Alendronic Acid + Vitamin D3 interactions

Food & lifestyle

• food

  Moderate

  Absorption

  Food significantly decreases the bioavailability of alendronate, possibly to negligible levels.

  What to do: Alendronate should be administered with 6 to 8 ounces of plain water, at least 30 minutes before the first food, beverage, or medication of the day. Patients should remain upright for at least 30 minutes following administration of alendronate.

  1 source

  1. "Product Information. Fosamax (alendronate)." Merck & Co., Inc (2001):

Conditions

Conditions in which Alendronic Acid + Vitamin D3 needs care, as documented in this source.

• Arrhythmias, Cardiac

  Major

  Vitamin D analogs function to increase serum calcium concentrations and can exacerbate arrhythmias, particularly in patients receiving cardiac glycosides. Therapy with vitamin D analogs should be administered cautiously in patients with or predisposed to cardiac arrhythmias. Clinical monitoring of serum electrolyte concentrations and cardiac function is recommended.

  3 sources

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma (2001):
  2. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  3. "Product Information. Calderol (calcifediol)." Organon (2001):

• Bisphosphonate-Associated Osteonecrosis of the Jaw

  Major

  Osteonecrosis of the jaw (ONJ), which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients taking bisphosphonates. Known risk factors for osteonecrosis of the jaw include invasive dental procedures (e.g., tooth extraction, dental implants, boney surgery), diagnosis of cancer, concomitant therapies (e.g., chemotherapy, corticosteroids, angiogenesis inhibitors), poor oral hygiene, and co-morbid disorders (e.g., periodontal and/or other pre-existing dental disease, anemia, coagulopathy, infection, ill-fitting dentures). The manufacturers of bisphosphonates recommend discontinuation of bisphosphonate treatment for patients undergoing invasive dental procedures. Patients who develop osteonecrosis of the jaw while on bisphosphonate therapy should receive care by an oral surgeon. In these patients, extensive dental surgery to treat ONJ may exacerbate the condition. Discontinuation of bisphosphonate therapy should be considered based on individual benefit/risk assessment.

  6 sources

  1. "Product Information. Fosamax (alendronate)." Merck & Co., Inc (2001):
  2. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals (2001):
  3. "Product Information. Zometa (zoledronic acid)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Boniva (ibandronate)." Roche Laboratories (2005):
  5. "Product Information. Reclast (zoledronic acid)." Quality Care Products/Lake Erie Medical (2011):
  6. "Product Information. Binosto (alendronate)." Mission Pharmacal Company (2012):

• Hypercalcemia

  Major

  Vitamin D analogs such as calciferol and ergocalciferol should not be given to patients with hypercalcemia, malabsorption syndrome, or evidence of vitamin D toxicity.

  4 sources

  1. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  2. "Product Information. Zemplar (paricalcitol)." Abbott Pharmaceutical (2001):
  3. "Product Information. Delta D3 (cholecalciferol)." Freeda Vitamins Inc (2002):
  4. "Product Information. Drisdol (ergocalciferol)." sanofi-aventis (2016):

• Hypocalcemia

  Major

  The use of bisphosphonates is contraindicated for the treatment of osteoporosis in patients with hypocalcemia. These agents increase bone mineral density, a process that requires an adequate supply of calcium in the body. Following the initiation of therapy, a short-term reduction in serum calcium and phosphate levels usually occurs due to inhibition of bone resorption, especially in patients with Paget's disease, in whom the pretreatment rate of bone turnover may be greatly elevated. Hypocalcemia and other disturbances of mineral metabolism, such as vitamin D deficiency, should be treated prior to initiation of therapy. Appropriate intake of calcium and vitamin D should be ensured throughout the course of treatment.

