Contraindications and Precautions for Fosamax (Alendronate) Therapy

Absolute Contraindications

• The American Academy of Family Physicians recommends that Fosamax (alendronate) is absolutely contraindicated in patients with esophageal abnormalities, inability to stand or sit upright for at least 30 minutes, hypocalcemia, and hypersensitivity to any component of the product, as well as in patients at increased risk of aspiration 1

Relative Contraindications and Clinical Considerations

• The National Comprehensive Cancer Network recommends caution when using oral alendronate in patients with renal impairment, and advises against using intravenous bisphosphonates in patients with creatinine clearance less than 30 mL/min 2
• The American Dental Association and Infectious Diseases Society of America suggest considering delaying initiation of alendronate in patients who have recently undergone dental procedures or extractions due to the rare risk of osteonecrosis of the jaw 3, 4
• The Endocrine Society recommends correcting vitamin D deficiency before initiating bisphosphonate therapy to avoid hypocalcemia, especially with intravenous formulations 4