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

Patient Education for Fosamax (Alendronate)

Critical Administration Instructions

Patients must take Fosamax with a full glass (6-8 ounces) of plain water only, first thing in the morning on an empty stomach, at least 30 minutes before any food, beverage, or other medication, and must remain upright (sitting or standing) for at least 30 minutes after taking the medication. 1

Specific Morning Routine

• Take the tablet immediately upon arising for the day, before eating or drinking anything 1
• Use only plain water—never orange juice, coffee, or any other beverage, as these markedly reduce absorption 1
• Swallow the tablet whole with a full glass of water; do not chew, crush, or suck on the tablet due to risk of mouth and throat ulcers 1
• Remain upright (standing or sitting) for at least 30 minutes after taking the dose 1
• Wait at least 30 minutes before consuming the first food, beverage, or medication of the day 1
• Never take Fosamax at bedtime or while still in bed 1

Why These Instructions Matter

• Failure to follow these specific instructions significantly increases the risk of serious esophageal problems, including ulceration 1
• The upright position and water intake facilitate delivery to the stomach and reduce esophageal irritation 1
• Food and beverages interfere with gastrointestinal absorption, reducing effectiveness 2

Absolute Contraindications—When NOT to Take Fosamax

Patients should not take Fosamax if they have: 3

• Esophageal abnormalities that delay esophageal emptying 4, 3
• Inability to stand or sit upright for at least 30 minutes 4, 3
• Current hypocalcemia (low blood calcium) 4, 3
• Hypersensitivity to any component of the product 4, 3
• Increased risk of aspiration 3

Warning Signs—When to Stop and Call Your Doctor

Patients must immediately stop taking Fosamax and contact their physician if they develop: 1

• Difficulty or pain with swallowing
• Chest pain behind the breastbone (retrosternal pain)
• New or worsening heartburn
• Any symptoms suggesting esophageal problems

Required Supplementation

• Take supplemental calcium (1000-1200 mg daily) and vitamin D (800 IU daily) unless dietary intake is adequate 4, 1
• Vitamin D levels should ideally be checked before starting therapy, with a target of ≥30 ng/mL 4
• If vitamin D deficiency is present, it must be corrected before starting bisphosphonates to prevent hypocalcemia 4, 3

Dosing Schedule

For Osteoporosis Treatment

• Standard dose: 70 mg once weekly 4
• Alternative formulation: Fosamax Plus D (70 mg alendronate plus 2,800 IU or 5,600 IU vitamin D) once weekly 4

If You Miss a Dose

• Take one dose the morning after you remember 1
• Do not take two doses on the same day 1
• Return to your regular once-weekly schedule on your chosen day 1

Lifestyle Modifications

Patients should be counseled to: 5

• Engage in weight-bearing exercise
• Stop smoking
• Limit alcohol consumption to two or fewer units daily
• Maintain adequate calcium intake through diet and supplements

Duration of Therapy and Monitoring

• Treatment typically continues for 5-10 years, after which a drug holiday may be considered due to concerns about rare long-term adverse effects 4, 5
• Bone mineral density should be monitored every 1-2 years during long-term therapy 5
• Fracture protection may persist for up to 5 years after stopping therapy 4

Rare but Serious Adverse Effects

Patients should be aware of uncommon but serious risks: 6

• Osteonecrosis of the jaw (MRONJ): Rare, with incidence less than one to 28 cases per 100,000 person-years; risk increases with duration of therapy beyond 2 years 6
• Atypical femoral fractures: Incidence ranges from 3.0 to 9.8 cases per 100,000 patient-years 6
• Inform your dentist that you are taking Fosamax before any dental procedures 3

Special Populations

Renal Impairment

• Fosamax should not be used in patients with kidney disease and GFR < 35 mL/min/1.73 m² 4
• Renal function should be assessed before starting therapy, especially in elderly patients 4

Elderly Patients

• Age-related decline in kidney function may require dose adjustment 4
• Elderly patients with multiple medications may have increased risk of drug interactions 4

Common Pitfalls to Avoid

• Never take with coffee, juice, or any beverage other than plain water 1
• Never lie down within 30 minutes of taking the medication 1
• Never take on a full stomach or after eating 1
• Never chew or dissolve the tablet in your mouth 1