Uses

What is alendronate used for?

Alendronate is commonly used for the following conditions.

  • Treatment or prevention of osteoporosis in women after menopause; osteoporosis is a condition in which your bones become thin and weak and may break more easily.
  • Treatment of osteoporosis in men
  • Treatment or prevention of osteoporosis caused by steroid drug therapy
  • Treatment of Paget’s Disease, a condition in which your body’s natural bone-building process is disrupted, causing your bones to become weak and misshapen

Alendronate may also be used for other conditions as determined by your healthcare provider.

How does alendronate work (mechanism of action)?

Alendronate slows the natural breakdown of your bones. This helps them stay stronger and reduces the risk for bone fractures.

How is alendronate supplied (dosage forms)?

Alendronate is available as Binosto, Fosamax, and generic alendronate in the following dosage forms that are taken by mouth.

  • 5 mg oral tablets
  • 10 mg oral tablets
  • 35 mg oral tablets
  • 40 mg oral tablets
  • 70 mg oral tablets
  • 70 mg effervescent tablets for oral solution
  • 70 mg/75 mL oral solution

How should I store alendronate?

Oral Tablets and Solution. Alendronate oral tablets and solution should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Keep tightly closed. Protect from light and moisture.

Effervescent Tablets. Alendronate effervescent tablets should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Each effervescent tablet should be kept in the original blister pack until ready to use. Store in a cool, dry place. Protect from light and moisture.

Side Effects

What are the most common side effects of alendronate?

The most common side effects of alendronate are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Stomach pain
  • Heartburn
  • Constipation
  • Diarrhea
  • Upset stomach or indigestion
  • Bone, joint, or muscle pain (see below)
  • Nausea

There may be other side effects of alendronate that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of alendronate?

While less common, the most serious side effects of alendronate are described below, along with what to do if they happen.

Severe Allergic Reactions. Alendronate may cause allergic reactions, which can be serious. Stop taking alendronate and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Esophagus Problems. Taking alendronate by mouth may irritate the esophagus or upper part of your gastrointestinal (GI) tract. This irritation can be worse in people who already have stomach or esophagus problems. In some cases, it can lead to problems such as ulcers, bleeding, or tears in the esophagus, which may require hospitalization. Stop taking alendronate and call your healthcare provider right away if you have any of the following symptoms.

  • Trouble or pain while swallowing 
  • Chest pain
  • New or worsening heartburn

Low Calcium Level (Hypocalcemia). Alendronate can cause low calcium levels, also known as hypocalcemia, which can be serious. Decreased calcium levels can cause a rare dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium, or who take some medicines for other heart rhythm problems. Call your healthcare provider if you have any of the following symptoms.

  • Changes in your heart rate or rhythm, such as fast or skipping heartbeat
  • Fainting
  • Numbness, tingling, or burning sensation in your arms, feet, or face (paresthesia)
  • Muscle pain, spasms, twitching, or cramps
  • Seizures

Severe Pain in the Bones, Joints, or Muscles. Alendronate may cause severe pain in the bones, joints, or muscles (musculoskeletal pain). The pain can be severe enough that it could be difficult to carry out normal activities. Call your healthcare provider if you experience severe pain while on alendronate.

Severe Jawbone Problems (Osteonecrosis). Alendronate can rarely cause severe jawbone problems, also called osteonecrosis of the jaw. In this condition, your jawbone may get damaged due to reduced blood flow. You may be at higher risk if you are undergoing certain dental procedures (such as a tooth extraction or dental implants), if you have poor oral health, or if you have cancer or certain other conditions. You may be told to see a dentist before starting alendronate and to practice good mouth care. Call your healthcare provider right away if you experience any of the following symptoms of jaw osteonecrosis.

  • Jaw pain or discomfort
  • Mouth sores
  • Loose teeth

Unusual Thigh Bone Fractures. Alendronate may cause an increased risk for fractures in your thigh bone, even with a light force. Call your healthcare provider if you experience new or unusual pain in your thigh, hip, or groin.

Warnings & Precautions

Who should not use alendronate?

Allergies to Ingredients. People who are allergic to any of the following should not take alendronate.

  • Alendronate
  • Fosamax
  • Binosto
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific alendronate products they stock.

Esophagus Problems. Alendronate should not be taken if you have problems with your esophagus. Alendronate can cause irritation, inflammation, or sores in your esophagus if you already have esophagus problems.

Unable to Sit Upright or Stand. Alendronate is not recommended if you cannot sit upright or stand for at least 30 minutes. You need to be able to sit upright or stand for this long to reduce your risk of irritation of the esophagus.

Low Calcium Levels (Hypocalcemia). Alendronate can cause low calcium levels, also known as hypocalcemia. It should not be used if you have low blood calcium levels.

Kidney Problems. Alendronate should not be taken if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your healthcare provider may do tests to determine if they are working well enough for you to take this medicine.

Risk of Accidental Inhalation (Aspiration). Alendronate oral solution is not recommended if you are at an increased risk of accidentally inhaling the liquid into your airway. This can include those who often have trouble swallowing.

