Alendronate

From Pubdrug

Jump to: navigation, search

Contents
image:pdgreen.GIF This page has been completed and reviewed for accuracy.
You are reading a certified PubDrug document. This document is complete and accurate to the best of the knowledge of the author and reviewer. This document cannot be edited without being unlocked by a PubDrug admin. Edits or updates may be recommended under the Discussion tab.

Authored by: khlee3
Certified by: Aahynes 20:03, 22 February 2007 (PST)

Alendronate quick reference

Alendronate
Alendronate general drug information
 Pronunciation a LEN droe nate (.wav file)
 Trade Name(s) Fosamax
 How Supplied Oral Tablets: 5mg, 10mg, 35mg, 40mg, 70mg
Solution: 70mg/75ml
 Generic Availability No generics available
 Patent Expiry Date 5/18/2010
 Classification bisphosphonate
 Schedule Rx
 Pregnancy Category C
 Breast-feeding No data available. Use caution.
Alendronate chemical information
 IUPAC Name Sodium [4-amino-1-hydroxy-1-(hydroxy-oxido-phosphoryl)- butyl]phosphonic acid trihydrate
 Empirical Formula C4H18NNaO10P2
 Molecular Weight 325.124 g/mol
pharmacokinetic information  |  pharmacogenomic information

Description

Alendronate belongs to a class of medications known as bisphosphonates. It is a second generation bisphosphonate which strengthens bones in addition to preventing bone loss. Alendronate inhibits osteoclast-mediated bone resorption. It also binds to the hydroxyapatite found in bone.[1]

Alendronate was approved by the FDA for the treatment and prevention of osteoporosis and for the treatment of Paget's disease.

Mechanism of Action

Bisphosphonates are antiresorptive agents. They prevent the transformation of calcium phosphate into hydroxyapatite. In addition, bisphosphonates inhibit osteoclast-mediated bone resorption through an unknown mechanism. Current theories suggest that alendronate is incorporated into osteoclasts and disrupts the cellular ruffled border. As a result, active bone resorption is reduced. [2]

Time Required for Therapeutic Response

  • Data not available.[1]

Pharmacokinetics

Absorption
The bioavailability of alendronate is about 60%. Coadministration with food decreases the bioavailability of alendronate by about 40%. Coffee or orange juice can decrease the bioavailability of alendronate by about 60%.[1]

Distribution
Approximately 78% of the circulating drug is bounded to plasma protein. The volume of distribution is approximately 28 L (exclusively contained within bone).[1]

Metabolism
None known.[1]

Excretion
About 50% of alendronate is recovered in the urine. The terminal half-life (t1/2) of alendronate is > 10 years.[1]

Back to top

Special Population Pharmacokinetics

  • Renal insufficiency: The accumulation of alendronate may be greater for patients with renal insufficiency. Alendronate is not recommended in patients with creatinine clearance less than 35 ml/min (severe renal insufficiency).[1]
  • Hepatic insufficiency: There is no known evidence that alendronate is metabolized through the liver. No dosage adjustment is needed.[1]
  • Hemodialysis: Data not available.[1]
  • Geriatric: No dosage adjustment is needed.[1]
  • Pediatric: Alendronate is not indicated for use in children.[1]
  • Gender: No dosage adjustment is needed.[1]

Indications and Dosages

NOTE: * The safety of alendronate in treating and preventing osteoporosis has only been studied for up to 7 years of therapy.[1]

FDA Approved Indications

Treatment and prevention of osteoporosis in postmenopausal women[3]

  • Starting & maintenance dose for treatment of osteoporosis:
    • 70 mg once a week; or
    • 10 mg once a day
  • Starting & maintenance dose for prevention of osteoporosis:
    • 35 mg once a week; or
    • 5 mg once a day

Treatment to increase bone mass in men with osteoporosis[4]

  • Starting & maintenance dose:
    • 70 mg once a week; or
    • 10 mg once a day

Treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids in a daily dosage equivalent to 7.5 mg or greater of prednisone and who have low bone mineral density[5]

  • Starting & maintenance dose:
    • 5 mg once a day
    • 10 mg once a day (ONLY for postmenopausal women not receiving estrogen)

Treatment of Paget's disease of bone in men and women

  • Starting & maintenance dose:
    • 40 mg once a day for 6 months
    • Can consider retreating with alendronate with a six-month post-treatment evaluation.

