Fosamax is the brand name for the medication alendronate. It is within a class of medications called bisphosphonates and is used to help treat osteoporosis, which causes bones to become thinner, leaving them prone to fractures. It is also used in the treatment of abnormally high calcium levels. It is generally taken by mouth, in liquid or tablet form; patients are instructed to take it in the morning with a full glass of water, and to remain upright for 30 minutes after taking the medication. Several side effects are potentially dangerous of which patients should be aware when taking Fosamax.
Severe Skin Reactions
The online pharmacology database MicroMedex reports that severe skin reactions have occurred in patients taking Fosamax in both the tablet or liquid forms. Two skin reactions are specifically mentioned: Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). Stevens-Johnson syndrome is a life-threatening reaction that may occur in response to a variety of medications. Symptoms include fever, reddish flat areas of rash, skin pain, and blisters that form on the skin; eventually, the skin begins to die and come off. In Stevens-Johnson syndrome, less than 10 percent of the skin is involved. The related condition, toxic epidermal necrolysis, or TEN, is a more severe version of Stevens-Johnson syndrome. In TEN, over 30 percent of the body surface area is involved. Like Stevens-Johnson, TEN is a life-threatening reaction to a medication and may have symptoms of fever and skin pain. Dr. Milton H. Nirken, of Baylor College of Medicine, and Dr. Whitney A. High, of the University of Colorado School of Medicine, write in the online medical reference UpToDate that one potential way to distinguish the two skin reactions is that in TEN, the skin pain is severe and is often the most significant symptom. In addition, a higher fever is often more common in TEN than in Stevens-Johnson. Regardless of the exact name given to the skin reaction, the point to note is that such a reaction is extremely serious and is a medical emergency.
Esophagus-Related Complications Including Cancer
MicroMedex reports a variety of potential complications that are related to the esophagus. Inflammation of the esophagus, perforation of the esophagus, and erosion of the esophagus with bleeding as a result have all been reported by the manufacturers of Fosamax. In addition, cancer of the esophagus has also been reported in association with Fosamax use. There have only been a few reports of cancer in association with the medication, and an underlying condition called Barrett's esophagus may also play a role. However, these are important and potentially dangerous side effects that should be noted. While it is not entirely clear why all these esophagus-related complications may occur, it seems that one possible reason is that patients were not correctly taking the medication with a full glass of water, or were not staying upright for 30 minutes after taking the medication. This does not mean that patients should not take this medication--only that they should be careful to take the medication exactly as directed, and to mention any unusual symptoms, such as difficulty swallowing, to their doctor.
Severe Muscle, Joint, or Bone Pain
The product information for Fosamax, as reported in MicroMedex, includes the potentially serious side effects of muscle, joint, or bone pain that can be so severe that it interferes with a patient's daily life. The pain could begin as early as one day into therapy or start after several months of treatment. Fortunately, the muscle, joint, or bone pain is generally found to be temporary, resolving after treatment with Fosamax is stopped. Since up to 4 percent of patients may experience this debilitating pain, the general recommendation is to stop therapy if symptoms of muscle aches, joint pain, or bone tenderness begin.
Osteonecrosis of the Jaw
Osteonecrosis is a term that literally means death of the bone. There have been rare reports of the jawbone being affected by this condition when Fosamax, as well as other bisphosphonates, is used. A major risk factor for osteonecrosis of the jaw, or ONJ, is some sort of invasive procedure, such as a tooth extraction, being performed. However, according to MicroMedex, spontaneous cases of ONJ have also been observed. Patients who experience ONJ should discuss with their healthcare providers the benefits of staying on Fosamax compared to the risks of continuing treatment with Fosamax.
References
- "UpToDate"; Denise S. Basow: 2009
- Micromedex: Alendronate
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