Fosamax Plus D
Fosamax Plus D (alendronate / cholecalciferol) is a combination medication that's used to treat osteoporosis. It helps improve bone mineral density (BMD) and lower the risk for fractures. Fosamax Plus D (alendronate / cholecalciferol) is approved for people who've reached menopause and for men. This osteoporosis medication contains alendronate, a bisphosphonate, and the dietary supplement cholecalciferol (also known as vitamin D3) in a single tablet. It's taken by mouth once a week. Side effects include stomach pain and nausea.
What is Fosamax Plus D (alendronate / cholecalciferol)?
What is Fosamax Plus D (alendronate / cholecalciferol) used for?
- Osteoporosis in women who've gone through menopause
- Osteoporosis in men
How Fosamax Plus D (alendronate / cholecalciferol) works
Fosamax Plus D (alendronate / cholecalciferol) is a combination of two medications.
- Alendronate is a bisphosphonate. It works by slowing down bone breakdown. This gives the body time to make new, healthy, and strong bones.
- Cholecalciferol (also known as vitamin D3) is a dietary supplement. Vitamin D is an important nutrient for bone health. It helps the body absorb calcium from the food you eat and regulates normal bone remodeling (bone formation and breakdown).
By working together, alendronate and cholecalciferol help raise BMD, which is a measure of how dense your bones are. A higher BMD means your bones are stronger, which helps lower your risk for bone fractures.
Drug facts
Side effects of Fosamax Plus D (alendronate / cholecalciferol)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Stomach pain (4%)
- Indigestion (3%)
- Bone, muscle, or joint pain (3%)
- Nausea (2%)
- Acid reflux (2%)
Less Common Side Effects
- Bloating
- Constipation
- Passing gas
Note: Side effects were reported in postmenopausal women who were taking 70 mg of alendronate (Fosamax) once weekly.
Fosamax Plus D (alendronate / cholecalciferol) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Stomach or esophagus irritation: trouble swallowing, new pain with swallowing, pain around the middle of your chest, new or worsening heartburn
- Severe pain in the bone, muscle, or joint
- New fracture: dull or aching pain in your thigh or groin
The following Fosamax Plus D (alendronate / cholecalciferol) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Chest pain, discomfort, or burning
difficulty with swallowing
muscle or bone pain
pain with swallowing
vomiting blood
Rare
Abdominal or stomach cramps
blistering, peeling, or loosening of the skin
bloating or swelling of the face, arms, hands, lower legs, or feet
chills
confusion
convulsions
difficulty with breathing
irregular heartbeats
joint pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
mood or mental changes
muscle cramps in the hands, arms, feet, legs, or face
numbness and tingling around the mouth, fingertips, or feet
rapid weight gain
red skin lesions, often with a purple center
red, irritated eyes
shortness of breath
sores, ulcers, or white spots in the mouth or on the lips
swelling of the neck
unusual tiredness or weakness
unusual weight gain or loss
vomiting
Incidence not known
Burning upper abdominal or stomach pain
difficulty with moving
heavy jaw feeling
loosening of a tooth
loss of appetite
muscle aching or cramping
muscle pains or stiffness
pain or burning in the throat
pain, swelling, or numbness in the mouth or jaw
severe bone, joint, or muscle pain
stomach bloating, burning, cramping, or pain
swollen joints
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Acid or sour stomach
belching
excess air or gas in the stomach or intestines
full feeling
headache
indigestion
passing gas
pressure in the stomach
stomach discomfort, upset, or pain
swelling of the abdominal or stomach area
Rare
Blurred vision or other change in vision
decreased vision
eye redness
eye tenderness
flushing or redness of the skin
increased tearing
rash
redness of the eye
sensitivity of the eye to light
severe eye pain
tearing
unusually warm skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Fosamax Plus D (alendronate / cholecalciferol)
Pros
- Taken once a week
- Lowers the risk for fracture in different areas, including the hip and back
- Combines alendronate (Fosamax) with vitamin D in a single pill for convenience
Cons
- Must take at least 30 minutes before the first food, drink, or any other medication of the day
- Can cause stomach upset
- Not recommended for people with severe kidney problems
Pharmacist tips for Fosamax Plus D (alendronate / cholecalciferol)
- Take Fosamax Plus D (alendronate / cholecalciferol) once a week. Choose a day of the week that's convenient for you. Mark the day of the week that you chose on your calendar or use a reminder app on your phone. These tips help you remember when to take the medication.
