Community pharmacist Raj Patel has urged people taking alendronic acid for osteoporosis to be aware of key side effects and follow strict rules when taking the medication. The drug, sold under the brand names Fosamax and Binosto, is widely used to treat the bone condition.
Mr Patel, known for dispensing medical advice, answered common questions about the tablet, including what to do if you feel unwell after taking it.
When to call 999
Speaking about safety, he said: "Safety first: stop alendronic acid and contact a doctor for painful or difficult swallowing, chest pain, or new or worsening heartburn. Call 999 for sudden chest pain that persists or comes with sweating or breathlessness."
He also advised against taking calcium at the same time as the medicine. "Not at the same time," he said. "Calcium tablets and antacids can reduce absorption. Wait at least 30 minutes before other oral medicines, and check their own instructions too. If several tablets need an empty stomach, ask your pharmacist for a timetable that fits your morning."
Missed doses and swallowing difficulties
For those who forget their weekly pill, Mr Patel said: "Take one tablet the morning after you remember, then return to your usual weekly day. Never take two on the same day. Daily treatment has different missed-dose advice."
On swallowing difficulties, he advised: "Don't crush, chew or suck standard tablets. Ask about a suitable alternative if swallowing is difficult. Soluble tablets and liquid are different formulations with their own instructions."
He also addressed whether the medicine is working: "You may not feel a change. Alendronic acid reduces fracture risk; it is not a painkiller and cannot prevent every fracture. Bone density usually increases after 6 to 12 months. Treatment is commonly reviewed after 3 to 5 years, rather than stopped automatically."
How to take it correctly
Mr Patel stressed the importance of taking the tablet correctly: "First, take it when you first get up, before you eat anything, with a full glass of plain tap water. Tea? No. Coffee? No. Juice? No. Milk? Still no. They can reduce how much of your medicine your body absorbs."
He added: "Then stay sitting or standing for at least 30 minutes and until after you've eaten. That helps the tablet reach your stomach and reduces the chance of it irritating your food pipe."
He also advised telling your dentist you take alendronic acid, especially before a tooth extraction, as a rare side effect is jawbone damage.
NHS guidance
The NHS explains that alendronic acid is a bisphosphonate that slows down bones becoming weaker. It can be used as a preventative measure or if you already have osteoporosis, and is only available on prescription.
Osteoporosis is more likely if you've been through the menopause, have a low body mass index (BMI), drink a lot of alcohol or smoke, have taken steroid tablets such as prednisolone daily for three months or longer, or have had certain types of cancer treatment.
The medicine is usually taken as a tablet or liquid once a week, and often takes at least six months to start making bones stronger. The NHS says it "usually takes years for it to work fully".
