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It is given orally, usually once weekly. Refer if ocular pain or visual loss occurs Rare but serious ocular complications can occur with alendronate treatment. Of these, most of the clinically significant reactions reported to CARM and internationally are ocular inflammation such as conjunctivitis, uveitis, episcleritis and scleritis.
Non-specific conjunctivitis seldom requires treatment and usually diminishes in intensity with subsequent exposures to alendronate. However, alendronate may need to be discontinued for other ocular inflammation to resolve; this is always necessary for scleritis. These reactions were rarely severe. The time to onset varied from one day to several months after starting treatment.
Alendronate and Inflammatory Adverse Reactions
Recovery was usual when alendronate was discontinued. Recurrence in patients re-challenged with alendronate or another bisphosphonate has been reported. Three patients experienced recurrence on re-challenge. In one, the synovitis was severe enough to cause carpal tunnel syndrome that required urgent decompression.
Oesophagitis and oesophageal ulceration can also occur Abdominal pain, nausea, vomiting, dyspepsia and diarrhoea have been frequently reported to CARM. Oesophagitis, stomatitis and pharyngitis have also been reported.
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More serious reports include oesophageal ulceration, oesophageal stricture, gastric ulceration and gastrointestinal haemorrhage. Post-marketing studies have identified oesophageal disorders including oesophagitis, erosive oesophagitis and oesophageal ulceration as adverse reactions to alendronate.
Gastric ulcer, gastritis and gastroduodenitis have also been attributed to alendronate. Food should not be eaten until 30 minutes after taking alendronate. Patients should not lie down for at least 30 minutes and not until they have eaten their first food for the day.
A wide variety of skin exanthems have also been reported with no particular type predominating. Post-marketing events reported include photosensitivity rashes, pruritis and, rarely, serious skin reactions including Stevens Johnson syndrome and toxic epidermal necrolysis. The intravenous agents pamidronate and zoledronate belong to this same chemical class of bisphosphonates, and have also been causally associated with musculoskeletal pain, influenza-like disorders and ocular inflammation.
Conjunctivitis is the only ocular inflammation that has been reported with etidronate. This problem is being observed in oncology patients, many of whom have been treated with high-dose monthly bisphosphonates such as pamidronate and zoledronate. A small number of such cases have been reported worldwide in association with alendronate use 11 — see boxed item below for more information about ONJ. Fosamax alendronate data sheet 17 October Bisphosphonates and ocular inflammation [Letter].
N Eng J Med ; Bisphosphonates and ocular inflammation. Aust Adv Drug Reactions Bull ;23 2. Synovitis induced by alendronic acid can present as acute carpal tunnel syndrome. Acute polyarthritis related to once-weekly alendronate in a woman with osteoporosis [Letter].
J Rheumatol ;31 4: Alendronate and oesophageal ulceration.
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Pamisol pamidronate data sheet. Zometa zoledronate data sheet.
Association of osteonecrosis of the jaws and bisphosphonate pharmacotherapy: New Zealand Dental Journal ; 1: Bisphosphonates and osteonecrosis of the jaw Prescriber Update 27 1: It refers to the development of areas of exposed, necrotic bone in either the mandible or maxilla, which persist for a number of months. This problem is being recognised in oncology patients, many of whom have been treated with high-dose monthly bisphosphonates. This is most commonly seen in those with metastatic breast cancer or with multiple myeloma.
There have now been some case reports of this phenomenon, although they constitute less than five percent of the total number of cases recorded. For instance, there have been about one hundred cases reported worldwide with alendronate in the context of twenty million patient-years of use of this medicine. The lesions seem to develop following major dental procedures, such as extractions or dental implants, although they are sometimes associated with local trauma from dentures.
Some dentists are recommending such procedures are entirely avoided in those with a history of bisphosphonate use. To many working in the field, this seems an over-reaction to what is, outside the context of oncological practice, a very rare event.
While the pathogenesis and aetiology of this condition are being further explored, it does seem cautious to carry out any planned major dental procedures before individuals start on bisphosphonates.
However, it must be borne in mind that substantial delays to the initiation of bisphosphonate therapy in those at a substantial risk of fracture will lead to the occurrence of preventable fractures.