- Take Fosamax Plus D (alendronate / cholecalciferol) first thing in the morning after you get out of bed. Swallow the tablet whole with a full glass of plain water (6 oz to 8 oz) while standing or sitting upright. This lowers the risk that the medication irritates your esophagus (the tube that connects your throat to your stomach). Don't chew or suck on the tablet to prevent ulcers in your esophagus.
- Take Fosamax Plus D (alendronate / cholecalciferol) on an empty stomach. Take it at least 30 minutes before eating anything, drinking anything else (e.g., orange juice, coffee, mineral water), or taking other medications or supplements. This helps your body absorb the osteoporosis medication. Foods, drinks, and medications can block Fosamax Plus D (alendronate / cholecalciferol) from getting into the body and from working well.
- Don't lie down for at least 30 minutes after you take Fosamax Plus D (alendronate / cholecalciferol) and until after you eat. Otherwise, it can cause damage to your esophagus.
- It's important to take Fosamax Plus D (alendronate / cholecalciferol) with plain water and not mineral water. Mineral water can contain more calcium, which can block the medication from working as well.
- You can take calcium supplements every day to help your bones grow stronger. Be sure to take any supplements at least 30 minutes after you take Fosamax Plus D (alendronate / cholecalciferol). Waiting is helpful to prevent calcium from interfering with how well the osteoporosis medication gets absorbed into the body.
- It's important to have good mouth care while you're taking Fosamax Plus D (alendronate / cholecalciferol). This helps lower the risk of jaw problems. Let your dentist know that you're taking Fosamax Plus D (alendronate / cholecalciferol) and tell your prescriber about any planned dental procedures.
- Stop taking Fosamax Plus D (alendronate / cholecalciferol) and tell your prescriber right away if you have trouble swallowing, pain when you swallow, chest or stomach pain, new or worsening heartburn, or any pain around your hips, thighs, or jaw. These can be signs of serious side effects from the medication.
- If you miss your dose of Fosamax Plus D (alendronate / cholecalciferol), take 1 tablet of the medication in the morning after you remember. Don't take 2 tablets to make up for the missed dose because this can raise your risk for side effects. You can go back to taking Fosamax Plus D (alendronate / cholecalciferol) once a week on the usual day of the week that you chose.
Common questions about Fosamax Plus D
Fosamax Plus D is taken once a week as a way to be more convenient for you. You only need to take it once each week instead of having to remember to take the medication every day like most other medications. But if you prefer to take your medication once a day, speak with your prescriber about taking alendronate (Fosamax) and vitamin D supplements separately instead of this combination medication. Alendronate (Fosamax) by itself has both once-weekly and once-daily dosing options.
How long it takes for side effects from Fosamax Plus D to go away can be different for each person. In general, side effects include stomach upset, indigestion, and nausea. Some people might also have diarrhea, constipation, or headache. Be sure to wait at least 30 minutes after you take Fosamax Plus D to try to relieve side effects, whether with food, fluids, antacids, or pain relievers. Food, drink, and medication can interfere with how well Fosamax Plus D works. Also wait 30 minutes before lying down for relief. Lying down too soon after you take the medication raises your risk for more side effects. Talk to a healthcare professional if any side effects don't go away after a couple days.
Common side effects of Fosamax Plus D can include stomach upset, stomach pain, and nausea. But Fosamax Plus D does carry a few rare risks that are more serious. These can include possible ulcers in the esophagus; severe bone, muscle, or joint pain; and fracture in the leg bone. It's important to carefully follow your prescriber's instructions on how to take Fosamax Plus D to lessen your risk of some side effects and risks. Contact your prescriber if you have any side effects that are very bothersome. Also get medical help if you have trouble swallowing; new pain with swallowing; chest pain; severe bone, muscle, or joint pain; or dull or aching pain in your thigh or groin.