What should I know about alendronate before using it?

Do not take alendronate unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share alendronate with other people, even if they have the same condition as you. It may harm them.

Keep alendronate out of the reach of children.

Take alendronate after you get up for the day. Take it on an empty stomach, at least 30 minutes before the first food or drink (other than plain water) of the day and before taking any other medicines or supplements. Alendronate will work only if it is taken on an empty stomach. 

Do not eat or drink anything except plain water, or take other medicines for at least 30 minutes after taking alendronate. Do not take it with mineral water, coffee, tea, soda, or juice. These may make alendronate not work as well. See the Interactions section for more details. 

In order to lower the risk of irritation of the esophagus, follow the instructions below for the alendronate product prescribed to you.

  • Oral Tablets. Swallow the tablet whole with a full glass (6 to 8 ounces) of plain water. 
  • Effervescent Tablets. Dissolve the tablet in a half glass (4 ounces) of plain water at room temperature (do not use hot or cold water). Wait at least 5 minutes after the bubbling stops to make sure that the tablet has completely dissolved. Stir the mixture  for about 10 seconds, then drink the entire liquid.
  • Oral Solution. After taking a dose, drink at least a quarter cup (2 ounces) of plain water to make sure that the medicine washes down completely.

Sit upright or stand when you take alendronate and afterwards. Do not lie down for at least 30 minutes after you take your dose of alendronate. You may sit, stand, walk, or do other activities where you are upright (like reading). 

Do not chew or suck on alendronate tablets, including effervescent tablets. This could lead to irritation or sores in the mouth or throat.

If you are taking alendronate oral solution, use an accurate measuring device to measure your dose. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist to recommend an appropriate measuring device.

Your healthcare provider may tell you to take calcium and vitamin D supplements while using alendronate. Wait at least 30 minutes after taking a dose of alendronate before taking any other medicines or supplements by mouth. 

Your healthcare provider may recommend that you have a dental exam before starting treatment with alendronate.

Talk with your healthcare provider about how long you should use alendronate. 

What should I tell my healthcare provider before using alendronate?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if alendronate is right for you.

In particular, make sure that you discuss any of the following.

Problems Absorbing Nutrients. Tell your healthcare provider if you have been told that you have malabsorption syndrome, a condition where you have trouble absorbing minerals in the stomach or intestines. Alendronate may increase the risk of side effects if you already have this condition.

Esophagus, Stomach, or Intestine Problems. Tell your healthcare provider if you have any problems in your upper digestive tract, including Barrett’s esophagus (a condition where the lining of your esophagus thickens), stomach ulcers, or any inflammation. Alendronate can irritate your digestive tract and worsen these conditions.

Planned Dental Surgery. Tell your healthcare provider if you are planning to undergo any dental treatments, such as tooth extraction or dental implant surgery, while using alendronate. Certain dental procedures may increase the risk of osteonecrosis of the jaw.

Other Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Trouble swallowing
  • Low calcium levels (hypocalcemia)
  • Kidney problems
  • Poor oral health or dental problems (including use of dentures)
  • Cancer
  • Blood disorders

Other Medicines and Supplements. Alendronate may interact with other medicines and supplements. Before using alendronate, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Low Sodium Diet. Each effervescent tablet contains 650 mg of sodium. Tell your healthcare provider if you have to maintain low sodium intake. 

Pregnancy. It is not known if or how alendronate could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.  If you become pregnant while taking alendronate, stop taking it right away and contact your healthcare provider. 

Breastfeeding. It is not known if alendronate passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take alendronate while breastfeeding.

Interactions

Does alendronate interact with foods or drinks?

Avoid eating food or drinking beverages (including mineral water, coffee, tea, soda, juice, or milk) other than plain water within 30 minutes of taking alendronate, because this may decrease the amount of medicine your body absorbs and make it not work as well. 

It is unknown if drinking alcohol will affect alendronate.

Does alendronate interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using alendronate.

  • An antacid, supplement, or vitamin containing calcium, aluminum, magnesium, or iron
  • A nonsteroidal anti-inflammatory drug (NSAIDs) such as aspirin, ibuprofen, naproxen, and others, which are contained in many prescription and OTC products for pain, swelling, and fever
  • A corticosteroid, which is a medicine for certain inflammatory conditions
  • Chemotherapy or radiation for treating cancer
  • Levothyroxine, which is a thyroid medicine used to raise your thyroid hormone levels

This may not be a complete list of medicines that can interact with alendronate. Always check with your healthcare provider.

Does Alendronate interact with other drugs you are taking?
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Overdose/Missed Dose

What should I do if I accidentally use too much alendronate?

If you or someone else has used too much alendronate, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222. Do not try to vomit. Do not lie down.

What should I do if I miss a dose of alendronate?

If you miss a dose of alendronate, do not take it later in the day. Take the missed dose the morning after the day you remember, and then return to your normal schedule. Do not take 2 doses on the same day. 

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