Fosamax (Alendronate Sodium) - Side Effects and Adverse Reactions

ADVERSE REACTIONS

Clinical Studies

In clinical studies of up to five years in duration adverse experiences associated with FOSAMAX usually were mild, and generally did not require discontinuation of therapy.

FOSAMAX has been evaluated for safety in approximately 8000 postmenopausal women in clinical studies.

Treatment of osteoporosis Postmenopausal women

In two identically designed, three-year, placebo-controlled, double-blind, multicenter studies (United States and Multinational; n=994), discontinuation of therapy due to any clinical adverse experience occurred in 4.1% of 196 patients treated with FOSAMAX 10 mg/day and 6.0% of 397 patients treated with placebo. In the Fracture Intervention Trial (n=6459), discontinuation of therapy due to any clinical adverse experience occurred in 9.1% of 3236 patients treated with FOSAMAX 5 mg/day for 2 years and 10 mg/day for either one or two additional years and 10.1% of 3223 patients treated with placebo. Discontinuations due to upper gastrointestinal adverse experiences were: FOSAMAX, 3.2%; placebo, 2.7%. In these study populations, 49-54% had a history of gastrointestinal disorders at baseline and 54-89% used nonsteroidal anti-inflammatory drugs or aspirin at some time during the studies. Adverse experiences from these studies considered by the investigators as possibly, probably, or definitely drug related in ≥1% of patients treated with either FOSAMAX or placebo are presented in the following table.

Osteoporosis Treatment Studies in Postmenopausal Women: Adverse Experiences Considered Possibly, Probably, or Definitely Drug Related by the Investigators and Reported in ≥1% of Patients

	United States/ Studies	Multinational	Fracture Trial	Intervention
	FOSAMAX * %          (n=196)	Placebo % (n=397)	FOSAMAX † Gastrointestinal
abdominal pain	6.6	4.8	1.5	1.5
nausea	3.6	4.0	1.1	1.5
dyspepsia	3.6	3.5	1.1	1.2
constipation	3.1	1.8	0.0	0.2
diarrhea	3.1	1.8	0.6	0.3
flatulence	2.6	0.5	0.2	0.3
acid regurgitation	2.0	4.3	1.1	0.9
esophageal ulcer	1.5	00	0.1	0.1
vomiting	1.0	1.5	0.2	0.3
dysphagia	1.0	0.0	0.1	0.1
abdominal distention	1.0	0.8	0.0	0.0
gastritis	0.5	1.3	0.6	0.7
Musculoskeletal
musculoskeletal (bone,    muscle or joint) pain	4.1	2.5	0.4	0.3
muscle cram	0.0	1.0	0.2	0.1
Nervous System/Psychiatric
headache	2.6	1.5	0.2	0.2
dizziness	0.0	1.0	0.0	0.1
Special Senses
taste perversion	0.5	1.0	0.1	0.0

*    10 mg/day for three years
†    5 mg/day for 2 years and 10 mg/day for either 1 or 2 additional years

Rarely, rash and erythema have occurred.

One patient treated with FOSAMAX (10 mg/day), who had a history of peptic ulcer disease and gastrectomy and who was taking concomitant aspirin developed an anastomotic ulcer with mild hemorrhage, which was considered drug related. Aspirin and FOSAMAX were discontinued and the patient recovered.

The adverse experience profile was similar for the 401 patients treated with either 5 or 20 mg doses of FOSAMAX in the United States and Multinational studies. The adverse experience profile for the 296 patients who received continued treatment with either 5 or 10 mg doses of FOSAMAX in the two-year extension of these studies (treatment years 4 and 5) was similar to that observed during the three-year placebo-controlled period. During the extension period, of the 151 patients treated with FOSAMAX 10 mg/day, the proportion of patients who discontinued therapy due to any clinical adverse experience was similar to that during the first three years of the study.

In a one-year, double-blind, multicenter study, the overall safety and tolerability profiles of once weekly FOSAMAX 70 mg and FOSAMAX 10 mg daily were similar. The adverse experiences considered by the investigators as possibly, probably, or definitely drug related in ≥1% of patients in either treatment group are presented in the following 

table.