Take Fosamax Plus D before you eat or drink anything in the morning with a full glass of plain water while standing or sitting upright. Don't take the medication with mineral water because it can block the medication from working well. It's important that you don't lie down for at least 30 minutes after you take Fosamax Plus D and until after you eat to prevent esophagus and stomach irritation. Wait at least 30 minutes after you take Fosamax Plus D to eat, drink, or take other medications (like vitamins, supplements, or antacids). Ask your prescriber or pharmacist if you have more questions about how to take Fosamax Plus D.
How long you should take Fosamax Plus D depends on your bone health. In general, people typically take the medication for 3 to 5 years at a time. Longer treatment with bisphosphonates like Fosamax Plus D can have long-term risks. Your prescriber will check your bone health through DEXA scans to see how well the medication is working to improve your BMD. Once you've taken the medication for up to 5 years, your prescriber will recommend that you take a break from treatment for a few years. They'll recheck your bone health in later years to see whether you need the medication again.
Coffee can interfere with how well Fosamax Plus D gets absorbed into your body. The medication might not work as well to improve your bone health when less of it gets absorbed into the body. This is why it's important to take Fosamax Plus D first thing in the morning with only plain water. Wait at least 30 minutes after you take the medication before you drink any coffee.
You can take antacids while you're taking Fosamax Plus D, but make sure that it's been at least 30 minutes after you've taken the osteoporosis medication. Antacids can interact with the osteoporosis medication if taken at the same time. In particular, antacids that contain calcium, like Tums or Rolaids, can cause less Fosamax Plus D to get absorbed into the body. This can make the osteoporosis medication work less well. Waiting at least 30 minutes after taking Fosamax Plus D before taking antacids helps prevent this drug interaction from happening.
There are two strengths of Fosamax Plus D containing different amounts of cholecalciferol or vitamin D. Note that this medication is taken once a week. One of the strengths contains 2,800 international units (IU) of vitamin D, which amounts to 400 IU of vitamin D per day. The other strength contains 5,600 IU of vitamin D, which provides 800 IU of vitamin D per day. Ask your prescriber about whether the amount of vitamin D that you get from Fosamax Plus D is enough for you. Even though there's vitamin D in this combination medication, it's not used to treat vitamin D deficiency.
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Risks and warnings for Fosamax Plus D (alendronate / cholecalciferol)
Fosamax Plus D (alendronate / cholecalciferol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Irritation and damage to the stomach or esophagus
- Risk factors: History of ulcers or other digestive problems | Taking with aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) | Not drinking enough water when taking Fosamax Plus D (alendronate / cholecalciferol) | Lying down after taking Fosamax Plus D (alendronate / cholecalciferol)
Fosamax Plus D (alendronate / cholecalciferol) can cause irritation and inflammation in the stomach and esophagus. This can include heartburn, pain, and even ulcers. Let your prescriber know if you have any digestive problems so they can check that the medication is safe for you to take.
To help prevent irritation, it's very important to follow your prescriber's directions on how to take Fosamax Plus D (alendronate / cholecalciferol). Take the medication with a full glass of plain water while standing or sitting upright. Avoid lying down for at least 30 minutes after taking the medication and until after you eat.
Stop taking Fosamax Plus D (alendronate / cholecalciferol) right away and get medical help if you notice you have trouble swallowing, new pain with swallowing, pain around the middle of your chest, or new or worsening heartburn. These can be signs of stomach or esophagus irritation that might require more medical attention.
Breakdown of the jawbone (osteonecrosis of the jaw)
- Risk factors: Gum or dental disease | Dental procedure (e.g., tooth extraction, dental implant, bony surgery in the mouth) | Anemia | Bleeding problems | Cancer | Taking cancer medications or corticosteroids | Infection | Poor mouth care | Dentures that don't fit well | Taking Fosamax Plus D (alendronate / cholecalciferol) for a long time
Although rare, some people who took bisphosphonates like Fosamax Plus D (alendronate / cholecalciferol) developed osteonecrosis of the jaw (ONJ). This happens when the jaw bone starts to break down and weaken. Risk factors for ONJ include poor dental care, tooth extraction, dental implant, and infection in the mouth that hasn't healed, among others. The risk might be higher the longer you take Fosamax Plus D (alendronate / cholecalciferol).
