Home Drug Guide Alendronate Sodium

Drug Guide

Generic Name

Alendronate Sodium

Brand Names Fosamax, Binosto

Classification

Therapeutic: Bone resorption inhibitor, Bisphosphonate

Pharmacological: Nitrogen-containing bisphosphonate

FDA Approved Indications

  • Treatment and prevention of osteoporosis in postmenopausal women
  • Treatment of glucocorticoid-induced osteoporosis in men and women
  • Treatment of Paget's disease of bone

Mechanism of Action

Alendronate binds to hydroxyapatite crystals in bone, inhibiting osteoclast-mediated bone resorption, leading to an increase in bone mineral density.

Dosage and Administration

Adult: Typically 70 mg once weekly or 10 mg once daily for osteoporosis; 40 mg once daily for Paget's disease.

Pediatric: Not generally recommended for children.

Geriatric: Use with caution; dosage adjustments usually not necessary but monitor renal function.

Renal Impairment: Use with caution; contraindicated in severe renal impairment (creatinine clearance <35 mL/min).

Hepatic Impairment: No specific dosage adjustment necessary.

Pharmacokinetics

Absorption: Poor oral absorption (~0.5-1%), affected by food and calcium supplements.

Distribution: Widely distributed in bone, minimal in plasma.

Metabolism: Not metabolized.

Excretion: Excreted unchanged in urine.

Half Life: Approximately 10 years in bone tissue.

Contraindications

  • Hypocalcemia
  • Esophageal abnormalities that delay esophageal emptying
  • Inability to sit or stand upright for at least 30 minutes

Precautions

  • Renal impairment
  • Gastrointestinal disorders
  • Dose adjustment in renal impairment

Adverse Reactions - Common

  • Gastrointestinal upset (abdominal pain, dyspepsia, nausea) (Common)
  • Musculoskeletal pain (Common)
  • Headache (Common)

Adverse Reactions - Serious

  • Atypical femoral fractures (Rare)
  • Osteonecrosis of the jaw (Rare)
  • Esophageal irritation, ulcers (Rare)

Drug-Drug Interactions

  • Calcium supplements, antacids, magnesium, iron (reduce absorption)

Drug-Food Interactions

  • Food delays absorption

Drug-Herb Interactions

  • No well-established interactions

Nursing Implications

Assessment: Monitor calcium levels, renal function, and dental health.

Diagnoses:

  • Risk for decreased bone density
  • Risk for injury related to fractures

Implementation: Administer with water after an empty stomach, at least 30 minutes before the first food or drink of the day. Advise patient to remain upright for at least 30 minutes.

Evaluation: Assess changes in bone density, monitor for adverse effects, evaluate medication adherence.

Patient/Family Teaching

  • Take the medication on an empty stomach with a full glass of water.
  • Remain upright for at least 30 minutes after taking.
  • Report new persistent pain in hip, groin, or thigh.
  • Maintain adequate calcium and vitamin D intake.

Special Considerations

Black Box Warnings:

  • Esophageal ulceration and damage, risk of osteonecrosis of the jaw, and atypical femoral fractures.

Genetic Factors: No specific genetic considerations known.

Lab Test Interference: May alter calcium and phosphate levels; monitor as appropriate.

Overdose Management

Signs/Symptoms: Severe hypocalcemia, gastrointestinal irritation.

Treatment: Discontinue drug, administer calcium and vitamin D, provide supportive care.

Storage and Handling

Storage: Store at room temperature away from moisture and light.

Stability: Stable when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.