|What is Alendronate||Chemistry and Physiology||Side Effects|
Treatment With Alendronate
Alendronate comes as a tablet to take by mouth. The solution is usually taken on an empty stomach once a week in the morning. The 5-mg and 10-mg tablets are usually taken on an empty stomach once a day in the morning, and the 30-mg and 70-mg tablets are usually taken on an empty stomach once a week in the morning. The 40-mg tablets are usually taken once a day in the morning for six months to treat Paget's disease of bone. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take alendronate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Alendronate may not work properly and may damage the esophagus (tube between the mouth and stomach) or cause sores in the mouth if it is not taken according to the recommended instructions.
Alendronate has also been tried for treatment of anorexics, who often have skeletal problems due to malnutrition. However, tests have not been good and alendronate is not widely used for anorexics.
A report in the Journal of Clinical Oncology in 2008 stated that alendronate improves bone density in men having androgen-deprivation therapy for prostate cancer. This was found through the results of a double-blind study. The study authors recommend doctors consider once-a-week alendronate for such patients.
A large study published in 2006 suggested that some women may be able to quit taking alendronate after 5 years without increasing bone fracture risk for another 5 years, but this mode of treatment is not widely used. Some doctors feel the medicine should be stopped because of diminishing returns and because of the possibility (not definitively proven) that the medicine actually causes too much suppression of bone turnover, resulting in bones that become brittle along with increase density.
Recent systematic reviews have continued to show that alendronate reduces the risk of bone fractures. These studies followed women who took the drug for up to four years.
Interestingly, many doctors recommend against monitoring bone marrow density in patients on bisphosphonates, at least during the first three years. The results are thought to be of little value in determining whether to continue bisphosphonate administration. The density often continues to decline after the drug is started (even if the drug is working) and the accuracy of the density tests is not good enough.
Kids don't take this drug (their bones are still growing) and pregnant women don't take it. Alendronate has side effects, but overall it is well tolerated.
Alendronate is not metabolized by the body and stays in the bones for years. While it might not be absorbed in the intestine and eliminate through the feces, alendronate that does enter the bloodstream has a half-life in the body of over 10 years. It is not easily flushed out.
Treatment with Risedronate
As a prescription drug, risedronate can and should be used only under a doctor's supervision. Your pharmacist may also be able to answer questions.
Bisphosphonates are poorly absorbed medications. They should be taken on an empty stomach to maximize absorption. It is recommended to take risedronate with six to eight ounces of water at least 30 minutes before the first food or drink of the day. Patients are advised not to lay down for 30 minutes after swallowing this medication. This prevents the tablet from lodging in the throat which can lead to esophageal irritation or ulcers.
The dosage frequency varies according to the patient's lifestyle or depending on the tolerance of the medication. In the treatmen of osteoporosis in postmenopausal women, a typical dose may be 5 mg daily, 35 mg once a week, 75 mg two consecutive days each month, or 150 mg once a month.
Many doctors and patients prefer a dosage of 150 mg of risedronate once a month. The health care providers feel that once-a-month dose improves the patients compliance. Patients are told to take medication on the first of each month. Patients prefer the once a month dose because of the complications of taking medication on an empty stomach, no food and not allowed to lay down. Patients may have to switch to weekly or daily doses due to stomach irritation.
To prevent osteoporosis in postmenopausal women the dose is either 5mg daily or 35 mg once a week. Men with osteoporosis are recommended to take 35 mg once a week. To treat or prevent glucocorticoid-induced osteoporosis the recommended dose is 5 mg of Risedronate. Paget’s Disease patients are given 30 mg risedronate daily for 2 months.
There is a debate in the medical community about how long women should take a bisphosphonate for osteoporosis. Many postmenopausal women take these medications indefinitely. However this may not be necessary or safe. Bisphosphonates can stay in your bones years after you stop taking the medication. Also long-term use of bisphosphonates may increase the risk of femur fractures that occur without trauma. This may be due to delays of healing microscopic cracks in the bone that may occur during normal daily activities. A bone density check is recommended every two years for patients who stop bisphosphonates and only restart if the bone density falls more then 4% in the spine or 5% in the hip.
Scientists believe risedronte works at the molecular level by inhibiting an enzyme in the HMG-CoA reductase pathway, which is somewhat similar to the way statin medications used to treat high cholesterol work. Risedronte disrupts protein synthesis involved in the cytoskeleton of osteoclast which ends up slowing bone resorption
Japanese researchers looked into risedronate for Paget's Disease and found it was well tolerated. It more or less works, but does not appear to be all that durable in effects. Paget's Disease is less common in Japan than the US.
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