  7 sources

  1. "Product Information. Fosamax (alendronate)." Merck & Co., Inc (2001):
  2. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals (2001):
  3. Watts NB "Treatment of osteoporosis with bisphosphonates." Rheum Dis Clin North Am 20 (1994): 717-34
  4. Lourwood DL "The pharmacology and therapeutic utility of bisphosphonates." Pharmacotherapy 18 (1998): 779-89
  5. Schussheim DH, Jacobs TP, Silverberg SJ "Hypocalcemia associated with alendronate." Ann Intern Med 130 (1999): 329
  6. "Product Information. Boniva (ibandronate)." Roche Laboratories (2005):
  7. "Product Information. Reclast (zoledronic acid)." Quality Care Products/Lake Erie Medical (2011):

• Kidney Diseases

  Major

  Ergocalciferol, cholecalciferol, and calcifediol undergo renal biotransformation during metabolic activation. Renal impairment can alter metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as dihydrotachysterol (hepatic activation) and calcitriol (active form) may be considered in patients with compromised renal function.

  3 sources

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma (2001):
  2. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  3. "Product Information. Calderol (calcifediol)." Organon (2001):

• Peptic Ulcer

  Major

  Bisphosphonates may cause local irritation of the upper gastrointestinal mucosa. Esophagitis and esophageal ulcers and erosions, occasionally with bleeding, as well as gastric and duodenal ulcers, have been reported, primarily with alendronate. Because of their structural similarities, therapy with all bisphosphonates should be administered cautiously in patients with active upper gastrointestinal disorders. The usual precautions should be followed closely to minimize the risk of irritation (i.e. taking the medication with a full glass of water after arising for the day and remaining upright for at least 30 minutes afterwards and until the first food intake of the day). Therapy should be discontinued if dysphagia, odynophagia or retrosternal pain occurs. The manufacturer of alendronate considers its use to be contraindicated in patients with abnormalities of the esophagus that may delay esophageal emptying, such as stricture or achalasia.

  19 sources

  1. Maconi G, Porro GB "Multiple ulcerative esophagitis caused by alendronate." Am J Gastroenterol 90 (1995): 1889-90
  2. "Product Information. Fosamax (alendronate)." Merck & Co., Inc (2001):
  3. Nightingale SL "Important information regarding alendronate adverse reactions." JAMA 275 (1996): 1534
  4. Abdelmalek MF, Douglas DD "Alendronate-induced ulcerative esophagitis." Am J Gastroenterol 91 (1996): 1282-3
  5. Castell DO ""Pill esophagitis"--the case of alendronate." N Engl J Med 335 (1996): 1058-9
  6. Liberman UA, Hirsch LJ "Esophagitis and alendronate." N Engl J Med 335 (1996): 1069-70
  7. Degroen PC, Lubbe DF, Hirsch LJ, Daifotis A, Stephenson W, Freedholm D, Pryortillotson S, Seleznick MJ, Pinkas H, Wang KK "Esophagitis associated with the use of alendronate." N Engl J Med 335 (1996): 1016-21
  8. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals (2001):

  Show all 19 sourcesShow fewer sources

  9. Colina RE, Smith M, Kikendall JW, Wong RK "A new probable increasing cause of esophageal ulceration: alendronate." Am J Gastroenterol 92 (1997): 704-6
  10. Rimmer DE, Rawls DE "Improper alendronate administration and a case of pill esophagitis." Am J Gastroenterol 91 (1996): 2648-9
  11. Levine J, Nelson D "Esophageal stricture associated with alendronate therapy." Am J Med 102 (1997): 489-91
  12. Cameron RB "Esophagitis dissecans superficialis and alendronate: case report." Gastrointest Endosc 46 (1997): 562-3
  13. Lourwood DL "The pharmacology and therapeutic utility of bisphosphonates." Pharmacotherapy 18 (1998): 779-89
  14. Yue QY, Mortimer O "Alendronate - Risk for esophageal stricture." J Am Geriat Soc 46 (1998): 1581-2
  15. Wallace JL "Upper gastrointestinal ulceration with alendronate." Digest Dis Sci 44 (1999): 311-2
  16. Peter CP "Upper gastrointestinal ulceration with alendronate - Response." Digest Dis Sci 44 (1999): 312-3
  17. Bauer DC, Black D, Ensrud K, Thompson D, Hochberg M, Nevitt M, Musliner T, Freedholm D "Upper gastrointestinal tract safety profile of alendronate - The Fracture Intervention Trial." Arch Intern Med 160 (2000): 517-25
  18. Lowe CE, Depew WT, Vanner SJ, Paterson WG, Meddings JB "Upper gastrointestinal toxicity of alendronate." Am J Gastroenterol 95 (2000): 634-40
  19. "Product Information. Boniva (ibandronate)." Roche Laboratories (2005):

• Pneumonia, Aspiration

  Major

  The manufacturer considers the use of alendronate sodium oral solution to be contraindicated in patients at increased risk of aspiration.

