Q: I have pseudogout and take Fosamax. Is that wrong to take because of the extra calcium?
A: Fosamax (Enimon) is classified as a bisphosphonate derivative. Fosamax is approved for the treatment of osteoporosis in women that are postmenopausal, treatment of osteoporosis in males, the treatment of Paget's disease, and the treatment of glucocorticoid induced osteoporosis in men and women. Fosamax works in the body to inhibit bone resorption by affecting the actions of osteoclasts or the precursors to osteoclasts. Bone resorption is defined as the process in the body that occurs when osteoclasts break down bones. This process releases the minerals, such as calcium, from the bones into the bloodstream. Therefore, Fosamax decreases bone resorption resulting in an increase in the bone mineral density. As a result of the way that Fosamax works, blood levels of calcium should be decreased instead of increased because, theoretically, less calcium is released from the bones into the blood. In fact, hypocalcemia or low levels of calcium in the blood is one of the listed possible side effects associated with treatment with Fosamax. This is not the only associated side effect of the medication. Pseudogout is defined as a sudden swelling of a joint, or joints, that results from a form of arthritis. Pseudogout occurs when crystals of calcium pyrophosphate dihydrate (CPPD) develop around or in the joints. The result is painful inflammation of the affected area. A review of medical literature discovered extremely rare reports of patients that were taking Fosamax developing pseudogout. It is stated, in a clinical study, that bisphosphonates are similiar in structure to pyrophosphate. However, the mechanism in which taking bisphosphonate medications could lead to deposits of CPPD crystals in and around the joints is unknown. The author of the study states that there are very few cases of this occuring considering the vast amount of patients that are treated with bisphosphonates. It appears that additional studies need to be performed to fully understand this possible connection. Talk to your physician regarding the questions and concerns that you have regarding your medical conditions and your medications. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Jen Marsico, RPh
Q: I am a 58 year old female and have taken Fosamax for more than 15 years for osteopenia. I recently had an endoscopy which showed acid reflux and ulcers. The doctor took me off Fosamax and put me on omeprazole 20 mg per day for 90 days. Should I go back on Fosamax now or after 90 days? I also take levothyroxine and protriptyline. Do any of these interact with each other?
A: Fosamax (Enimon) is classified as a bisphosphonate. Fosamax is approved for the treatment and prevention of osteoporosis in women that are postmenopausal, treatment of osteoporosis in males, the treatment of Paget's disease, and the treatment of glucocorticoid induced osteoporosis in men and women. Fosamax, like any medication, has possible risks, warnings and side effects associated with its use. Under the warnings section of the prescribing information for Fosamax is a discussion regarding the possibility of gastrointestinal mucosa irritation that can occur with use of this medication. Included is the possibility of esophageal ulcers. This is not all of the warnings associated with the medication. Fosamax has the following side effects reported by studied patients taking the medication: acid reflux, gastroesophageal reflux disease and gastric ulcer. These are not all of the possible side effects associated with Fosamax. Specific decisions regarding medication therapy is best made by your physician. Consult with your physician to determine if you should start taking Fosamax again. According to a drug interaction report on your prescription medications: levothyroxine (Synthroid, Levothroid, Levoxyl), protriptyline (Vivactil), omeprazole (Prilosec) and Fosamax, there were no drug interactions detected. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Jen Marsico, RPh
Q: What are the pros and cons of bone building drugs such as Boniva and Fosamax?