Osteoporosis Treatment Studies in Postmenopausal Women: Adverse Experiences Considered Possibly, Probably, or Definitely Drug Related by the Investigators and Reported in ≥1% of Patients

	Once Weekly FOSAMAX 70 mg % (n=519)	FOSAMAX 10 mg/day % (n=370)
Gastrointestinal      abdominal pain      dyspepsia      acid regurgitation      nausea      abdominal distention      constipation      flatulence      gastritis      gastric ulcer	3.7 2.7 1.9 1.9 1.0 0.8 0.4 0.2 0.0	3.0 2.2 2.4 2.4 1.4 1.6 1.6 1.1 1.1
Musculoskeletal      musculoskeletal (bone, muscle,          joint) pain      muscle cramp	2.9 0.2	3.2 1.1

Men

In two placebo-controlled, double-blind, multicenter studies in men (a two-year study of FOSAMAX 10 mg/day and a one-year study of once weekly FOSAMAX 70 mg) the rates of discontinuation of therapy due to any clinical adverse experience were 2.7% for FOSAMAX 10 mg/day vs. 10.5% for placebo, and 6.4% for once weekly FOSAMAX 70 mg vs. 8.6% for placebo. The adverse experiences considered by the investigators as possibly, probably, or definitely drug related in ≥2% of patients treated with either FOSAMAX or placebo are presented in the following table.

Osteoporosis Studies in Men: Adverse Experiences Considered Possibly, Probably, or Definitely Drug Related by the Investigators and Reported in ≥2% of Patients

	Two-year Study	One-year Study
	FOSAMAX 10 mg/day % (n=146)	Placebo % (n=95)	Once Weekly FOSAMAX 70 mg % (n=109)	Placebo % (n=58)
Gastrointestinal      acid regurgitation      flatulence      gastroesophageal          reflux disease      dyspepsia      diarrhea      abdominal pain      nausea	4.1 4.1 0.7 3.4 1.4 2.1 2.1	3.2 1.1 3.2 0.0 1.1 1.1 0.0	0.0 0.0 2.8 2.8 2.8 0.9 0.0	0.0 0.0 0.0 1.7 0.0 3.4 0.0

Prevention of osteoporosis in postmenopausal women

The safety of FOSAMAX 5 mg/day in postmenopausal women 40-60 years of age has been evaluated in three double-blind, placebo-controlled studies involving over 1,400 patients randomized to receive FOSAMAX for either two or three years. In these studies the overall safety profiles of FOSAMAX 5 mg/day and placebo were similar. Discontinuation of therapy due to any clinical adverse experience occurred in 7.5% of 642 patients treated with FOSAMAX 5 mg/day and 5.7% of 648 patients treated with placebo.

In a one-year, double-blind, multicenter study, the overall safety and tolerability profiles of once weekly FOSAMAX 35 mg and FOSAMAX 5 mg daily were similar.

The adverse experiences from these studies considered by the investigators as possibly, probably, or definitely drug related in ≥1% of patients treated with either once weekly FOSAMAX 35 mg, FOSAMAX 5 mg/day or placebo are presented in the following table.

Osteoporosis Prevention Studies in Postmenopausal Women: Adverse Experiences Considered Possibly, Probably, or Definitely Drug Related by the Investigators and Reported in ≥1% of Patients

	Two/Three-Year Studies	One-Year Study
	FOSAMAX 5 mg/day % (n=642)	Placebo % (n=648)	FOSAMAX 5 mg/day % (n=361)	Once Weekly FOSAMAX 35 mg % (n=362)
Gastrointestinal      dyspepsia      abdominal pain      acid regurgitation      nausea      diarrhea      constipation      abdominal distention	1.9 1.7 1.4 1.4 1.1 0.9 0.2	1.4 3.4 2.5 1.4 1.7 0.5 0.3	2.2 4.2 4.2 2.5 1.1 1.7 1.4	1.7 2.2 4.7 1.4 0.6 0.3 1.1
Musculoskeletal      musculoskeletal (bone,          muscle or joint) pain	0.8	0.9	1.9	2.2

Concomitant use with estrogen/hormone replacement therapy

In two studies (of one and two years' duration) of postmenopausal osteoporotic women (total: n=853), the safety and tolerability profile of combined treatment with FOSAMAX 10 mg once daily and estrogen ± progestin (n=354) was consistent with those of the individual treatments.

