What patient education is necessary for individuals taking Fosamax (alendronate)?

Patient Education for Individuals Taking Fosamax (Alendronate)

Patients taking Fosamax (alendronate) must be instructed to take it with a full glass of plain water first thing in the morning, at least 30 minutes before any food, beverage, or other medication, and to remain upright for at least 30 minutes afterward to ensure proper absorption and minimize the risk of esophageal irritation.

Administration Instructions

• Timing and method:

  • Take Fosamax on an empty stomach after an overnight fast
  • Take with 6-8 ounces (full glass) of plain water only
  • Remain upright (sitting or standing) for at least 30 minutes after taking
  • Wait at least 30 minutes before consuming any food, beverage, or other medications
  • Do not take with orange juice, coffee, or other beverages as this markedly reduces absorption 1

• Dosing schedule:

  • For weekly dosing (preferred): 70 mg once weekly on the same day each week
  • For daily dosing: 10 mg daily 2
  • If a weekly dose is missed, take one dose on the morning after remembering, then return to the original weekly schedule 1

• Important warnings:

  • Do not chew or suck on the tablet (risk of oropharyngeal ulceration)
  • Do not lie down after taking the medication
  • Do not take at bedtime or before getting out of bed 1

Nutritional Supplementation

• Ensure adequate calcium intake (1000-1200 mg daily) through diet or supplements
• Take vitamin D supplements (600-800 IU daily) as recommended
• Take calcium supplements at a different time of day than Fosamax 2

Potential Side Effects to Monitor

• Common side effects:

  • Upper GI symptoms (abdominal pain, dyspepsia, acid regurgitation)
  • Musculoskeletal pain 2

• Serious side effects requiring immediate medical attention:

  • Difficulty or pain when swallowing
  • Retrosternal (chest) pain
  • New or worsening heartburn
  • Stop taking Fosamax and consult physician if these occur 1

• Rare but serious side effects:

  • Osteonecrosis of the jaw (more common with IV bisphosphonates)
  • Atypical femoral fractures 2

Preventive Measures

• Complete any necessary dental work before starting therapy when possible
• Maintain good oral hygiene
• Inform dentist about Fosamax use before procedures 2
• Engage in weight-bearing exercise as tolerated
• Modify behavioral factors such as smoking cessation and limiting alcohol consumption 1

Monitoring

• Bone mineral density (BMD) testing may be performed every 1-2 years
• Follow-up with healthcare provider regularly to assess effectiveness and need for continued therapy
• The optimal duration of therapy is typically 5 years, after which continuation should be reassessed 2

Special Considerations

• Fosamax is not recommended for patients with severe renal impairment (creatinine clearance <35 mL/min)
• Hypocalcemia should be corrected before starting therapy
• Patients with esophageal abnormalities should discuss alternatives with their healthcare provider 2

Following these specific instructions will maximize the effectiveness of Fosamax therapy while minimizing potential adverse effects, ultimately reducing fracture risk and improving long-term bone health.