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Alendronate counselling — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsAlendronate counsellingGPhC CRA

A patient starting once-weekly alendronic acid asks why the dose must be taken after getting up, before food, while remaining upright. Which explanation is most accurate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Use plain water while fasting and remain upright for 30 minutes

Use plain water while fasting and remain upright for 30 minutes: Oral alendronate has very poor bioavailability with food and can cause serious local oesophageal irritation if tablet transit is delayed. Use plain water to accelerate renal clearance and limit hypocalcaemia: Upright posture protects the oesophagus; it does not accelerate renal elimination. Eat breakfast immediately after swallowing to activate tablet absorption: Food reduces absorption, and at least 30 minutes should elapse before the first food or drink. Use tea to prevent tablet adhesion within the upper gastrointestinal tract: The dose should be swallowed with plain water; tea can impair absorption and is not protective. Use the full precautions for the first dose and relax them subsequently: Administration precautions apply to every oral dose.

Reference: BNF: alendronic acid: https://bnf.nice.org.uk/drugs/alendronic-acid/; NOGG clinical guideline for osteoporosis: https://www.nogg.org.uk/full-guideline