Alendronic acid: clinical use

Prescribing considerations

• Confirm that the patient can follow administration instructions and remain upright.
• Correct hypocalcaemia and address vitamin D deficiency or other mineral-metabolism disorders before initiation.
• Assess renal function, upper gastrointestinal disease and oesophageal symptoms.
• Review dental status and osteonecrosis risk factors; encourage oral hygiene and routine dental care.
• Ensure adequate calcium and vitamin D intake where dietary intake is insufficient.
• Periodically reassess fracture benefit and treatment risks.

Contraindications and cautions

• Oesophageal abnormalities or other factors delaying oesophageal emptying, including stricture or achalasia.
• Inability to sit or stand upright for at least 30 minutes.
• Hypocalcaemia.
• Hypersensitivity to alendronic acid or an excipient.
• The selected tablet contains lactose and is unsuitable in specified rare hereditary disorders of galactose metabolism or absorption.

Monitoring

• Renal function before treatment and when clinically indicated; the selected product is not recommended when creatinine clearance is below 35 mL/min.
• Calcium and symptoms of hypocalcaemia in patients with risk factors.
• New dysphagia, odynophagia, retrosternal pain or worsening heartburn.
• Oral symptoms, dental mobility and planned invasive dental procedures.
• New thigh, hip or groin pain.
• Persistent ear pain, discharge or recurrent infection, considering external auditory canal osteonecrosis.

Clinical pharmacology

Alendronate is a nitrogen-containing bisphosphonate that localises at sites of active bone resorption and inhibits osteoclast activity without directly suppressing bone formation. Oral absorption is very low and is further reduced by food, drinks and several oral medicines. It is not metabolised; unbound drug is excreted renally, while skeletal drug is released slowly over time.

Formulation and product differences

• The selected product is a conventional tablet that must be swallowed whole and contains lactose.
• Other UK products include soluble tablets and oral liquids; preparation-specific administration instructions are not interchangeable.

Tablet

Route: Oral

Strengths: 70 mg