Indications for BINOSTO:
Treatment of postmenopausal osteoporosis. To increase bone mass in men with osteoporosis.
Limitations of Use:
Optimal duration of use has not been determined. For patients at low-risk for fracture: consider drug discontinuation after 3–5yrs.
Dissolve one tab in 4oz plain (not mineral) water only; after effervescence stops, wait 5mins and stir soln for 10secs. Take in the AM at least 30mins before the first food, drink, or medication of the day. Do not lie down for at least 30mins and until after the first food of the day. 70mg once weekly.
Esophagus abnormalities which delay esophageal emptying (eg, stricture, achalasia). Inability to stand or sit upright for at least 30mins. Increased risk of aspiration. Hypocalcemia.
Active upper GI disease; discontinue and reevaluate if signs/symptoms of esophageal reaction occur. Correct preexisting hypocalcemia or other mineral metabolism disorders (eg, Vit. D deficiency) before starting. Monitor for hypocalcemia during therapy. Ensure adequate Vit. D and calcium intake. Risk of osteonecrosis of the jaw; consider discontinuing therapy during invasive dental procedures (eg, tooth extraction, implants, surgery). History of bisphosphonate exposure: evaluate for atypical fractures if thigh/groin pain develops; consider withholding therapy until risk/benefit assessment. Sodium restriction (including heart failure, hypertension, or other cardiovascular diseases). Reevaluate periodically. Severe renal impairment (CrCl <35mL/min): not recommended. Pregnancy. Nursing mothers.
Calcium supplements, antacids, other multivalent cations reduce absorption (separate dosing by at least 30mins). Increased upper GI events with aspirin-containing products and alendronate >10mg/day; caution with NSAIDs. May be antagonized by levothyroxine.
Abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, musculoskeletal pain (discontinue if severe), nausea; esophagitis, esophageal ulcers or erosions; jaw osteonecrosis, atypical femur fractures; rare: gastric or duodenal ulcer.