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Alendronate is a bisphosphonate. It has direct inhibitory effects on osteoclasts. The antiresorptive activity involves two primary mechanisms: osteoclast apoptosis and inhibition of components of the cholesterol biosynthetic pathway. (1)

Treatment of osteoporosis in postmenopausal women Treatment to increase bone mass in men with osteoporosis (2)

Abnormalities of the esophagus which delay emptying such as stricture or achalasia Esophageal ulcer Inability to stand/sit upright for at least 30 minutes Increased risk of aspiration Hypocalcemia Hypersensitivity to any component of this product (2)

Oesophagitis Abdominal pain with cramps Abdominal swelling Constipation Diarrhea Dysphagia Headache Myalgia Nausea, vomiting Peptic ulcer Flatulence Retrosternal pain Bodyache (2,3)

Calcium supplements, antacids or oral medications containing multivalent cations: Interfere with absorption of alendronate Aspirin/ non- steroidal anti- inflammatory drugs: Use with caution as it may worsen gastro- intestinal function (2)

Not recommended in patients with renal impairment (creatinine clearance less than 35 mL/min) (2)

70 mg effervescent tablet once weekly. (2)

1. Friedman P. Agents Affecting Mineral Ion Homeostasis and Bone Turnover. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. USA: McGraw Hill; 2011: 1275- 1306 2. BINOSTO (alendronate sodium) effervescent tablets for oral solution [Internet] [cited 2013 Oct 20]. Available from: 3. National Formulary of India. 4th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011.