Non-FDA Approved Indications

Dosage Limits

  • Adults: 10 mg/day PO or 70 mg/week PO for osteoporosis; 40 mg/day PO for Paget's disease[1]
  • Elderly: 10 mg/day PO or 70 mg/week PO for osteoporosis; 40 mg/day PO for Paget's disease[1]
  • Adolescents and children: Unknown; safety and efficacy has not been established in this population.[1]


Back to top

Administration

  • Route: Oral[1]
  • Method:[1]
    • Take tablet or solution, at least 30 minutes before the first food, beverage or medication, once a day (5mg, 10mg and 40mg formulations) or once a week (35mg and 70mg formulations) in the morning.
    • Swallow the tablet with a full glass (8 oz.) of plain water. (2 oz. of plain water is sufficient for the liquid formulation)
    • Do not lie down for at least 30 minutes and until after the first food consumption.

Monitoring Parameters

  • Serum alkaline phosphatase
  • Serum calcium
  • Serum creatinine and BUN (patients with renal insufficiency)
  • Bone mineral density

Contraindications/Precautions

Contraindications

  • Esophageal abnormalities e.g. stricture or achalasia[1]
  • Unable to stand or sit upright for at least 30 minutes
  • Oral solution formulation should be avoided in patients at risk for aspiration
  • Hypersensitivity to any component of alendronate
  • Hypocalcemia

Precautions

  • Musculoskeletal pain
  • Osteonecrosis of the jaw
  • Renal insufficiency
  • Glucocorticoid-induced osteoporosis (patients receiving less than 7.5mg of prednisone or equivalent)

Pregnancy indications

Category C [1]

Animal reproduction studies have shown adverse effects on the fetus including slightly increased offspring mortality and growth retardation. Alendronate may be used during pregnancy if the potential benefits justify the potential risks to the fetus.[1]

Breast-feeding indications

No data available. Alendronate may be used in nursing mothers if the potential benefits to the mother justify the potential risks to the infant.[1]

Back to top

Drug-Drug, -Food, -Herb Interactions

Click the link above to go to the drug interactions page.

Adverse Reactions/Side Effects

Alendronate Adverse Reactions Chart[8]
Incidence Body System Adverse Reactions
>10% All Hypocalcemia (transient, mild, 18%); hypophosphatemia (transient, mild, 10%)
1-10% CNS Headache (up to 3%)
GI Abdominal pain (1% to 7%), acid reflux (1% to 4%), dyspepsia (1% to 4%), nausea (1% to 4%), flatulence (up to 4%), diarrhea (1% to 3%), gastroesophageal reflux disease (1% to 3%), constipation (up to 3%), esophageal ulcer (up to 2%), abdominal distension (up to 1%), gastritis (up to 1%), vomiting (up to 1%), dysphagia (up to 1%), gastric ulcer (1%), melena (1%)
Neuromuscular & skeletal Arthralgia, limb pain, muscle cramp, myalgia, neck/shoulder pain, paresthesia, tremor
<1% All Postmarketing, and/or case reports: Anastomotic ulcer, angioedema, bone, muscle, or joint pain (occasionally severe, considered incapacitating in rare cases), dizziness, duodenal ulcer, episcleritis, erythema, esophageal erosions, esophageal perforation, esophageal stricture, esophagitis, fever, flu-like syndrome, hypersensitivity reactions, hypocalcemia (symptomatic), joint swelling, lymphocytopenia, malaise, myalgia, oropharyngeal ulceration, osteonecrosis (jaw), peripheral edema, photosensitivity (rare), pruritus, rash, scleritis (rare), Stevens-Johnson syndrome, taste perversion, toxic epidermal necrolysis, urticaria, uveitis (rare), vertigo, weakness

Overdosage Measures

Symptoms of overdose include hypocalcemia, hypophosphatemia, and upper GI adverse affects. Treatment:

  • Give patient milk or antacids to bind alendronate.
  • Keep patient fully upright.[1]
Back to top