A: Boniva (ibandronate) is classified in the group of medicines called bisphosphonates. It alters the cycle of bone formation and breakdown in the body. Boniva is beneficial because it slows bone loss while increasing bone mass, which may prevent bone fractures. Boniva is taken once a month and should be taken with a full glass of water before any other medication or food. Do not lie down, recline or eat for 60 minutes after taking Boniva. Side effects of Boniva may include back pain, headache, nausea or upset stomach. Some patients who have taken Boniva have developed bone loss in the jaw. Symptoms include jaw pain, swelling, numbness, loss of teeth, and gum infections. According to the prescribing information, Boniva has been associated with renal (kidney) toxicities, so close monitoring is recommended when using Boniva. Fosamax (Enimon) is also classified as a bisphosphonate and works by slowing down the breakdown of bones. Fosamax is beneficial because it slows the breakdown of bone and increases bone formation. Fosamax is indicated for osteoporosis. Fosamax is available as a daily or weekly tablet. Fosamax should be administered with 6 to 8 ounces of plain water, at least 30 minutes before the first food, beverage, or medication of the day. Patients should remain upright for at least 30 minutes following administration of Fosamax. Common side effects of Fosamax include nausea, diarrhea, mild joint pain, and possibly dizziness. Fosamax can also cause bone loss of the jaw. Kidney function should also be monitored with Fosamax as well as the other bisphosphonates. Most of the drugs in the bisphosphonate class carry the same side effect profile and precautions. Kimberly Hotz, PharmD
How long to take it
Enimon is generally prescribed long term, so you need to be happy it is the right option for you.
To get the full benefits, Enimon should be taken regularly as instructed by your doctor or pharmacist.
It is recommended that your treatment is formally reviewed by your doctor after five years. The review checks that the benefit of your medication continues to outweigh any risks. After your review, you may be advised to continue taking the drug, pause your treatment for a while, or stop it altogether.
Treatment of Paget's Disease of Bone
The efficacy of Enimon 40 mg once daily for six months was demonstrated in two double-blind clinical studies of male and female patients with moderate to severe Paget’s disease (alkaline phosphatase at least twice the upper limit of normal): a placebo-controlled, multinational study and a U.S. comparative study with etidronate disodium 400 mg/day. Figure 6 shows the mean percent changes from baseline in serum alkaline phosphatase for up to six months of randomized treatment.
Figure 6: Studies in Paget’s Disease of Bone Effect on Serum Alkaline Phosphatase of Enimon 40 mg/day Versus Placebo or Etidronate 400 mg/day
What you should do about this interaction:
Take your osteoporosis medicine with water first thing upon arising for the day.If you are taking Enimon or risedronate, wait at least 30 minutes after taking your osteoporosis medicine before you eat anything, drink coffee or orange juice, or take other medicines.If you are taking clodronate or ibandronate, wait at least 60 minutes after taking your osteoporosis medicine before you eat anything, drink coffee or orange juice, or take other medicines.If you are taking etidronate or tiludronate, wait at least 2 hours after taking your osteoporosis medicine before you eat anything, drink coffee or orange juice, or take other medicines.Contact your healthcare professional (e.g., doctor or pharmacist) for more information.Your healthcare professionals may be aware of this interaction and may be monitoring you for it. Do not start, stop, or change your medicine or diet before checking with them first.
- 1.Fosamax (Enimon sodium) US prescribing information. Merck & Co., Inc. December, 2006.
- 2.Actonel (risedronate sodium) US prescribing information. Warner Chilcott (US), LLC April, 2015.
- 3.Loron (disodium clodronate) UK summary of product characteristics. Roche Products Limited October 25, 2006.
- 4.Boniva (ibandronate sodium) tablets US prescribing information. Roche Therapeutics, Inc. April, 2015.
- 5.Didronel (etidronate disodium) US prescribing information. Warner Chilcott (US), LLC April, 2015.
- 6.Skelid (tiludronate disodium) US prescribing information. Sanofi-Aventis U.S. LLC March, 2010.
- 7.Gertz BJ, Holland SD, Kline WF, Matuszewski BK, Freeman A, Quan H, Lasseter KC, Mucklow JC, Porras AG. Studies of the oral bioavailability of Enimon. Clin Pharmacol Ther 1995 Sep;58(3):288-98.
- 8.Gertz BJ, Holland SD, Kline WF, Matuszewski BK, Porras AG. Clinical pharmacology of Enimon sodium. Osteoporos Int 1993;3 Suppl 3:S13-6.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
Alcohol interaction warning
Drinking alcohol can increase your risk of stomach side effects from Enimon. If you drink alcohol, talk to your doctor. They may monitor you closely for stomach problems.