What is the appropriate dosing schedule for Alendronate (generic name) in a post-operative patient following left knee surgery?

From the Guidelines

Alendronate should be taken once weekly on the same day each week, first thing in the morning with a full glass of plain water (6-8 oz) at least 30 minutes before any food, beverage, or other medication. The patient must remain upright (sitting or standing) for at least 30 minutes after taking the medication to prevent esophageal irritation, as indicated in the study 1. Since the daughter mentioned taking it at 6am, this timing is appropriate as long as the patient can remain upright afterward. The medication should be swallowed whole without chewing or sucking on the tablet. Alendronate is a bisphosphonate that works by slowing bone loss and increasing bone density, commonly prescribed for osteoporosis prevention or treatment. Some key points to consider when taking Alendronate include:

• Taking the medication with a full glass of plain water
• Remaining upright for at least 30 minutes after taking the medication
• Swallowing the tablet whole without chewing or sucking on it
• Not lying down after taking the medication and waiting at least 30 minutes before consuming anything else, including other medications. If a dose is missed, the patient should take it the next morning following these same instructions and then resume the regular weekly schedule on the originally chosen day, as there is no specific guidance on missed doses in the provided studies 1. It's also important to note that the patient's kidney function should be considered when taking Alendronate, as indicated in the study 1, but since there is no information provided about the patient's kidney function, it is assumed that the patient's doctor has already considered this factor when prescribing the medication.

From the FDA Drug Label

2.1 Treatment of Osteoporosis in Postmenopausal Women The recommended dosage is: one 70 mg tablet once weekly or one 10 mg tablet once daily 2.8 Administration Instructions for Missed Doses If a once-weekly dose of alendronate sodium tablets is missed, instruct patients to take one dose on the morning after they remember. They should not take two doses on the same day but should return to taking one dose once a week, as originally scheduled on their chosen day. The patient should take Alendronate 70 mg once weekly, and if a dose is missed, it should be taken on the morning after they remember, then return to the original schedule 2.

• The medication should be taken at 6am with plain water, at least 30 minutes before the first food, beverage, or medication of the day.
• The patient should not lie down for at least 30 minutes after taking the medication and until after their first food of the day.

From the Research

Alendronate Usage and Osteonecrosis of the Jaw

• Alendronate is a bisphosphonate used for the prevention and treatment of osteoporosis, and it has been associated with osteonecrosis of the jaw (ONJ) 3, 4, 5, 6, 7.
• The overall incidence of bisphosphonate-related ONJ is low, ranging from 0.7% to 12%, mainly observed in those patients receiving intravenously treatment 4.
• However, ONJ can also occur in patients receiving oral bisphosphonates, such as alendronate, although it is rare in this setting, with an incidence rate of 2.53 per 10,000 patient years 5.
• Recent, long-term, and compliant use of alendronate are associated with an increased risk of surgically treated ONJ, with a higher risk observed in patients with rheumatoid diseases and those using proton pump inhibitors 5.

Patient Guidance

• Patients taking alendronate should be informed of the low risk of ONJ and the importance of good dental hygiene 3, 7.
• Elective invasive dental procedures should be completed before initiating high-dose intravenous bisphosphonate therapy for cancer, and patients with osteoporosis receiving lower-dose bisphosphonate therapy do not require special precautions 3.
• However, it is crucial to prepare the oral cavity before bisphosphonate therapy, providing a careful dental evaluation and all needed dental treatment 7.

Dosage and Administration

• Alendronate is typically taken weekly, as in the case of the patient in question, who was instructed to take the medication at 6am 3, 4, 5, 6, 7.
• The patient's daughter reported that the patient must take the medication weekly, which is consistent with the standard dosage regimen for alendronate 3, 4, 5, 6, 7.