Product Information and Distribution

Note: appearance only available for brand-name product
Dose/form Drug color(s) Drug shape Markings or odor/flavor
5 mg tablet white round MRK 925/picture of bone
10 mg tablet white oval MRK/936
35 mg tablet white oval 77/picture of bone
40 mg tablet white triangle FOSAMAX/MRK 212
70 mg tablet white oval 31/picture of bone
70 mg/75 mL solution clear - raspberry flavor
  • Inactive ingredients for tablets: croscarmellose sodium, magnesium stearate, microcrystalline cellulose
  • Inactive ingredients for solution: citric acid, saccharin, sodium citrate

Patient Information

  • Take tablet or solution at least 30 minutes before the first food, beverage, or medication in the morning.
  • Swallow the tablet with a full glass (8 oz.) of plain water (2 oz. of plain water is sufficient for the liquid formulation).
  • Do not lie down for at least 30 minutes and until after the first food consumption.
  • Avoid OTC medications unless instructed by your physician.
  • Possible side effects include flatulence, bloating, nausea, and acid regurgitation. Small frequent meals may help reduce side effects.
  • Report acute headache or stomach pain, unresolved GI upset, or acid stomach.
  • Inform your doctor if you are or intend to become pregnant.
Back to top

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 Fosamax® (alendronate sodium) package insert. Whitehouse Station, NJ; Merck & Co.Inc; 2006 Nov.
  2. ↑ Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 5th Edition ed. New York, NY: The McGraw-Hill Companies, Inc 2002.
  3. ↑ Iwamoto J, Takeda T, Sato Y, Uzawa M.Comparison of the effect of alendronate on lumbar bone mineral density and bone turnover in men and postmenopausal women with osteoporosis. Clin Rheumatol. 2007 Feb;26(2):161-7.Epub 2006 Mar 25.
  4. ↑ Drake AJ 3rd, Brietzke SA, Aprill BS, Shakir KM.Effect of alendronate treatment on bone mineral density in male patients with osteoporosis.Endocr Pract. 1999 Jul-Aug;5(4):184-90.
  5. ↑ Sambrook PN, Kotowicz M, Nash P, Styles CB, Naganathan V, Henderson-Briffa KN, Eisman JA, Nicholson GC.Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium.J Bone Miner Res. 2003 May;18(5):919-24.
  6. ↑ Saunders Y, Ross JR, Broadley KE, Edmonds PM, Patel S; Steering Group.Systematic review of bisphosphonates for hypercalcaemia of malignancy.Palliat Med. 2004 Jul;18(5):418-31.
  7. ↑ Rizzoli R, Buchs B, Bonjour J-P. Effect of a single infusion of alendronate in malignant hypercalcemia; dose dependency and comparison with clodronate. Int J Cancer 1992;50:706—12.
  8. ↑ Lexi-Comp (2003). Drug Information Handbook. 11th Edition., APhA.

