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The following safety warnings highlight crucial information regarding the use of alendronate (Fosamax). It is important to consider these risks and precautions and to consult your healthcare provider if you have any questions or concerns.

• Stomach and Esophagus Irritation: Alendronate can cause irritation and ulcers in the stomach and esophagus. To minimize risk, take this medication with 6-8 ounces of water and remain standing or sitting upright for at least 30 minutes post-dose. Inform your healthcare provider if this is challenging for you, as alternative medications may be available. Report any new swallowing pain or heartburn to your provider as these could indicate ulcers. Increased risk may occur if you have existing stomach issues, take other stomach-irritating medications, or have trouble maintaining an upright position.

• Decreased Calcium Levels: Ensure any low calcium or vitamin D levels are addressed before starting alendronate, as it can further decrease calcium levels. Follow your healthcare provider's advice on supplements and attend all scheduled blood tests. Notify your provider of any muscle spasms or twitching, indicative of low calcium levels. Risks include existing low calcium or vitamin D levels, Paget’s disease, and steroid medication use.

• Muscle Pain: Rarely, severe bone, muscle, or joint pain may occur, potentially appearing days to months after starting treatment. Postmenopausal women are at higher risk. Contact your healthcare provider if you experience these symptoms, which often resolve once the medication is discontinued.

• Jaw Bone Issues: Alendronate can rarely affect the jaw bone, especially after major dental surgeries, with poor oral hygiene, prolonged use, or concurrent use of certain medications. Ensure your healthcare provider and dentist are informed of any dental procedures. Report any mouth or jaw pain, swelling, or infection to your provider. Risks include dental surgery, cancer, certain medications, poor oral hygiene, existing dental issues, anemia, ill-fitting dentures, and prolonged alendronate use.

• Leg Bone Fractures: There have been rare reports of unusual leg fractures with minimal force. While the link to alendronate is uncertain, report any new hip or thigh pain to your provider. The risk increases with concurrent steroid medication use.

• Kidney Issues: Alendronate is not recommended for individuals with severe kidney problems. Consult your healthcare provider to determine if this medication is suitable for you.

In addition to these warnings, certain conditions contraindicate the use of alendronate due to significant health risks. Avoid this medication if you have:

• Disorders affecting the throat or gastrointestinal tract that impede food passage.
• Inability to remain upright for at least 30 minutes.
• Hypocalcemia (low calcium levels).

For any of these conditions, seek guidance from your healthcare provider before using this medication.

Common side effects:

• Stomach pain
• Constipation
• Diarrhea
• Gas
• Nausea
• Bloating
• Headaches

Less common but important to monitor:

• Muscle pain
• Bone pain
• Joint pain
• Heartburn or indigestion
• Ulcers in the esophagus

Serious side effects:

• Severe allergic reaction (trouble breathing, hives, swelling of the face, tongue, or throat)
• Low calcium levels (muscle spasms, tingling sensations)
• Severe bone or joint pain
• Unusual hip, thigh, or groin pain
• Black or tarry stools
• Vomiting resembling coffee grounds
• Serious esophageal irritation (new or worsening heartburn, chest pain, difficulty swallowing)

When taking alendronate, it's important to be aware of potential interactions with other substances that can affect its effectiveness or increase the risk of side effects. Here are some key considerations:

Calcium Supplements and Antacids: Products containing calcium, Magnesium, aluminum, or Iron can interfere with the absorption of alendronate. To ensure proper absorption, take alendronate at least 30 minutes before consuming these supplements or antacids.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Using NSAIDs, such as Ibuprofen or Naproxen, alongside alendronate may increase the risk of gastrointestinal irritation. If you need to use NSAIDs while on alendronate, consult your healthcare provider for guidance.

Aspirin: Combining aspirin with alendronate can also elevate the risk of gastrointestinal side effects. It's advisable to discuss with your doctor before using aspirin concurrently with alendronate.

Food and Beverages: Consuming food or drinks other than plain water close to the time you take alendronate can significantly reduce its absorption. To maximize effectiveness, take alendronate first thing in the morning with a full glass of plain water, and wait at least 30 minutes before eating, drinking, or taking other medications.

Other Medications: Certain medications, such as Deferasirox, may increase the risk of gastrointestinal issues when taken with alendronate. Always inform your healthcare provider about all medications and supplements you are currently taking to assess potential interactions.

By following these guidelines and consulting with your healthcare provider, you can help ensure that alendronate works effectively and safely as part of your treatment plan.