Treatment of glucocorticoid-induced osteoporosis

In two, one-year, placebo-controlled, double-blind, multicenter studies in patients receiving glucocorticoid treatment, the overall safety and tolerability profiles of FOSAMAX 5 and 10 mg/day were generally similar to that of placebo. The adverse experiences considered by the investigators as possibly, probably, or definitely drug related in ≥1% of patients treated with either FOSAMAX 5 or 10 mg/day or placebo are presented in the following table.

One-Year Studies in Glucocorticoid-Treated Patients: Adverse Experiences Considered Possibly, Probably, or Definitely Drug Related by the Investigators and Reported in ≥1% of Patients

	FOSAMAX 10 mg/day % (n=157)	FOSAMAX 5 mg/day % (n=161)	Placebo % (n=159)
Gastrointestinal      abdominal pain      acid regurgitation      constipation      melena      nausea      diarrhea Nervous System/Psychiatric      headache	3.2 2.5 1.3 1.3 0.6 0.0 0.6	1.9 1.9 0.6 0.0 1.2 0.0 0.0	0.0 1.3 0.0 0.0 0.6 1.3 1.3

The overall safety and tolerability profile in the glucocorticoid-induced osteoporosis population that continued therapy for the second year of the studies (FOSAMAX: n=147) was consistent with that observed in the first year.

Paget's disease of bone

In clinical studies (osteoporosis and Paget's disease), adverse experiences reported in 175 patients taking FOSAMAX 40 mg/day for 3-12 months were similar to those in postmenopausal women treated with FOSAMAX 10 mg/day. However, there was an apparent increased incidence of upper gastrointestinal adverse experiences in patients taking FOSAMAX 40 mg/day (17.7% FOSAMAX vs. 10.2% placebo). One case of esophagitis and two cases of gastritis resulted in discontinuation of treatment.

Additionally, musculoskeletal (bone, muscle or joint) pain, which has been described in patients with Paget's disease treated with other bisphosphonates, was considered by the investigators as possibly, probably, or definitely drug related in approximately 6% of patients treated with FOSAMAX 40 mg/day versus approximately 1% of patients treated with placebo, but rarely resulted in discontinuation of therapy. Discontinuation of therapy due to any clinical adverse experience occurred in 6.4% of patients with Paget's disease treated with FOSAMAX 40 mg/day and 2.4% of patients treated with placebo.

Osteogenesis Imperfecta

FOSAMAX is not indicated for use in children.

The overall safety profile of FOSAMAX in OI patients treated for up to 24 months was generally similar to that of adults with osteoporosis treated with FOSAMAX. However, there was an increased occurrence of vomiting in OI patients treated with FOSAMAX compared to placebo. During the 24-month treatment period, vomiting was observed in 32 of 109 (29.4%) patients treated with FOSAMAX and 3 of 30 (10%) patients treated with placebo.

In a pharmacokinetic study, 6 of 24 pediatric OI patients who received a single oral dose of FOSAMAX 35 or 70 mg developed fever, flu-like symptoms, and/or mild lymphocytopenia within 24 to 48 hours after administration. These events, lasting no more than 2 to 3 days and responding to acetaminophen, are consistent with an acute-phase response that has been reported in patients receiving bisphosphonates, including FOSAMAX. See ADVERSE REACTIONS, Post-Marketing Experience, Body as a Whole.

Laboratory Test Findings

In double-blind, multicenter, controlled studies, asymptomatic, mild, and transient decreases in serum calcium and phosphate were observed in approximately 18% and 10%, respectively, of patients taking FOSAMAX versus approximately 12% and 3% of those taking placebo. However, the incidences of decreases in serum calcium to less than 8.0 mg/dL (2.0 mM) and serum phosphate to less than or equal to 2.0 mg/dL (0.65 mM) were similar in both treatment groups.

Post-Marketing Experience

The following adverse reactions have been reported in post-marketing use:

Body as a Whole: hypersensitivity reactions including urticaria and rarely angioedema. Transient symptoms of myalgia, malaise, asthenia and rarely, fever have been reported with FOSAMAX, typically in association with initiation of treatment. Rarely, symptomatic hypocalcemia has occurred, generally in association with predisposing conditions. Rarely, peripheral edema.