PUBMED References

Efficacy Trial Articles

  1. Adachi JD, Saag KG, Delmas PD, Liberman UA, Emkey RD, Seeman E, Lane NE, Kaufman JM, Poubelle PE, Hawkins F, Correa-Rotter R, Menkes CJ, Rodriguez-Portales JA, Schnitzer TJ, Block JA, Wing J, McIlwain HH, Westhovens R, Brown J, Melo-Gomes JA, Gruber BL, Yanover MJ, Leite MO, Siminoski KG, Nevitt MC, Sharp JT, Malice MP, Dumortier T, Czachur M, Carofano W, Daifotis A.Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial.Arthritis Rheum. 2001 Jan;44(1):202-11.
  2. Ascott-Evans BH, Guanabens N, Kivinen S, Stuckey BG, Magaril CH, Vandormael K, Stych B, Melton ME.Alendronate prevents loss of bone density associated with discontinuation of hormone replacement therapy: a randomized controlled trial.Arch Intern Med. 2003 Apr 14;163(7):789-94.
  3. Bell NH, Bilezikian JP, Bone HG 3rd, Kaur A, Maragoto A, Santora AC; MK-063 Study Group.Alendronate increases bone mass and reduces bone markers in postmenopausal African-American women.J Clin Endocrinol Metab. 2002 Jun;87(6):2792-7.
  4. Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, Satterfield S, Wallace RB, Bauer DC, Palermo L, Wehren LE, Lombardi A, Santora AC, Cummings SR; FLEX Research Group.Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial.JAMA. 2006 Dec 27;296(24):2927-38.
  5. Chevrel G, Schott AM, Fontanges E, Charrin JE, Lina-Granade G, Duboeuf F, Garnero P, Arlot M, Raynal C, Meunier PJ.Effects of oral alendronate on BMD in adult patients with osteogenesis imperfecta: a 3-year randomized placebo-controlled trial.J Bone Miner Res. 2006 Feb;21(2):300-6. Epub 2005 Oct 24.
  6. Chow CC, Chan WB, Li JK, Chan NN, Chan MH, Ko GT, Lo KW, Cockram CS.Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism.J Clin Endocrinol Metab. 2003 Feb;88(2):581-7.
  7. Cranney A, Wells G, Willan A, Griffith L, Zytaruk N, Robinson V, Black D, Adachi J, Shea B, Tugwell P, Guyatt G; Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group.Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women.Endocr Rev. 2002 Aug;23(4):508-16.
  8. Ensrud KE, Barrett-Connor EL, Schwartz A, Santora AC, Bauer DC, Suryawanshi S, Feldstein A, Haskell WL, Hochberg MC, Torner JC, Lombardi A, Black DM; Fracture Intervention Trial Long-Term Extension Research Group.Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the Fracture Intervention Trial long-term extension.J Bone Miner Res. 2004 Aug;19(8):1259-69. Epub 2004 Mar 29.
  9. Greenspan SL, Schneider DL, McClung MR, Miller PD, Schnitzer TJ, Bonin R, Smith ME, DeLucca P, Gormley GJ, Melton ME.Alendronate improves bone mineral density in elderly women with osteoporosis residing in long-term care facilities. A randomized, double-blind, placebo-controlled trial.Ann Intern Med. 2002 May 21;136(10):742-6.
  10. Guaraldi G, Orlando G, Madeddu G, Vescini F, Ventura P, Campostrini S, Mura MS, Parise N, Caudarella R, Esposito R.Alendronate reduces bone resorption in HIV-associated osteopenia/osteoporosis.HIV Clin Trials. 2004 Sep-Oct;5(5):269-77.
  11. Kushida K, Shiraki M, Nakamura T, Kishimoto H, Morii H, Yamamoto K, Kaneda K, Fukunaga M, Inoue T, Nakashima M, Orimo H.Alendronate reduced vertebral fracture risk in postmenopausal Japanese women with osteoporosis: a 3-year follow-up study.J Bone Miner Metab. 2004;22(5):462-8. Erratum in: J Bone Miner Metab. 2005;23(1):95.
  12. Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J, Adami S, Weber K, Lorenc R, Pietschmann P, Vandormael K, Lombardi A.Alendronate for the treatment of osteoporosis in men.N Engl J Med. 2000 Aug 31;343(9):604-10.
  13. Recker R, Lips P, Felsenberg D, Lippuner K, Benhamou L, Hawkins F, Delmas PD, Rosen C, Emkey R, Salzmann G, He W, Santora AC.Alendronate with and without cholecalciferol for osteoporosis: results of a 15-week randomized controlled trial.Curr Med Res Opin. 2006 Sep;22(9):1745-55.
  14. Rizzoli R, Buchs B, Bonjour J-P. Effect of a single infusion of alendronate in malignant hypercalcemia; dose dependency and comparison with clodronate.Int J Cancer 1992;50:706—12.
  15. Sambrook PN, Kotowicz M, Nash P, Styles CB, Naganathan V, Henderson-Briffa KN, Eisman JA, Nicholson GC.Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium.J Bone Miner Res. 2003 May;18(5):919-24.
  16. Sawka AM, Papaioannou A, Adachi JD, Gafni A, Hanley DA, Thabane L.Does alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women.BMC Musculoskelet Disord. 2005 Jul 11;6:39.
  17. Weber TJ, Drezner MK.Effect of alendronate on bone mineral density in male idiopathic osteoporosis.Metabolism. 2001 Aug;50(8):912-5.
  18. Wiernikowski JT, Barr RD, Webber C, Guo CY, Wright M, Atkinson SA.Alendronate for steroid-induced osteopenia in children with acute lymphoblastic leukaemia or non-Hodgkin's lymphoma: results of a pilot study.J Oncol Pharm Pract. 2005 Jun;11(2):51-6.
Back to top

