Alendronic acid

CLINICAL USE

Treatment and prophylaxis of osteoporosis

DOSE IN NORMAL RENAL FUNCTION

5–10 mg daily or 70 mg once weekly

PHARMACOKINETICS

  • Molecular weight                           :
    249.1 (325.1 as
    sodium salt)
  • %Protein binding                           :
    78
  • %Excreted unchanged in urine     :
    Approx 50
  • Volume of distribution (L/kg)       :
    28 litres
  • half-life – normal/ESRD (hrs)      :
    >10 years/Increased

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

    35–50 Dose as in normal renal function
    <35
    Avoid. See ‘Other Information’

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :
    Unlikely to be dialysed. Dose as in
    GFR<35 mL/min
  • HD                     :
    Not dialysed. Dose as in
    GFR<35 mL/min
  • HDF/high flux   :
    Unknown dialysability. Dose as in
    GFR<35 mL/min
  • CAV/VVHD      :
    Unlikely to be dialysed. Dose as in
    GFR<35 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
    Calcium salts: reduced absorption of

    alendronate

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

  • Swallow whole with a glass of water on anempty stomach, at least 30 minutes before
    breakfast and any other oral medication
  • Patient should stand or sit upright for atleast 30 minutes after taking tablets
  • Combination therapy with alendronate andintravenous calcitriol, for the treatment
    of secondary hyperparathyroidism in
    haemodialysis patients, has been used
    at a dose of 10 mg alendronate plus IV
    calcitriol 2 mcg post dialysis to reduce
    PTH levels. (McCarthy JT, Kao PC,
    Demick DS, et al. Combination therapy
    with alendronate and intravenous
    calcitriol for the treatment of secondary
    hyperparathyroidism in hemodialysis
    patients. J Am Soc Nephrol. 1999; 10
    Program, 81A–82A.)
    Manufacturers do not recommend use of

    alendronate in severe renal impairment
    due to lack of data

  • One paper reviewed all the informationavailable and concluded that 50% of the
    recommended dose may be possible
    in ESRD, but more trials are required
    and osteomalacia and adynamic bone
    disease must first be excluded. (Miller
    PD. Treatment of osteoporosis in chronic
    kidney disease and end-stage renal disease.
    Curr Osteoporos Rep. 2005; 3: 5–12.)
  • Anecdotally, several renal units use either70 mg weekly or standard doses of all
    preparations in patients with CKD 3, 4 and
    5 to good effect
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