| Brand
Name: Actonel
Therapeutic Category:
Bisphosphonate derivative
Use: Approved by
the Food and Drug Administration for Paget’s disease of the bone; treatment
and prevention of glucocorticoid-induced osteoporosis; and treatment and
prevention of osteoporosis in postmenopausal women. Also, prescribed for
bone disorders in HIV-positive people.
Warnings:
Bisphosphonates may cause upper gastrointestinal disorders such as dysphagia,
esophageal ulcer, and gastric ulcer. Use caution in patients with renal
impairment; hypocalcemia must be corrected before therapy initiation with
Actonel. Adequate calcium and vitamin D intake is vital, especially for
patients with Paget’s disease in whom the pretreatment rate of bone turnover
may be greatly elevated.
Adverse Reactions:
headache, diarrhea, abdominal pain, nausea, dizziness, constipation, and
rash.
Drug Interactions:
Decreased Effect: Calcium supplements and antacids interfere with
the absorption of Actonel.
Ethanol/Nutrient/Herb
Interactions: Food may reduce absorption; mean oral bioavailability
is decreased when given with food.
Mechanism of Action:
A bisphosphonate that inhibits bone resorption via actions on osteoclasts
or on osteoclast precursors; decreases the rate of bone resorption direction,
leading to an indirect decrease in bone formation.
Pharmacodynamics:
Onset of Action:
may require weeks; Absorption: rapid; Protein binding:
~24%; Bioavailability: Poor; Metabolism: none; Excretion:
urine
Dosage Forms: Tablet-
5 mg; 30 mg
Usual Dosage/ Nutrition
Considerations: Actonel should be taken at least 30 minutes before
the first food or drink of the day other than water.
Administration:
It is imperative to administer Actonel 30-60 minutes before the patient
takes any food, drink, or other medications orally to avoid interference
with absorption. The patient should take Actonel on an empty stomach with
a full glass (8oz) of plain water (not mineral water) and avoid lying down
for 30 minutes after swallowing the tablet to help delivery to the stomach.
A diet adequate in calcium and vitamin D is essential.
Monitoring Parameters:
Alkaline phosphatase should be periodically measured along with serum calcium,
phosphorus, and possibly potassium due to its drug class. Bone density
should be monitored as well.
Additional Information:
Procter & Gamble Pharmaceuticals and Aventis Pharmaceuticals offer
a free Welcome Kit of helpful materials including the Stepping Stones
to Better Bones™ program for patients who fill out their survey. Visit
the Actonel
web site to see the survey and for full prescribing information.
The American Pharmaceutical Association offers a New
Therapeutics Bulletin with comprehensive information on the use
of risedronate. The bulletin includes a patient education handout with
questions and answers on osteoporosis and Actonel.
References
-
Lacy C, et al. Drug Information
Handbook 2003. 10th Edition. Lexi-Comp: Hudson, OH; 2003: 1199-1200.
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