Special attention should be paid to any signs of the emergence of side effects. reactions in the esophagus. The patient should be informed of the possible risk of damage to the mucous membrane of the esophagus if the instructions for use are not complied with and the need to stop taking Tevant® and contact a doctor for dysphagia, pain when swallowing, chest pain, or the appearance or intensification of heartburn.
In connection with the existing risk of irritation of the mucous membrane of the upper part of the gastrointestinal tract, as well as aggravation of the course of the underlying disease,caution should be exercised when prescribing Tevant® to patients with gastrointestinal disorders in the exacerbation phase, including dysphagia, gastroesophageal reflux disease, gastritis, duodenitis, peptic ulcer and duodenal ulcer, and recent (during the previous year) gastrointestinal diseases (ulcerative stomach and duodenal ulcers, active bleeding from the digestive tract, surgical intervention in the upper gastrointestinal tract, except pyloroplasty).
In patients with Barrett's esophagus, therapy with Tevanat® should be started only after a thorough assessment of the relationship between the intended benefit and the possible risk of esophageal cancer.
There are reports of cases of osteonecrosis of the jaw, usually associated with tooth extraction and / or local infection (including osteomyelitis), in patients with oncological diseases receiving treatment regimens including bisphosphonates (BF) (primarily intravenous). Many of these patients also received chemotherapy and corticosteroids. There are also reports of osteonecrosis of the jaw in patients with osteoporosis receiving oral bisphosphonates.Prior to the use of bisphosphonates, patients with concomitant risk factors (eg, cancer, chemotherapy, radiation therapy, corticosteroid therapy, insufficient oral hygiene) should undergo dental examination with appropriate preventive dental treatment. Patients in the treatment of BF should, whenever possible, avoid invasive dental procedures. In patients with osteonecrosis of the jaw, who are on therapy with BF, dental surgical interventions can lead to deterioration. If it is necessary to perform surgical interventions, 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 abolition of the BF. The appointments and recommendations of the attending physician should be based on an individual assessment of the benefit / risk ratio for each patient.
If the patient forgot to take the Tevanat® pill, then it should be taken the next morning. Do not take two tablets in one day, you need to continue taking 1 tablet once a week on the day that was chosen for admission from the beginning of treatment.
In patients with hypocalcemia, hypovitaminosis D and hypoparathyroidism, it is necessary to carry out corrective therapy of mineral metabolism disorders before the beginning of treatment with Tevanat®. Due to the positive effect of alendronic acid on bone mineral density during treatment, there may be a slight asymptomatic decrease in the concentration of calcium and phosphorus in the blood serum. There are isolated reports of symptomatic hypocalcemia, sometimes severe, usually in patients with a predisposition to it (eg, hypoparathyroidism, vitamin deficiency D, malabsorption of calcium).
There are reports of stress fractures in the proximal femur with prolonged treatment with Tevanat®. (from 18 months to 10 years). Fractures occurred after minimal injury or without it. Some patients initially experienced pain in the proximal part of the thigh that persisted for several weeks or even months before the symptom ended with a fracture of the femur. Often fractures were bilateral, so when fracture of one femur in the patient, it is necessary to monitor the condition of the other femur.
In patients taking Tevanat ®, especially with concomitant therapy with glucocorticosteroid drugs, it is extremely important to ensure sufficient intake of calcium and vitamin D with food or in the form of medicines.
Absorption of BF is significantly reduced with simultaneous intake of food.