  2 sources

  1. "Product Information. Fosamax (alendronate)." Merck & Co., Inc (2001):
  2. "Product Information. Binosto (alendronate)." Mission Pharmacal Company (2012):

• Water-Electrolyte Imbalance

  Major

  Vitamin D analogs administered in the presence of hyperphosphatemia can result in precipitation of calcium-phosphate deposits within the vascular or renal systems or other soft tissue calcifications. A solubility product (Serum Calcium X Phosphate) should not exceed 70. Serum electrolyte concentrations should be corrected prior to vitamin D analog therapy and monitored during therapy.

  4 sources

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma (2001):
  2. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  3. "Product Information. Calderol (calcifediol)." Organon (2001):
  4. "Product Information. Zemplar (paricalcitol)." Abbott Pharmaceutical (2001):

• Asthma

  Moderate

  There have been reports of bronchoconstriction in aspirin-sensitive patients receiving bisphosphonates. Use of these agents in asthmatic and in aspirin-sensitive patients should be used with caution.

  6 sources

  1. "Product Information. Fosamax (alendronate)." Merck & Co., Inc (2001):
  2. "Product Information. Actonel (risedronate)." Procter and Gamble Pharmaceuticals (2001):
  3. "Product Information. Zometa (zoledronic acid)." Novartis Pharmaceuticals (2001):
  4. "Product Information. Boniva (ibandronate)." Roche Laboratories (2005):
  5. "Product Information. Reclast (zoledronic acid)." Quality Care Products/Lake Erie Medical (2011):
  6. "Product Information. Binosto (alendronate)." Mission Pharmacal Company (2012):

• Heart Diseases

  Moderate

  Each tablet of Binosto (alendronate effervescent) contains 650 mg sodium, equivalent to 1650 mg NaCl. Use caution in patients on sodium restriction, such as patients with a history of heart failure, hypertension, or other cardiovascular diseases.

  1 source

  1. "Product Information. Binosto (alendronate)." Mission Pharmacal Company (2012):

• Kidney Diseases

  Moderate

  Alendronate is primarily eliminated by the kidney. In healthy controls, drug that is not deposited in bone is rapidly excreted in the urine. Although clinical information is not available, animal studies suggest reduced drug clearance in renal failure. Alendronate is not recommended for use in patients with creatinine clearance less than 35 mL/min due to a lack of clinical experience in this setting. No dosage adjustment is necessary in patients with mild to moderate renal impairment (CrCl >= 35 mL/min).

  1 source

  1. "Product Information. Fosamax (alendronate)." Merck & Co., Inc (2001):

• Liver Diseases

  Moderate

  Vitamin D analogs are fat soluble and oral formulations require bile for adequate intestinal absorption. Hepatic and/or biliary dysfunction decrease the absorption of vitamin D analogs. Metabolites of vitamin D analogs are primarily excreted in bile and feces. Ergocalciferol, cholecalciferol, and dihydrotachysterol undergo hepatic hydroxylation during metabolic activation. Hepatic impairment can alter the metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as calcifediol (requires renal activation) and calcitriol (active form) may be considered in patients with compromised hepatic function.

  3 sources

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma (2001):
  2. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  3. "Product Information. Calderol (calcifediol)." Organon (2001):

Therapeutic duplication

Drug classes that overlap with Alendronic Acid + Vitamin D3, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• vitamin d analogs

  The recommended maximum number of medicines in the 'vitamin d analogs' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'vitamin d analogs' category.

  Example product in the source data (US market): Os-cal extra d3