Guidelines for Taking Oral Fosamax (Alendronate)
Alendronate (Fosamax) must be taken with a full glass of plain water (6-8 oz) first thing in the morning, at least 30 minutes before any food, beverage, or other medication, and patients must remain upright for at least 30 minutes afterward to reduce the risk of esophageal adverse effects. 1
Proper Administration Technique
- Take alendronate immediately upon arising for the day, with plain water only (6-8 ounces) 1
- Wait at least 30 minutes before consuming any food, other beverages (including mineral water), or other medications 1
- Remain upright (sitting or standing) for at least 30 minutes after taking the medication and until after your first food of the day 1
- Swallow tablets whole - do not chew, crush, or suck on the tablet as this may cause oropharyngeal ulceration 1
- Never take alendronate at bedtime or before getting out of bed 1
Dosing Options
- For postmenopausal osteoporosis treatment: 70 mg once weekly or 10 mg once daily 1
- For osteoporosis prevention in postmenopausal women: 35 mg once weekly or 5 mg once daily 1
- For treatment of osteoporosis in men: 70 mg once weekly or 10 mg once daily 1
- For glucocorticoid-induced osteoporosis: 5 mg once daily (10 mg daily for postmenopausal women not on estrogen) 1
Weekly Dosing Benefits
- Once-weekly 70 mg dosing provides therapeutic equivalence to daily 10 mg dosing 2
- Weekly dosing may enhance compliance and long-term persistence with therapy 3, 2
- Weekly dosing may be associated with fewer serious upper GI adverse events compared to daily dosing 2
Missed Dose Instructions
- If a once-weekly dose is missed, take one dose on the morning after remembering 1
- Do not take two doses on the same day 1
- Return to taking one dose once a week on your originally chosen day 1
Important Precautions
- Do not take alendronate if you have abnormalities of the esophagus or cannot sit/stand upright for at least 30 minutes 4, 1
- Discontinue and consult your physician if you develop symptoms of esophageal disease (difficulty swallowing, pain when swallowing, retrosternal pain, new or worsening heartburn) 1
- Patients at increased risk of aspiration should not receive alendronate solution 4
Supplementation Requirements
- Take supplemental calcium if dietary intake is inadequate 1
- Vitamin D supplementation may be needed, especially for those over 70 years, nursing home-bound, or chronically ill 1
- Patients with gastrointestinal malabsorption syndromes may require higher doses of vitamin D supplementation 1
- Patients treated with glucocorticoids should receive adequate amounts of calcium and vitamin D 1
Additional Lifestyle Recommendations
- Engage in weight-bearing exercise 4, 1
- Stop smoking 4
- Limit alcohol consumption to two or fewer units daily 4
- Maintain adequate calcium intake through diet and supplements 4
Monitoring
- For patients on long-term bisphosphonate therapy, bone mineral density (BMD) with vertebral fracture assessment or spinal x-ray should be performed every 1-2 years 4
- Some experts recommend considering interruption of bisphosphonate therapy after five years due to concerns about long-term safety 4
By following these specific guidelines for taking oral Fosamax, patients can maximize the medication's effectiveness while minimizing the risk of adverse effects, particularly those affecting the esophagus and upper gastrointestinal tract.