Tell your dentist that you're going to start taking Fosamax Plus D (alendronate / cholecalciferol). They can discuss with you about any necessary dental work that you need before you start treatment. Then, let your prescriber know if you have any dental procedures planned while you're taking Fosamax Plus D (alendronate / cholecalciferol) to see whether you need to take a break from the medication to lower your risk for ONJ.
Be sure to keep your teeth healthy with regular brushing and flossing to lower your risk for ONJ. Talk to your prescriber or dentist right away if you notice signs of ONJ, like pain or swelling in your jaw, while you're taking Fosamax Plus D (alendronate / cholecalciferol).
Severe bone, muscle, or joint pain
In rare cases, some people who took bisphosphonates like Fosamax Plus D (alendronate / cholecalciferol) had severe pain in their bones, muscles, or joints. Sometimes, this pain greatly affected how well people could go about their daily lives. It happened as quickly as one day or after several months after treatment started. Generally, the pain improved after stopping the medication.
Stop taking Fosamax Plus D (alendronate / cholecalciferol) and talk to your prescriber if you feel severe pain in the bone, muscle, or joint.
Leg bone fractures
- Risk factors: Taking corticosteroid medications at the same time
Although rare, some people who took a bisphosphonate medication like Fosamax Plus D (alendronate / cholecalciferol) had fractures in the leg bone. These fractures can happen anywhere along the upper leg. They can also happen with minimal to no injury to the area. It's not clear what causes these leg fractures.
Call your prescriber and go to urgent care right away if you notice new dull or aching pain in your thighs or groin area. These can be signs of a possible fracture. You might need to stop taking Fosamax Plus D (alendronate / cholecalciferol) for a while as your prescriber weighs the risks and benefits of continuing treatment.
Abnormal levels of calcium in the blood
- Risk factors: Conditions that cause abnormal calcium or vitamin D levels in the blood
Before you start Fosamax Plus D (alendronate / cholecalciferol), it's important to first treat any abnormal electrolyte and vitamin levels in your blood.
Don't take Fosamax Plus D (alendronate / cholecalciferol) if you have low calcium levels. The medication can lower your calcium levels in the blood even more because it uses the calcium to make your bones strong. Contact your healthcare team if you have symptoms of low calcium, like dry skin, brittle nails, and muscle cramps.
If your vitamin D levels are already high because of certain medical conditions, getting more vitamin D from Fosamax Plus D (alendronate / cholecalciferol) can raise your calcium levels to dangerous levels. This is because vitamin D helps your body absorb calcium. Your prescriber might check your calcium levels during treatment. Call your care team if you have symptoms of high calcium levels, like tiredness, muscle weakness, and constipation.
Fosamax Plus D (alendronate / cholecalciferol) dosage
Dose pack| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 4 tablets of 70mg/2800iu | 1 dose pack | $217.15 | $217.15 |
| 4 tablets of 70mg/5600iu | 3 dose packs | $638.94 | $212.98 |
Typical dosage for Fosamax Plus D (alendronate / cholecalciferol)
The tablets are available in two different strengths:
- 70 mg of alendronate and 2,800 international units (IU) of cholecalciferol
- 70 mg of alendronate and 5,600 IU of cholecalciferol
The typical dose is 1 tablet by mouth once a week (every 7 days).
Interactions between Fosamax Plus D (alendronate / cholecalciferol) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Erdafitinib
- Parathyroid Hormone
How much does Fosamax Plus D (alendronate / cholecalciferol) cost?
$217.15
Fosamax Plus D (alendronate / cholecalciferol) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Fosamax Plus D (alendronate / cholecalciferol) will not be safe for you to take.
- Issues affecting your esophagus
- Can't stand or sit upright for at least 30 minutes after taking the medication
- Low calcium levels in the blood
What are alternatives to Fosamax Plus D (alendronate / cholecalciferol)?
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