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 &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
249.1 (325.1 as
sodium salt)

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
78

%Excreted unchanged in urine &nbsp &nbsp :
Approx 50

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :
28 litres

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :
>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 &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:
Unlikely to be dialysed. Dose as in
GFR<35 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
Not dialysed. Dose as in
GFR<35 mL/min

HDF/high flux &nbsp :
Unknown dialysability. Dose as in
GFR<35 mL/min

CAV/VVHD &nbsp &nbsp &nbsp:
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 an

empty stomach, at least 30 minutes before
breakfast and any other oral medication

Patient should stand or sit upright for at

least 30 minutes after taking tablets

Combination therapy with alendronate and

intravenous 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 information

available 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 either

70 mg weekly or standard doses of all
preparations in patients with CKD 3, 4 and
5 to good effect

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