Alendronic acid counselling — GPhC CRA MCQ

Correct answer: D — Hold alendronate and review treatment at creatinine clearance 28 mL/min

Hold alendronate and review treatment at creatinine clearance 28 mL/min: Alendronate is not recommended below a creatinine-clearance threshold of 35 mL/min; normal calcium does not remove the renal suitability concern. Start 70 mg weekly using eGFR rather than creatinine clearance: Medicine-specific renal advice should be applied using the stated creatinine clearance, not substituted with eGFR. Start 35 mg weekly and repeat creatinine clearance after three months: A 35-mg weekly renal-adjusted osteoporosis regimen is not an authorised workaround. Change to 10 mg daily to remove the renal restriction: Changing frequency does not remove the renal suitability warning or reduce total weekly exposure appropriately. Substitute risedronate 35 mg weekly under an unrestricted renal threshold: Other bisphosphonates also have renal restrictions and substitution requires a complete authorised assessment.

Reference: BNF: alendronic acid: https://bnf.nice.org.uk/drugs/alendronic-acid/; MHRA: use creatinine clearance for medicines requiring renal dose adjustment: https://www.gov.uk/drug-safety-update/prescribing-medicines-in-renal-impairment-using-the-appropriate-estimate-of-renal-function-to-avoid-the-risk-of-adverse-drug-reactions; NOGG clinical guideline for osteoporosis: https://www.nogg.org.uk/full-guideline