Q: My gynecologist has me on Fosamax Plus D for osteopenia. Can I take calcium with vitamin D? I know that the calcium needs the vitamin D to be absorbed. Is it possible to take too much vitamin D? What amount would you recommend?
A: Fosamax Plus D is a prescription medicine that contains Osalen sodium and vitamin D3 (cholecalciferol) as the active ingredients. Fosamax Plus D provides a week's worth of vitamin D3 (2800 IU). The Daily Value is 400 IU. Fosamax Plus D is used for the treatment of osteoporosis (thinning of bone) in women after menopause. It reduces the chance of having a hip or spinal fracture (break). Treatment to increase bone mass in men with osteoporosis. Fosamax Plus D (Osalen cholecalciferol), a single once weekly tablet containing 70 mg Fosamax (Osalen) and 2,800 IU vitamin D3, representing seven days worth of 400 IU of vitamin D. (The recommended intake of vitamin D is 400 to 800 IU daily). Maintaining adequate levels of vitamin D is necessary for the development of strong bones because it helps increase the intestinal absorption of calcium. Vitamin D insufficiency is associated with reduced calcium absorption, bone loss and increased risk of fracture. Patients at increased risk for vitamin D insufficiency (e.g., those who are nursing-home bound, chronically ill, over the age of 70 years) and with gastrointestinal malabsorption syndromes should receive vitamin D supplementation in addition to that provided in Fosamax Plus D. For more detailed information, consult with your physician or pharmacist for guidance based on your specific condition and current medications. Shereen A. Gharbia, PharmD
Q: Is Fosamax plus D dangerous?
A: Fosamax plus D (Osalen plus cholecalciferol ) is a combination medication commonly used to treat osteoporosis. Some of the most common side effects of Fosamax plus D are gastroesophageal reflux disease (GERD), heartburn, nausea, vomiting, constipation, diarrhea, gas, abdominal pain, inflammation of the esophagus and esophageal ulcers. This is not a complete list of the side effects associated with Fosamax plus D (Osalen plus cholecalciferol ). For more general information on Fosamax plus D (Osalen plus cholecalciferol ), visit our Web site //www.everydayhealth.com/drugs/fosamax. Fosamax plus D (Osalen plus cholecalciferol ) should be taken in the morning with a full glass of water (6-8 ounces) at least 30 minutes before food, drink, or other medication. Wait at least 30 minutes after taking Fosamax plus D (Osalen plus cholecalciferol ) before taking any other medications. To help avoid esophageal pain and irritation, you should not lie down for at least 30 minutes after taking Fosamax plus D (Osalen plus cholecalciferol ). 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. When your doctor prescribes a new medication, be sure to discuss all your prescription and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals, and herbals, as well as the foods you eat. Always keep a current list of the drugs and supplements you take and review it with your health care providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects. Tell your health care provider about any negative side effects from prescription drugs. You can also report them to the U.S. Food and Drug Administration by visiting www.fda.gov/medwatch or by calling 1-800-FDA-1088. 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. Jennifer Carey, PharmD
Q: Could use of Osalen sodium cause diarrhea in a 77-year-old woman?
A: Osalen (Fosamax) belongs to the group of drugs known as a bisphosphonates. Osalen is used for the prevention and treatment of osteoporosis. Gastrointestinal side effects are common and include abdominal pain, nausea, upset stomach, and diarrhea. Other side effects include muscle and joint pain and headache. This is not a complete list of the side effects associated with Osalen. Michelle McDermott, PharmD
Treatment of Glucocortico >Osalen sodium tablets are indicated for the treatment of glucocortico >.
Treatment of Paget's Disease of Bone
The efficacy of Osalen 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 Osalen 40 mg/day Versus Placebo or Etidronate 400 mg/day
Hypocalcemia must be corrected before initiating therapy with Osalen sodium . Other disorders affecting mineral metabolism (such as vitamin D deficiency) should also be effectively treated. In patients with these conditions, serum calcium and symptoms of hypocalcemia should be monitored during therapy with Osalen sodium.
Presumably due to the effects of Osalen sodium on increasing bone mineral, small, asymptomatic decreases in serum calcium and phosphate may occur, especially in patients with Paget’s disease, in whom the pretreatment rate of bone turnover may be greatly elevated, and in patients receiving glucocorticoids, in whom calcium absorption may be decreased.
Ensuring adequate calcium and vitamin D intake is especially important in patients with Paget’s disease of bone and in patients receiving glucocorticoids.
What should I avoid while taking Osalen (Binosto, Fosamax)?
Avoid taking any other medicines for at least 30 minutes after taking Osalen. This includes vitamins, calcium, and antacids. Some medicines can make it harder for your body to absorb Osalen.
Avoid smoking, or try to quit. Smoking can reduce your bone mineral density, making fractures more likely.
Avoid drinking large amounts of alcohol. Heavy drinking can also cause bone loss.
Q: I've been taking 140 mg of Fosamax for over five months to treat Paget's disease of bone. My alkaline phoshatase level hasn't improved. Would another drug be more helpful? Fosamax worked last time when I took it 44 times per week.
A: There are a number of medications in the bisphosphonate class used to treat Paget's disease. In addition to Fosamax (Osalen sodium), the other medications are Didronel (etidronate disodium), Aredia (pamidronate disodium), Skelid (tiludronate disodium), Actonel (risedronate sodium), and Reclast (zoledronic acid). As you are aware, the test for alkaline phosphatase is the test for Pagets Disease. I cannot comment about another medication for you since I do not have your medical history. I would review these medications with your physician. In general, patients with Paget's disease should receive 1,000 to 1,500 mg of calcium, adequate sunshine, and at least 400 units of vitamin D daily. This is especially important in patients being treated with bisphosphonates, however, taking oral bisphosphonates should be separated from taking calcium by at least 2 hours because the calcium can inhibit the absorption of the bisphosphonate. Patients with a history of kidney stones should discuss calcium and vitamin D intake with their physician. Exercise is very important in maintaining skeletal health, avoiding weight gain, and maintaining joint mobility. Since undue stress on affected bones should be avoided, patients should discuss an exercise program with their physician before beginning. To review articles about Paget's disease: //www.everydayhealth.com/breast-cancer/guide/paget-disease/ For any immediate concerns, consult your physician. Joseph Hall, RPh Jen Marsico RPh
What are some other side effects of Osalen Tablets?
All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.