Fosamax is commonly used in the prevention or treatment of osteoporosis. It works by preventing the breakdown of bone and is classified as a bisphosphonate. It was approved by the FDA in 1995 and is available in a generic form as alendronate. It is typically taken once weekly. Although its effectiveness is clinically proven, there are several side effects of which patients should be made aware.
Esophagus and GI Tract Effects
One of the most serious dangers of Fosamax is its potential effect on the esophagus. There are reports of esophageal erosions, bleeding, ulcers and perforations. In addition, in 2009, Wysowski and Associates published in the New England Journal of Medicine evidence linking the use of Fosamax to esophageal cancer, particularly in patients that do not follow dosing recommendations.
Thus it is recommended that the medication be taken on an empty stomach with a full glass of water and patients should not lie down for at least 30 minutes after taking alendronate. No other food, drink or medication should be taken until a minimum of 30 minutes after the dosage. If a patient is unable to remain in an upright position for a minimum of 30 minutes, they are not a good candidate for Fosamax.
If a patient has a history of esophageal abnormality or difficulty swallowing, alendronate should not be used. Alendronate can also irritate other sections of the gastrointestinal tract. Ulcers and irritation in the stomach and pharynx have been reported as well.
Effects on Joint, Muscle and Bone
In 2008, the FDA disclosed that cases of severe disabling bone and muscle pain have been reported by patients taking Fosamax and other drugs in this drug class. These patients said they were incapacitated.
The users were unable to walk or complete their daily activities. Some stated their pain lasted from days to a full year. In some patients, the symptoms subsided when the drug was discontinued. However, in others, the symptoms reversed more slowly even after the drug was stopped.
Skin and Subcutaneous Tissue
According to Merck, the maker of Fosamax, several extreme skin reactions have been reported since Fosamax entered the market. Steven-Johnsons syndrome, a condition that involves a sloughing off of the skin, has been noted. Also, toxic epidermal necrolysis has also been associated with the drug. Merck also notes that patients taking alendronate have reported alopecia, commonly called hair loss.
Warnings
Alendronate should be swallowed whole. Do not crush or chew the tablet, as this could alter absorption of the medication.
References
- National Institutes of Health: "Reports of Esophageal Cancer With Oral Bisphosphonate Use"; Wysowski DK, New England Journal of Medicine, 2009, 360(1):89-90
- Merck and Co. Inc.: Product Information Fosamax Oral Tablets
- FDA: Bisphosphonates (Marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa)