Gastrointestinal: esophagitis, esophageal erosions, esophageal ulcers, rarely esophageal stricture or perforation, and oropharyngeal ulceration. Gastric or duodenal ulcers, some severe and with complications have also been reported (see WARNINGS, PRECAUTIONS, Information for Patients, and DOSAGE AND ADMINISTRATION).

Localized osteonecrosis of the jaw, generally associated with tooth extraction and/or local infection, often with delayed healing, has been reported rarely (see PRECAUTIONS, Dental).

Musculoskeletal: bone, joint, and/or muscle pain, occasionally severe, and rarely incapacitating (see PRECAUTIONS, Musculoskeletal Pain); joint swelling.

Nervous system: dizziness and vertigo.

Skin: rash (occasionally with photosensitivity), pruritus, alopecia, rarely severe skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis.

Special Senses: rarely uveitis, scleritis or episcleritis.

REPORTS OF SUSPECTED FOSAMAX SIDE EFFECTS / ADVERSE REACTIONS

Possible Fosamax side effects / adverse reactions in 86 year old female

Reported by a physician from Denmark on 2011-10-03

Patient: 86 year old female

Reactions: Bedridden, General Physical Health Deterioration, Mental Disorder, Eating Disorder

Adverse event resulted in: hospitalization

Suspect drug(s):
Bisoprolol Fumarate
    Dosage: 5 mg; po
    Administration route: Oral
    Start date: 2008-08-14
    End date: 2011-08-03

Fosamax
    Dosage: 70 mg;qw;po
    Administration route: Oral
    Start date: 2008-08-10
    End date: 2011-08-03

Furadantin
    Dosage: 100 mg; po
    Administration route: Oral
    Start date: 2011-08-02
    End date: 2011-08-03

Mianserin (Mianserin)
    Dosage: 60 mg; po
    Administration route: Oral
    Start date: 2008-08-10
    End date: 2011-08-02

Niferex (Polysaccharide-Iron Complex)
    Dosage: 100 mg; po
    Administration route: Oral
    Start date: 2011-08-02
    End date: 2011-08-05

Simvastatin
    Dosage: 40 mg; po
    Administration route: Oral
    Start date: 2008-08-14
    End date: 2011-08-02

Other drugs received by patient: Triobe; Calcevita; Levothyroxine Sodium; Lithionit

Possible Fosamax side effects / adverse reactions in 33 year old female

Reported by a physician from United States on 2011-10-03

Patient: 33 year old female weighing 80.0 kg (176.0 pounds)

Reactions: Femur Fracture, Myasthenia Gravis, Fracture Nonunion, Fall, Foot Fracture, Hypercholesterolaemia, Uterine Leiomyoma, Bacterial Infection, Fibula Fracture, LOW Turnover Osteopathy, Rectal Prolapse, Gout, Subcutaneous Abscess, Drug Hypersensitivity, Anaemia, Patellofemoral Pain Syndrome, Ovarian Cyst, Bursitis, Renal Failure Chronic, Meniscus Lesion, Osteoarthritis, Skin Papilloma, Neoplasm Malignant, Fungal Infection, Tibia Fracture, Hypertension

Adverse event resulted in: hospitalization

Suspect drug(s):
Fosamax
    Administration route: Oral
    Start date: 2001-01-06

Fosamax
    Administration route: Oral
    Indication: Osteoporosis Prophylaxis
    Start date: 1999-09-07

Fosamax
    Administration route: Oral
    Start date: 2004-09-01
    End date: 2009-02-25

Fosamax
    Administration route: Oral
    Start date: 2004-09-01
    End date: 2009-02-25

Fosamax
    Administration route: Oral
    Start date: 2001-01-06

Fosamax
    Administration route: Oral
    Indication: Osteoporosis
    Start date: 1999-09-07

Other drugs received by patient: Corticosteroids (Unspecified); Sumatriptan Succinate (Imitrex)

Possible Fosamax side effects / adverse reactions in 88 year old female

Reported by a health professional (non-physician/pharmacist) from Sweden on 2011-10-03

Patient: 88 year old female

Reactions: Pathological Fracture

Adverse event resulted in: hospitalization

Suspect drug(s):
Fosamax