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Alendronate / cholecalciferol Disease Interactions

There are 12 disease interactions with alendronate / cholecalciferol:

Major

Alendronate (Includes Alendronate/cholecalciferol) ↔ 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 Alendronate/cholecalciferol) ↔ 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 Alendronate/cholecalciferol) ↔ 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. Lourwood DL "The pharmacology and therapeutic utility of bisphosphonates." Pharmacotherapy 18 (1998): 779-89
  2. "Product Information. Fosamax (alendronate)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals, Cincinnati, OH.
View all 5 references
Major

Bisphosphonates (Includes Alendronate/cholecalciferol) ↔ 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. Yue QY, Mortimer O "Alendronate - Risk for esophageal stricture." J Am Geriat Soc 46 (1998): 1581-2
  2. "Product Information. Fosamax (alendronate)." Merck & Co, Inc, West Point, PA.
  3. Rimmer DE, Rawls DE "Improper alendronate administration and a case of pill esophagitis." Am J Gastroenterol 91 (1996): 2648-9
View all 17 references
Major

Vitamin D Analogs (Includes Alendronate/cholecalciferol) ↔ Arrhythmia

Severe Potential Hazard, High plausibility

Applies to: Arrhythmias

Vitamin D analogs function to increase serum calcium concentrations and can exacerbate arrhythmias, particularly in patients receiving cardiac glycosides. Therapy with vitamin D analogs should be administered cautiously in patients with or predisposed to cardiac arrhythmias. Clinical monitoring of serum electrolyte concentrations and cardiac function is recommended.

References

  1. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma, Mequon, WI.
  3. "Product Information. Calderol (calcifediol)." Organon, West Orange, NJ.
Major

Vitamin D Analogs (Includes Alendronate/cholecalciferol) ↔ Electrolyte Imbalance

Severe Potential Hazard, High plausibility

Applies to: Phosphate Imbalance

Vitamin D analogs administered in the presence of hyperphosphatemia can result in precipitation of calcium-phosphate deposits within the vascular or renal systems or other soft tissue calcifications. A solubility product (Serum Calcium X Phosphate) should not exceed 70. Serum electrolyte concentrations should be corrected prior to vitamin D analog therapy and monitored during therapy.

References

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma, Mequon, WI.
  2. "Product Information. Calderol (calcifediol)." Organon, West Orange, NJ.
  3. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories, Nutley, NJ.
View all 4 references
Major

Vitamin D Analogs (Includes Alendronate/cholecalciferol) ↔ Hypercalcemia

Severe Potential Hazard, Moderate plausibility

Applies to: Hypercalcemia, Malabsorption Syndrome, Hypervitaminosis D

Vitamin D analogs such as calciferol and ergocalciferol should not be given to patients with hypercalcemia, malabsorption syndrome, or evidence of vitamin D toxicity.

Major

Vitamin D Analogs (Includes Alendronate/cholecalciferol) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction, hemodialysis

Ergocalciferol, cholecalciferol, and calcifediol undergo renal biotransformation during metabolic activation. Renal impairment can alter metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as dihydrotachysterol (hepatic activation) and calcitriol (active form) may be considered in patients with compromised renal function. However, calcitriol increases inorganic phosphate levels in serum, which is desirable in patients with hypophosphatemia. but cautious should be used in patients with renal failure because of a danger of ectopic calcification.

References

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma, Mequon, WI.
  2. "Product Information. Calderol (calcifediol)." Organon, West Orange, NJ.
  3. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories, Nutley, NJ.
Moderate

Alendronate (Includes Alendronate/cholecalciferol) ↔ Cv

Moderate Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease, Hypertension, 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 Alendronate/cholecalciferol) ↔ 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 Alendronate/cholecalciferol) ↔ 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.

Moderate

Vitamin D Analogs (Includes Alendronate/cholecalciferol) ↔ Hepatobiliary Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease, Biliary Obstruction

Vitamin D analogs are fat soluble and oral formulations require bile for adequate intestinal absorption. Hepatic and/or biliary dysfunction decrease the absorption of vitamin D analogs. Metabolites of vitamin D analogs are primarily excreted in bile and feces. Ergocalciferol, cholecalciferol, and dihydrotachysterol undergo hepatic hydroxylation during metabolic activation. Hepatic impairment can alter the metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as calcifediol (requires renal activation) and calcitriol (active form) may be considered in patients with compromised hepatic function.

References

  1. "Product Information. Calderol (calcifediol)." Organon, West Orange, NJ.
  2. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories, Nutley, NJ.
  3. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma, Mequon, WI.

alendronate / cholecalciferol drug Interactions

There are 328 drug interactions with alendronate / cholecalciferol

alendronate / cholecalciferol alcohol/food Interactions

There are 3 alcohol/food interactions with alendronate / cholecalciferol

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.

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