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Fosamax (alendronate) Disease Interactions

There are 7 disease interactions with Fosamax (alendronate):

Major

Alendronate (Includes Fosamax) ↔ Aspiration

Severe Potential Hazard, High plausibility

Applies to: Gastrointestinal Obstruction

The manufacturer considers the use of alendronate sodium oral solution to be contraindicated in patients at increased risk of aspiration.

Major

Bisphosphonate (Includes Fosamax) ↔ Onj

Severe Potential Hazard, Moderate plausibility

Applies to: Infection - Bacterial/Fungal/Protozoal/Viral

Osteonecrosis of the jaw (ONJ), which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients taking bisphosphonates. Known risk factors for osteonecrosis of the jaw include invasive dental procedures (e.g., tooth extraction, dental implants, boney surgery), diagnosis of cancer, concomitant therapies (e.g., chemotherapy, corticosteroids, angiogenesis inhibitors), poor oral hygiene, and co-morbid disorders (e.g., periodontal and/or other pre-existing dental disease, anemia, coagulopathy, infection, ill-fitting dentures). The manufacturers of bisphosphonates recommend discontinuation of bisphosphonate treatment for patients undergoing invasive dental procedures. Patients who develop osteonecrosis of the jaw while on bisphosphonate therapy should receive care by an oral surgeon. In these patients, extensive dental surgery to treat ONJ may exacerbate the condition. Discontinuation of bisphosphonate therapy should be considered based on individual benefit/risk assessment.

Major

Bisphosphonates (Includes Fosamax) ↔ Hypocalcemia

Severe Potential Hazard, High plausibility

Applies to: Vitamin D Deficiency, Hypocalcemia

The use of bisphosphonates is contraindicated for the treatment of osteoporosis in patients with hypocalcemia. These agents increase bone mineral density, a process that requires an adequate supply of calcium in the body. Following the initiation of therapy, a short-term reduction in serum calcium and phosphate levels usually occurs due to inhibition of bone resorption, especially in patients with Paget's disease, in whom the pretreatment rate of bone turnover may be greatly elevated. Hypocalcemia and other disturbances of mineral metabolism, such as vitamin D deficiency, should be treated prior to initiation of therapy. Appropriate intake of calcium and vitamin D should be ensured throughout the course of treatment.

References

  1. "Product Information. Fosamax (alendronate)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals, Cincinnati, OH.
  3. Schussheim DH, Jacobs TP, Silverberg SJ "Hypocalcemia associated with alendronate." Ann Intern Med 130 (1999): 329
  4. Lourwood DL "The pharmacology and therapeutic utility of bisphosphonates." Pharmacotherapy 18 (1998): 779-89
  5. Watts NB "Treatment of osteoporosis with bisphosphonates." Rheum Dis Clin North Am 20 (1994): 717-34
View all 5 references
Major

Bisphosphonates (Includes Fosamax) ↔ Upper Gi Mucosal Irritation

Severe Potential Hazard, High plausibility

Applies to: Dysphagia, Esophageal Disease, Peptic Ulcer, Duodenitis/Gastritis, Dyspepsia

Bisphosphonates may cause local irritation of the upper gastrointestinal mucosa. Esophagitis and esophageal ulcers and erosions, occasionally with bleeding, as well as gastric and duodenal ulcers, have been reported, primarily with alendronate. Because of their structural similarities, therapy with all bisphosphonates should be administered cautiously in patients with active upper gastrointestinal disorders. The usual precautions should be followed closely to minimize the risk of irritation (i.e. taking the medication with a full glass of water after arising for the day and remaining upright for at least 30 minutes afterwards and until the first food intake of the day). Therapy should be discontinued if dysphagia, odynophagia or retrosternal pain occurs. The manufacturer of alendronate considers its use to be contraindicated in patients with abnormalities of the esophagus that may delay esophageal emptying, such as stricture or achalasia.