Therapeutic Class Comparison Articles

  1. Cortet B, Bera-Louville A, Gauthier P, Gauthier A, Marchandise X, Delcambre B.Comparative efficacy and safety study of etidronate and alendronate in postmenopausal osteoporosis. effect of adding hormone replacement therapy.Joint Bone Spine. 2001 Oct;68(5):410-5.
  2. Giavaresi G, Fini M, Gnudi S, Aldini NN, Rocca M, Carpi A, Giardino R.Comparison of calcitonin, alendronate and fluorophosphate effects on ovariectomized rat bone.Biomed Pharmacother. 2001 Sep;55(7):397-403.
  3. Guanabens N, Pares A, Ros I, Alvarez L, Pons F, Caballeria L, Monegal A, Martinez de Osaba MJ, Roca M, Peris P, Rodes J.Alendronate is more effective than etidronate for increasing bone mass in osteopenic patients with primary biliary cirrhosis.Am J Gastroenterol. 2003 Oct;98(10):2268-74.
  4. Lanza F, Schwartz H, Sahba B, Malaty HM, Musliner T, Reyes R, Quan H, Graham DY.An endoscopic comparison of the effects of alendronate and risedronate on upper gastrointestinal mucosae.Am J Gastroenterol. 2000 Nov;95(11):3112-7.
  5. Rosen CJ, Hochberg MC, Bonnick SL, McClung M, Miller P, Broy S, Kagan R, Chen E, Petruschke RA, Thompson DE, de Papp AE; Fosamax Actonel Comparison Trial Investigators.Treatment with once-weekly alendronate 70 mg compared with once-weekly risedronate 35 mg in women with postmenopausal osteoporosis: a randomized double-blind study.J Bone Miner Res. 2005 Jan;20(1):141-51. Epub 2004 Sep 29.
  6. Sambrook PN, Geusens P, Ribot C, Solimano JA, Ferrer-Barriendos J, Gaines K, Verbruggen N, Melton ME.Alendronate produces greater effects than raloxifene on bone density and bone turnover in postmenopausal women with low bone density: results of EFFECT (Efficacy of FOSAMAX versus EVISTA Comparison Trial) International.J Intern Med. 2004 Apr;255(4):503-11.
  7. Walsh JP, Ward LC, Stewart GO, Will RK, Criddle RA, Prince RL, Stuckey BG, Dhaliwal SS, Bhagat CI, Retallack RW, Kent GN, Drury PJ, Vasikaran S, Gutteridge DH.A randomized clinical trial comparing oral alendronate and intravenous pamidronate for the treatment of Paget's disease of bone.Bone. 2004 Apr;34(4):747-54.

Pharmacokinetics Articles

  1. Cremers SC, van Hogezand R, Banffer D, den Hartigh J, Vermeij P, Papapoulos SE, Hamdy NA.Absorption of the oral bisphosphonate alendronate in osteoporotic patients with Crohn's disease.Osteoporos Int. 2005 Dec;16(12):1727-30. Epub 2005 Jun 15.
  2. Stepensky D, Golomb G, Hoffman A.Pharmacokinetic and pharmacodynamic evaluation of intermittent versus continuous alendronate administration in rats.J Pharm Sci. 2002 Feb;91(2):508-16.
Back to top

Drug Interaction Articles

  1. Antoniucci DM, Sellmeyer DE, Bilezikian JP, Palermo L, Ensrud KE, Greenspan SL, Black DM.Elevations in Serum and Urinary Calcium with Parathyroid Hormone (1-84) with and without Alendronate for Osteoporosis.J Clin Endocrinol Metab. 2006 Dec 12.
  2. Black DM, Greenspan SL, Ensrud KE, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 2003;349:1207—15.
  3. Finkelstein JS, Hayes A, Hunzelman JL, et al. The effects of parathyroid hormone, alendronate or both in men with osteoporosis. N Engl J Med 2003;349:1216—26.
  4. Gomez-Garcia L, Esbrit P, Carreno L, Sabando P, Garcia-Flores M, Martinez ME.Alendronate interacts with the inhibitory effect of 1,25(OH)2D3 on parathyroid hormone-related protein expression in human osteoblastic cells.J Bone Miner Res. 2003 Jan;18(1):78-87.

