To drink Alendronate should be only ordinary water, since other beverages (including mineral water, coffee, tea, orange juice) reduce the absorption of alendronic acid.
Absorption of bisphosphonates is significantly reduced by simultaneous intake of food.
To reduce the irritating effect on the esophagus, Alendronate must be taken immediately after the morning ascent, with a full glass of water. After taking, you should be in a vertical position (standing or sitting) for 30 minutes (it is dangerous to use the drug in case the patient is unable to stand or sit for a specified time). Taking alendronate before bed or in a horizontal position increases the risk of esophagitis.
The patient should be informed of the need to stop taking Alendronate and contact a doctor when developing dysphagia, the appearance of pain during swallowing, chest pain, or heartburn.
With hypocalcemia, it is necessary to correct it before starting treatment. Including it is necessary to eliminate the disturbances of mineral metabolism, leading to hypocalcemia (vitamin deficiency D, hypoparathyroidism, calcium malabsorption). Therapy should be carried out against a background of a diet enriched with calcium salts.
When taking bisphosphonates (especially with concomitant therapy with glucocorticosteroid drugs), it is necessary to ensure the intakeadequate amounts of calcium and vitamin D with food or in the form of medicines.
In the course of treatment, due to the positive effect of alendronic acid on the bone mineral density, there may be a slight asymptomatic decrease in the concentration of calcium and phosphate in the blood serum.
Prior to the appointment of bisphosphonate therapy to patients with concomitant risk factors (eg cancer, chemotherapy, radiation therapy, intake of glucocorticoid preparations, insufficient oral hygiene), a dental examination with appropriate preventive dental treatment should be performed.
Patients on bisphosphonate treatment should avoid invasive dental procedures whenever possible. Osteonecrosis of the jaw, usually associated with tooth extraction and / or local infection (including osteomyelitis), has been reported in cancer patients who received bisphosphonates intravenously (many of whom also received chemotherapy and glucocorticosteroid medications). There are reports of the development of osteonecrosis of the jaw in patients with osteoporosis in the background of the use of bisphosphonates inside.
In patients with osteonecrosis of the jaw and those on bisphosphonate therapy, dental surgical interventions can lead to deterioration. If surgical intervention is necessary, it should be taken into account that there is no data on the possibility of reducing the risk of developing an osteonecrosis of the jaw after the bisphosphonate has been withdrawn.
The appointments and recommendations of the attending physician should be based on an individual assessment of the benefit / risk ratio for each patient.