References

  1. Rimmer DE, Rawls DE "Improper alendronate administration and a case of pill esophagitis." Am J Gastroenterol 91 (1996): 2648-9
  2. "Product Information. Fosamax (alendronate)." Merck & Co, Inc, West Point, PA.
  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 160 (2000): 517-25
  4. Levine J, Nelson D "Esophageal stricture associated with alendronate therapy." Am J Med 102 (1997): 489-91
  5. Degroen PC, Lubbe DF, Hirsch LJ, Daifotis A, Stephenson W, Freedholm D, Pryortillotson S, Seleznick MJ, Pinkas H, Wang KK "Esophagitis associated with the use of alendronate." N Engl J Med 335 (1996): 1016-21
  6. Lowe CE, Depew WT, Vanner SJ, Paterson WG, Meddings JB "Upper gastrointestinal toxicity of alendronate." Am J Gastroenterol 95 (2000): 634-40
  7. Cameron RB "Esophagitis dissecans superficialis and alendronate: case report." Gastrointest Endosc 46 (1997): 562-3
  8. Wallace JL "Upper gastrointestinal ulceration with alendronate." Digest Dis Sci 44 (1999): 311-2
  9. Peter CP "Upper gastrointestinal ulceration with alendronate - Response." Digest Dis Sci 44 (1999): 312-3
  10. Yue QY, Mortimer O "Alendronate - Risk for esophageal stricture." J Am Geriat Soc 46 (1998): 1581-2
  11. Castell DO ""Pill esophagitis"--the case of alendronate." N Engl J Med 335 (1996): 1058-9
  12. Abdelmalek MF, Douglas DD "Alendronate-induced ulcerative esophagitis." Am J Gastroenterol 91 (1996): 1282-3
  13. Nightingale SL "Important information regarding alendronate adverse reactions." JAMA 275 (1996): 1534
  14. Lourwood DL "The pharmacology and therapeutic utility of bisphosphonates." Pharmacotherapy 18 (1998): 779-89
  15. Maconi G, Porro GB "Multiple ulcerative esophagitis caused by alendronate." Am J Gastroenterol 90 (1995): 1889-90
  16. Colina RE, Smith M, Kikendall JW, Wong RK "A new probable increasing cause of esophageal ulceration: alendronate." Am J Gastroenterol 92 (1997): 704-6
  17. Liberman UA, Hirsch LJ "Esophagitis and alendronate." N Engl J Med 335 (1996): 1069-70
View all 17 references
Moderate

Alendronate (Includes Fosamax) ↔ Cv

Moderate Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease, Congestive Heart Failure

Each tablet of Binosto (alendronate effervescent) contains 650 mg sodium, equivalent to 1650 mg NaCl. Use caution in patients on sodium restriction, such as patients with a history of heart failure, hypertension, or other cardiovascular diseases.

Moderate

Alendronate (Includes Fosamax) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Alendronate is primarily eliminated by the kidney. In healthy controls, drug that is not deposited in bone is rapidly excreted in the urine. Although clinical information is not available, animal studies suggest reduced drug clearance in renal failure. Alendronate is not recommended for use in patients with creatinine clearance less than 35 mL/min due to a lack of clinical experience in this setting. No dosage adjustment is necessary in patients with mild to moderate renal impairment (CrCl >= 35 mL/min).

References

  1. "Product Information. Fosamax (alendronate)." Merck & Co, Inc, West Point, PA.
Moderate

Bisphosphonates (Includes Fosamax) ↔ Asthma

Moderate Potential Hazard, Moderate plausibility

Applies to: Asthma

There have been reports of bronchoconstriction in aspirin-sensitive patients receiving bisphosphonates. Use of these agents in asthmatic and in aspirin-sensitive patients should be used with caution.

Fosamax (alendronate) drug Interactions

There are 225 drug interactions with Fosamax (alendronate)

Fosamax (alendronate) alcohol/food Interactions

There are 2 alcohol/food interactions with Fosamax (alendronate)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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