Adverse Effects Articles

  1. Aki S, Eskiyurt N, Akarirmak U, Tuzun F, Eryavuz M, Alper S, Arpacioglu O, Atalay F, Kavuncu V, Kokino S, Kuru O, Nas K, Ozerbil O, Savas G, Sendur OF, Soy D, Akyuz G; Turkish Osteoporosis Society.Gastrointestinal side effect profile due to the use of alendronate in the treatment of osteoporosis.Yonsei Med J. 2003 Dec 30;44(6):961-7.
  2. Baker DE.Alendronate and risedronate: what you need to know about their upper gastrointestinal tract toxicity.Rev Gastroenterol Disord. 2002;2(1):20-33.
  3. Bauer DC, Black D, Ensrud K, Thompson D, Hochberg M, Nevitt M, Musliner T, Freedholm D.Upper gastrointestinal tract safety profile of alendronate: the fracture intervention trial.Arch Intern Med. 2000 Feb 28;160(4):517-25.
  4. Coleman CI, Perkerson KA, Lewis A.Alendronate-induced auditory hallucinations and visual disturbances.Pharmacotherapy. 2004 Jun;24(6):799-802.
  5. Graham DY, Malaty HM.Alendronate and naproxen are synergistic for development of gastric ulcers.Arch Intern Med. 2001 Jan 8;161(1):107-10. Erratum in: Arch Intern Med 2001 Aug 13-27;161(15):1862.
  6. Greenspan S, Field-Munves E, Tonino R, Smith M, Petruschke R, Wang L, Yates J, de Papp AE, Palmisano J.Tolerability of once-weekly alendronate in patients with osteoporosis: a randomized, double-blind, placebo-controlled study.Mayo Clin Proc. 2002 Oct;77(10):1044-52.
  7. Lanza F, Sahba B, Schwartz H, Winograd S, Torosis J, Quan H, Reyes R, Musliner T, Daifotis A, Leung A.Lanza F, Sahba B, Schwartz H, Winograd S, Torosis J, Quan H, Reyes R, Musliner T, Daifotis A, Leung A.The upper GI safety and tolerability of oral alendronate at a dose of 70 milligrams once weekly: a placebo-controlled endoscopy study.Am J Gastroenterol. 2002 Jan;97(1):58-64.
  8. Maalouf NM, Heller HJ, Odvina CV, Kim PJ, Sakhaee K.Bisphosphonate-induced hypocalcemia: report of 3 cases and review of literature.Endocr Pract. 2006 Jan-Feb;12(1):48-53.
  9. Marshall JK, Rainsford KD, James C, Hunt RH.A randomized controlled trial to assess alendronate-associated injury of the upper gastrointestinal tract.Aliment Pharmacol Ther. 2000 Nov;14(11):1451-7.
  10. Yanik B, Turkay C, Atalar H.Hepatotoxicity induced by alendronate therapy.Osteoporos Int. 2007 Jan 17.
Back to top

Compliance Articles

  1. Segal E, Tamir A, Ish-Shalom S.Compliance of osteoporotic patients with different treatment regimens.Isr Med Assoc J. 2003 Dec;5(12):859-62.

Pharmacoeconomic Articles

  1. Brecht JG, Kruse HP, Mohrke W, Oestreich A, Huppertz E.Health-economic comparison of three recommended drugs for the treatment of osteoporosis.Int J Clin Pharmacol Res. 2004;24(1):1-10.
  2. Buckley LM, Hillner BE.A cost effectiveness analysis of calcium and vitamin D supplementation, etidronate, and alendronate in the prevention of vertebral fractures in women treated with glucocorticoids.J Rheumatol. 2003 Jan;30(1):132-8.
  3. Christensen PM, Brixen K, Gyrd-Hansen D, Kristiansen IS.Cost-effectiveness of alendronate in the prevention of osteoporotic fractures in Danish women.Basic Clin Pharmacol Toxicol. 2005 May;96(5):387-96.
  4. Johnell O, Jonsson B, Jonsson L, Black D.Cost effectiveness of alendronate (fosamax) for the treatment of osteoporosis and prevention of fractures.Pharmacoeconomics. 2003;21(5):305-14.
  5. Stevenson M, Lloyd Jones M, De Nigris E, Brewer N, Davis S, Oakley J.A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis.Health Technol Assess. 2005 Jun;9(22):1-160.
Back to top

External Links

Clinical treatment guidelines

Patient information pages

Other resources

Back to top
Retrieved from "http://www.smbrower.com/mediawiki/index.php/Alendronate"
Personal tools