What patient education is necessary for a patient taking Fosamax (alendronate) to minimize side effects and ensure safe use?

Patient Education for Fosamax (Alendronate)

Patients taking Fosamax must take it first thing in the morning on an empty stomach with a full glass (6-8 oz) of plain water only, remain upright for at least 30 minutes, and wait 30 minutes before eating, drinking anything else, or taking other medications to minimize serious esophageal complications and ensure drug absorption. 1

Critical Administration Instructions

Timing and Preparation

• Take alendronate immediately upon arising for the day, after an overnight fast and before any food, beverage, or other medication 1
• Swallow the tablet whole with a full glass (6-8 oz) of plain water only—never with coffee, tea, juice, or mineral water, as these markedly reduce absorption 1
• Do not chew or suck on the tablet due to risk of oropharyngeal ulceration 1

Post-Administration Requirements

• Remain sitting or standing upright for at least 30 minutes after taking the medication 1
• Do not lie down until at least 30 minutes have passed AND after eating your first food of the day 1
• Never take alendronate at bedtime or before arising for the day 1
• Failure to follow these instructions significantly increases the risk of severe esophageal problems, including ulcerations and erosions 1, 2

Contraindications and When NOT to Take Fosamax

Absolute Contraindications

• Patients with esophageal abnormalities that delay esophageal emptying should not take alendronate 3, 1
• Those unable to sit or stand upright for at least 30 minutes must not use this medication 3, 1
• Patients with hypocalcemia (low blood calcium) cannot take alendronate until calcium levels are corrected 1
• Those at increased risk of aspiration should not receive alendronate solution 3

Essential Supplementation

Calcium and Vitamin D Requirements

• All patients must take supplemental calcium (1,000-1,200 mg daily) and vitamin D (400-800 IU daily) if dietary intake is inadequate 4, 1
• Vitamin D levels should be checked before starting therapy, with a target serum 25(OH)D level ≥30 ng/mL 5
• For vitamin D deficiency (levels <30 ng/mL), ergocalciferol 50,000 IU weekly for 8 weeks is recommended, then recheck levels 5
• Take calcium and vitamin D supplements at least 30 minutes after taking alendronate, never at the same time 1

Dosing Schedule

Weekly Dosing (Most Common)

• Take one 70 mg tablet once weekly on the same chosen day each week 4, 5
• If you miss a dose, take it the morning after you remember, then return to your regular weekly schedule 1
• Never take two doses on the same day 1

Daily Dosing Alternative

• Take one 5 mg or 10 mg tablet once daily every morning 4

Warning Signs Requiring Immediate Medical Attention

Esophageal Complications

• Stop taking alendronate immediately and contact your physician if you develop difficulty or pain with swallowing, retrosternal pain, or new or worsening heartburn 1
• These symptoms may indicate esophagitis, which can include severe ulcerations with discolored exudate, narrowed lumen, and hemorrhagic mucosa 6, 2
• Risk factors for esophagitis include taking the medication with little or no water, lying down during or after ingestion, continuing medication after symptom onset, and preexisting esophageal disorders 2

Rare but Serious Long-Term Complications

• Osteonecrosis of the jaw (ONJ) is rare but serious, with risk increasing after 2 years of therapy—maintain good dental hygiene and inform your dentist you are taking bisphosphonates 4, 5
• Atypical femoral fractures can occur with long-term use (incidence 3.0-9.8 per 100,000 patient-years)—report any new thigh or groin pain 5

Lifestyle Modifications

Bone Health Optimization

• Engage in regular weight-bearing exercise 4, 3
• Stop smoking completely 4, 3
• Limit alcohol consumption to two or fewer units daily 4, 3
• Maintain adequate calcium intake through diet and supplements 4, 3

Monitoring and Duration of Therapy

Regular Follow-Up

• Bone mineral density (BMD) with vertebral fracture assessment or spinal x-ray should be performed every 1-2 years during treatment 3, 5
• After 3-5 years of therapy, your physician should reassess whether continued treatment is necessary 3, 5
• Some experts recommend considering interruption of therapy after five years due to concerns about long-term safety, particularly for patients at lower fracture risk 3, 5

Common Side Effects

Expected Adverse Effects

• Stomach area (abdominal) pain, heartburn, constipation, diarrhea, upset stomach, and nausea are the most common side effects 1
• Pain in bones, joints, or muscles may occur 1
• Allergic reactions such as hives or swelling of face, lips, tongue, or throat require immediate medical attention 1

Drug Interactions

Medications to Discuss with Your Doctor

• Inform your physician if you take antacids, aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs) 1
• Keep a list of all medications, including prescription, non-prescription, vitamins, and herbal supplements, and show it to your doctor and pharmacist 1

Storage

• Store alendronate at room temperature (68°-77°F) in a tightly closed container 1
• Keep out of reach of children 1