|The Bisphosphonates : by drdoc on-line|
|Alendronate / Pamidronate / Etidronate / Desedronate / Risedronate|
Alendronate is a
Alendronate has a potential to cause esophageal ulceration and dyspepsia, or indigestion. You have to take it on waking in the morning, on an empty stomach, and with a full glass of water. YOU MUST NOT EAT OR TAKE ANYTHING BUT WATER FOR A FULL HALF HOUR or the drug will bind to the food and therefore not be effective. In addition, you should not lie flat after taking the tablet, and should preferably get out of bed and stay upright. This minimizes risk of esophageal ulceration.
In fact palmidronate has a probable higher potential for
esophageal ulceration, and it is therefore used by myself only in an intravenous form as
I usually monitor the effects of it by checking a bone dexa scan densitometry at baseline and after 12-18 months.
If you have osteoporosis-----ask your doctor.
I have found this group of drugs useful for treatment of symptomatic as well as asymptomatic osteoporosis.
I have found that with the use of Calcitonin and these Bisphosphonates used appropriately, that the crippling effects of spinal fractures is a thing of the past, and that my patients are almost fully mobile after 1 month ---without pain killers.
In the old days, a spinal fracture meant
prolonged bed rest and the use of powerful pain-killers. My personal regimen for patients with spinal fractures, is to use pamidronate -
Aredia - (Novartis) as a single intravenous pulse - 30mg in 400 ml saline over 4 hours
intravenously. This is extremely useful in spinal fractures - with excellent pain relief.
The patient is usually given 3 daily injections of miacalcic 100 units subcutaneously for
three days, and gets the pamidronate on day 4. Thereafter, the patient is mobilized with
physical therapy. The patient usually is able to stop all analgesia by day 10-14. The
Pamidronate is then given as an intravenous infusion every 6 months. In fact the infusion
is done as an outpatient, and is approximately 33% less expensive than oral alendronate,
which I personally do not find effective for bone pain.
Not all primary care physicians are aware of these
new category medications.
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