ABSTRACT
In a clinical practice setting, 77 females (ages 27-83) taking alendronate (10 mg daily) for 9 to 66 weeks were studied for possible side effects of alendronate. All patients were instructed on how to take the medication, including cautions against lying down after administration. Among the sev enty-seven, twenty four (31%) had significant side effects from the drug. Approximately 28% (22/27) experienced upper gastrointestinal problems re lated to gastroesophageal reflux including dyspepsia (16), heartburn (14), retrosternal pain (9), dysphagia (5), nausea (8) and vomiting (3). Two addi tional patients developed rashes which reversed with discontinuation of the drug. One patient developed esophageal stricture requiring dilation. Many patients experienced more than one side effect and 20 patients stopped the treatment due to the severity of the side effects. Side effects occurred within 2 to 50 weeks after treatment was started. Several patients admitted noncompli ance with instructions and laid down after taking alendronate. The authors concluded that some patients may be unable to tolerate alendronate therapy and that patients taking alendronate need to be monitored regularly for compli ance and side effects. Alendronate [ “Fosamax”]
ALENDRONATE: HYPO CALCEM IA
A 70-year-old woman with a history of thyroidectomy developed intermit tent throat tightness with hoarseness and dyspnea approximately two weeks after starting alendronate therapy (5 mg daily) for osteoporosis. The only other medication taken was levothyroxine (0.1 mg daily). Other symptoms included cramping in hands and feet, perioral muscle twitching, anxiety and chest
discomfort. Upon emergency room admission, abnormal laboratory values indicated hypocalcemia (3.9 mg/dL), hyperphosphatemia (6.7 mg/dL) and hypoparathyroidism (15 pg/mL). Normal values included serum magnesium (1.5 mg/dL) albumin (4.2 mg/dL) and thyroid function. The QTc interval was prolonged at 0.51 seconds. Intravenous calcium gluconate was administered (no dosage provided). Chvostek and Trousseau signs disappeared once the serum calcium level reached 6.0 mg/dL.
