ALENDRONATE (Fosamax / Fosavance) INFORMATION SHEET

Developed by Andy Thompson MD FRCPC

What is Fosamax?

Fosamax is a  of medication used to treat and prevent osteoporosis including osteoporosis related to chronic steroid (prednisone) use. Occasionally doctors use Bisphosphonates for other diseases such as Paget’s disease.

How does Fosamax work?

Healthy bones are constantly being broken down and renewed. This process is a delicate balance of the breaking down of old bone (by cells called osteoclasts) and the rebuilding of new bone (by cells called osteoblasts). Fosamax works by inhibiting the osteoclasts, slowing down the process of bone breakdown.

What is the usual dose of Fosamax?

• Fosamax can be given as 10 mg once a day or 70 mg once a week.
• Fosavance is the same thing as Fosamax but it contains Vitamin D.  Fosavance comes in doses of 70 mg Alendronate / 2,800 IU Vitamin D or 70 mg Alendronate / 5,600 IU Vitamin D. 
• It should be taken first thing in the morning, 1/2 hour before eating, drinking, or taking other medication.
• Take it with a full glass of water (NOT JUICE, COFFEE, TEA, etc).  Do not lie down after taking it.  Wait at least 1 hour before taking any other medication or eating or drinking anything.

How do I maximize the effect of Fosamax?

• Only a very small amount of the Fosamax is absorbed into the body (0.5%). Therefore, you must follow the instructions very carefully when taking this medication.
• Be certain you are receiving adequate amounts of Calcium and Vitamin D either from your diet or from supplemental tablets. (Please see the Calcium & Vitamin D Information Sheet)

Who should NOT take Fosamax?

• Patients who have had a previous allergic reaction to Fosamax.
• Women who are pregnant, planning pregnancy, or breast feeding.
• Patients with advanced kidney disease.
• Patients with low levels of calcium in the blood (hypocalcemia).
• Patients unable to stand or sit upright for 30 minutes should not take Fosamax.

When will I start to feel the effects of Fosamax?

Most patients will not feel any effects from Fosamax. Your doctor may monitor your response with bone mineral density testing. Fosamax is used to improve or stabilize the strength of your bones to prevent a fracture. It is often taken for many years.

What Medications are safe with Fosamax?

Virtually all medications are safe to take with Fosamax. An example of some of the medications which may be safely added to Fosamax include: Acetaminophen (Tylenol), Prednisone, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Other DMARDs (i.e. Methotrexate, Sulfasalazine, Hydroxychloroquine, and Gold), and Biologics (i.e. Etanercept, Infliximab, Anakinra).

What are the side-effects of Fosamax?

MORE COMMON side-effects include:

• Bloating, nausea, stomach pain, and heartburn
• Diarrhea or constipation
• Back pain or joint pain
• Headache

RARE side-effects include:

• Gastrointestinal Problems: Fosamax can cause irritation to the lining of the stomach, esophagus, and intestine. This may result in:
• Pain or trouble when swallowing.
• Ulcers in the stomach or esophagus.

How can I help to minimize the side-effects of Fosamax?

• Take your Fosamax as prescribed by your doctor and attend regular follow-up visits.
• Remember not to lie down after taking your Fosamax.

Do I need to have regular blood tests while taking a Fosamax?

NO, you do not need to have regular blood tests while taking Fosamax. However, your doctor will likely order blood tests to help follow the activity of your disease.

How do I stop the Fosamax?

You do not need to wean yourself off the Fosamax. It can simply be stopped. Please inform your doctor is you have stopped taking the medication.

What should I do if I miss a dose of Fosamax?

• If you forget to take your Fosamax, skip the dose, and take your usual dose tomorrow.
• If you forgot to take yesterday’s dose, skip yesterday’s dose and take your usual dose for today.

Is Fosamax safe in pregnancy?

• Fosamax is not recommended for use in pregnancy.
• If you become pregnant while taking a Fosamax NOTIFY YOUR DOCTOR IMMEDIATELY.
• Fosamax should not be taken if you are breast feeding.