Osterepar®, like other bisphosphonates, can cause local irritation of the mucous membrane of the upper gastrointestinal tract.Patients treated with Osterepar® receive side effects such as esophagitis, esophageal ulcers, and erosion of the esophagus, which occasionally lead to the development of strictures or perforation of the esophagus. In some cases, these undesirable phenomena may be severe and require hospitalization, so you should carefully monitor any symptoms that indicate possible abnormalities on the part of the esophagus. Patients should be cautioned to stop taking Ostaperpar® and seek medical attention if dysphagia, swallowing pain or chest pain occurs, or if heartburn occurs.
The risk of severe adverse events on the side of the esophagus is higher in patients who violate the recommendations for taking the drug and / or continue to take it when symptoms of esophageal irritation appear. It is especially important that the patient has recommendations for taking the drug, understood them and was informed that the risk of developing an esophageal lesion increases if these recommendations are not followed.
There are rare cases of the occurrence of gastric and duodenal ulcers, sometimes severe and complicated (the cause-and-effect relationship with taking the drug is not established).
Osterepar® The drug should be used with caution in patients with exacerbations of upper gastrointestinal diseases, such as dysphagia, oesophageal disease, gastritis, duodenitis and ulcers due to possible irritating effect of the drug on the mucosa of the upper gastrointestinal tract and the worsening of the underlying disease.
The decision to perform treatment should be taken individually for each patient after a thorough assessment of the risk / benefit ratio, especially for patients with Barrett's esophagus.
There are cases of local osteonecrosis of the jaw associated mainly with the previous extraction of the tooth and / or a local infection (including osteomyelitis), often with a slow recovery.
In most cases, osteonecrosis of the jaw in patients receiving bisphosphonates occurs in cancer patients treated with bisphosphonates in /. Known risk factors for osteonecrosis of the jaw include a cancer concomitant therapy (e.g., chemotherapy, radiotherapy, corticosteroids), poor oral hygiene and associated pathology (e.g., periodontal diseases and / or other dental diseases, anemia, coagulopathy, infection), and smoking.Patients who develop osteonecrosis of the jaw must be provided with specialized medical care by the maxillofacial surgeon, and the question of the abolition of bisphosphonate therapy should be considered based on an individual assessment of the risk / benefit ratio. Dental surgery can lead to a worsening of the condition.
The tactics of treating each patient who needs an invasive dental intervention (for example, tooth extraction, implantation), including bisphosphonate therapy, should be based on the clinical judgment of the attending physician and / or maxillofacial surgeon and the individual risk / benefit ratio. There have been reports of pain in the bones, joints and / or muscles in patients receiving bisphosphonates. These symptoms are rarely severe and / or lead to disability. The time to onset of symptoms varies from one day to several months from the start of therapy. In most patients, after the cessation of therapy, symptoms recede, but some patients appear again after the resumption of the same drug or other bisphosphonate.Reported on the emergence of pathological (i.e., under the influence of minor force or spontaneous) susceptible fractures or fractures of the proximal parts of the femoral diaphysis in a small number of patients taking bisphosphonates. Some of the fractures were classified as stressful (also known as stress fracture, march fracture, Deutscheland fracture) that occur in the absence of trauma. Some patients experienced prodromal pains in the affected area weeks or months before the onset of a complete fracture, often associated with a characteristic radiographic picture of a stress fracture. The number of reports was very small, in addition, stress fractures with similar clinical features occur in patients who do not take bisphosphonates. Patients with stress fractures should be examined with an assessment of known causes and risk factors (eg, vitamin deficiency D, infringement of absorption, use of corticosteroids, stress fracture in anamnesis, arthritis or fracture of lower limb, excessive or increased loads, diabetes, chronic alcoholism) and provide them with proper orthopedic care.Approximately one-third of stress fractures were bilateral; accordingly, in patients who underwent fracture of the femoral bone, the contralateral femur should be examined. Prior to receiving the results of the survey, consideration should be given to stopping the use of bisphosphonates in patients with stress fractures, based on an assessment of the benefit / risk ratio in each specific case.
Patients should be warned that if they miss a dose of Osterepar® once a week, they should take one pill in the morning of the next day. You should not take two doses in one day, but in the future you should return to reception the drug once a week on the day of the week that was selected at the beginning of the treatment. Other causes of osteoporosis should be taken into account, in addition to estrogen deficiency, age and treatment with glucocorticoids.
In the presence of hypocalcemia, the level of calcium in the blood should be normalized before starting treatment with Osterepar®. Other disorders of mineral metabolism (eg, vitamin deficiency D) should also be eliminated. In patients with these disorders it is necessary to monitor the calcium content in the blood and the symptoms of hypocalcemia.
Because Ostherepar® increases the mineral content in the bones, there may be a slight asymptomatic decrease in serum calcium and phosphate levels, especially in the case of 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 a decrease in calcium absorption. It is especially important to ensure adequate intake of calcium and vitamin in the body D in these patients.
In rare cases, hypocalcemia can be severe, usually in patients with a predisposition to this complication (hypoparathyroidism, vitamin deficiency D, malabsorption of calcium).
The preparation contains lactose. Patients with a deficiency of lactase, intolerance to galactose, glucose-galactose malabsorption should refrain from using the drug.