit / risk ratio estimate. Patients who developed local osteonecrosis of the jaw during treatment with bisphosphonate should be monitored by a dental surgeon. The condition of these patients can be exacerbated by extensive dental surgery for the treatment of osteonecrosis of the jaw. Consideration should be given to the need to discontinue bisphosphonate therapy, based on an individual benefit / risk ratio estimate.
Musculoskeletal pain.
Strong, sometimes disabling pains in the bones, joints and / or muscles of patients taking bisphosphonates (including alendronic acid), prescribed for the treatment of osteoporosis, most of them in women in the post-menopausal period. Symptoms appear between one day and several months after starting the drug. With the development of severe symptoms the drug should be discontinued. Most patients have symptoms after discontinuation of the drug.
When strong musculoskeletal patient should be inform the doctor about this.
Atypical susceptible and diaphyseal fractures of the femur.
There are data on atypical, low-energy, or low-traumatic fractures of the diaphysis of the femur in patients receiving bisphosphonate treatment. Such fractures can be localized anywhere in the femoral diaphysis, from a fracture directly under the small trochanter of the femur to the epicondylar fracture, and are transverse or oblique in the direction without signs of fragmentation. Causal dependence has not been established, as these fractures also occur in patients suffering from osteoporosis who are not receiving bisphosphonate treatment.
Atypical fractures of the femur often occur with minimal damage to the affected area or in its absence. They can be bilateral, and in many patients there are prodromal pains in the affected area, usually manifested as a dull, aching pain in the thigh, felt for several weeks to months before a complete fracture.In several cases, it was noted that patients also received glucocorticoid therapy at the time of the fracture.
In all patients receiving Alendronate, with complaints of pain in the thigh or in the groin, it is necessary to exclude an atypical or incomplete fracture of the thigh.
Patients with an atypical fracture should also be examined for symptoms and signs of fracture in the contralateral limb. Consideration should be given to discontinuing bisphosphonate therapy based on an individual benefit / risk ratio estimate.