From the FDA Drug Label
Patients being treated with zoledronic acid injection should not be treated with Reclast®. [see Warnings and Precautions (5. 1)] Inform patients not to take Reclast® or other bisphosphonates during the course of their zoledronic acid injection therapy [see Warnings and Precautions (5. 1)].
The patient should not take Fosamax (alendronate) the Monday before a Reclast (zoledronic acid) infusion, as the label advises against taking other bisphosphonates during the course of zoledronic acid injection therapy 1.
From the Research
No, a patient should not take Fosamax (alendronate) the Monday before receiving a Reclast (zoledronic acid) infusion, as this can increase the risk of adverse effects such as hypocalcemia, osteonecrosis of the jaw, and atypical femur fractures without providing additional therapeutic benefit 2. The patient should discontinue their oral Fosamax at least 1-2 weeks before receiving Reclast.
Reasons for Discontinuation
- Combining bisphosphonates can increase the risk of side effects without improving bone density outcomes
- The risk of hypocalcemia, a potentially life-threatening condition, is increased when bisphosphonates are taken together 3, 4
- Other adverse effects such as osteonecrosis of the jaw and atypical femur fractures can also occur with combined bisphosphonate therapy
Alternative Treatment Plan
- After receiving the Reclast infusion, which typically lasts for 12 months, the patient should not resume Fosamax unless specifically directed by their healthcare provider
- The patient should inform their healthcare provider about all medications they are taking to ensure proper coordination of their osteoporosis treatment plan
- According to a recent study, zoledronic acid injection in combination with alendronate sodium can increase bone mineral density and modulate IL-6, TNF-α, and IGF-1 in patients with osteoporosis, but this should be done under close medical supervision 2
Key Considerations
- The patient's healthcare provider should be informed of all medications being taken to ensure proper coordination of osteoporosis treatment
- Regular monitoring of bone mineral density and serum levels of IL-6, TNF-α, and IGF-1 can help assess the effectiveness of treatment and minimize the risk of adverse effects 2