alendronate sodium trihydrate: clinical use

Prescribing considerations

• Confirm the patient can follow formulation-specific administration instructions.
• Assess swallowing and oesophageal disorders, upper gastrointestinal disease, aspiration risk where relevant, renal function, mineral metabolism and dental risk.
• Correct hypocalcaemia and address vitamin D deficiency or other mineral-metabolism disorders before initiation.
• Consider preventive dental assessment in patients with poor dental status or other osteonecrosis-of-the-jaw risk factors.
• Reassess continuing benefit–risk periodically.

Contraindications and cautions

• Hypersensitivity to alendronate or product excipients
• Oesophageal abnormalities or other factors delaying oesophageal emptying, including stricture or achalasia
• Inability to sit or stand upright for at least 30 minutes
• Hypocalcaemia
• For the selected oral solution: difficulty swallowing liquids or risk of aspiration

Monitoring

• Renal function before treatment and when clinically indicated
• Calcium and vitamin D status; serum calcium and symptoms in patients with mineral-metabolism disorders
• New dysphagia, odynophagia, retrosternal pain or worsening heartburn
• Oral health and symptoms suggesting jaw osteonecrosis
• New thigh, hip or groin pain suggesting an incomplete atypical femoral fracture
• Ongoing fracture risk, adherence, administration technique and treatment benefit–risk

Clinical pharmacology

Oral bioavailability is very low and falls markedly with food or drinks other than plain water. Alendronate is not metabolised; absorbed medicine is deposited in bone or excreted by the kidneys, and skeletal release can continue for years.

Formulation and product differences

• Conventional tablet: swallowed whole with a full glass of plain water; essentially sodium-free in the selected product.
• Oral solution: ready-to-drink, single-use formulation followed by plain water; contraindicated where liquid swallowing is difficult or aspiration risk is present. It contains ethanol, Sunset Yellow and parabens.
• Effervescent tablet: dissolved fully in plain water to form a buffered solution and may suit someone unable or unwilling to swallow tablets. It has clinically relevant sodium content, which matters for sodium-restricted patients.

Effervescent tablet

Route: Oral

Strengths: 70 mg

Oral solution

Route: Oral

Strengths: 70 mg

Tablet

Route: Oral

Strengths: 70 mg