ALENDRONATE SODIUM
GENERIC NAME: alendronate sodium
BRAND NAME: Fosamax
DRUG CLASSES: Bisphosphonate, Calcium regulator
Pregnancy Category C
THERAPEUTIC ACTIONS
Slows normal and abnormal bone resorption without inhibiting bone formation and mineralization.
INDICATIONS
1. Treatment and prevention of osteoporosis in postmenopausal women
2. Treatment of men with osteoporosis
3. Treatment of glucocorticoid-induced osteoporosis
4. Treatment of Paget's disease of bone in patients with alkaline phosphatase at least two times upper limit of normal, those who are symptomatic, those at risk for future complications
CONTRAINDICATIONS
Contraindicated with allergy to biphosphonates; hypocalcemia. Use cautiously with renal dysfunction, upper GI disease, pregnancy, lactation.
SIDE EFFECTS
CNS: Headache
GI: Nausea, diarrhea, GI irritation, pain, esophageal erosion
Skeletal: Increased or recurrent bone pain, focal osteomalacia
INTERACTIONS
Drug-drug
1. Increased risk of GI distress with aspirin
2. Decreased absorption if taken with antacids, calcium, iron, multivalent cations; separate dosing by at least 30 min
Drug-food
1. Significantly decreased absorption and serum levels if taken with food; separate dosing from food and beverage by at least 30 min
NURSING CONSIDERATIONS
Assessment
History: Allergy to bisphosphonates, renal failure, upper GI disease, lactation, pregnancy
Physical: Muscle tone, bone pain; bowel sounds; urinalysis, serum calcium
Interventions
1. Give in AM with full glass of water at least 30 min before the first beverage, food, or medication of the day. Patient must stay upright for 30 min to decrease risk of potentially serious esophageal erosion.
2. Monitor serum calcium levels before, during, and after therapy.
3. Ensure 6-mo rest period after treatment for Paget's disease if retreatment is required.
4. Ensure adequate vitamin D and calcium intake.
5. Provide comfort measures if bone pain returns.
Teaching Points
1. Take drug in morning with a full glass of plain water (not mineral water), at least 30 minutes before any beverage, food, or medication, and stay upright for 30 minutes and until after the first food of the day; mark calendar for once weekly dosing.
2. You may experience these side effects: Nausea, diarrhea; bone pain, headache.
3. Report twitching, muscle spasms, dark-colored urine, severe diarrhea, difficulty swallowing.
REFERENCES:
Fosamax Image. http://www.msd.com.tw/images/content/Product/package/picture/FOSAMAX.jpg
Karch, Amy M. Lippincott Williams & Wilkins. 2007 Nursing Drug Guide.
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