Abstract
Alendronate sodium is an aminobiphosphonate, an analog of inorganic pyrophosphate, indicated for the treatment of osteoporosis in post-menopausal women. We analyzed events reported in patients prescribed alendronate by general practitioners (GPs) in England. A non-interventional observational cohort study was conducted using the technique of prescription event monitoring (PEM). Exposure data were obtained from dispensed prescriptions issued between October 1995 and January 1997. Outcome data were obtained by sending questionnaires to prescribing GPs. The cohort comprised 11,916 patients. Events most frequently reported as suspected adverse drug reactions and reason for stopping alendronate were recognized gastrointestinal events listed in the Summary of Product Characteristics. These included nausea/vomiting, abdominal pain, dyspepsia, esophagitis and esophageal reflux. Events with the highest incidence density (ID1 per 1000 patient months treatment) were dyspeptic conditions (32.2), nausea/vomiting (20.8) and abdominal pain (13.8). The term dyspeptic conditions included dyspepsia, esophagitis, esophageal reflux, duodenitis, gastritis and heartburn. Serious suspected adverse reactions possibly related to alendronate were single reports of angioedema, erythema multiforme, hypercalcemia and hypocalcemia. There were 540 deaths in this elderly cohort. This study suggests that alendronate appears to be well tolerated, though there may be risk of developing gastrointestinal side effects including esophagitis and esophageal ulcers.
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Acknowledgements
We thank the very many GPs who have, without payment, participated in this study. We also thank the Prescription Pricing Authority, The Office of the National Statistics and the Regional Authorities of the NHS, without whose support PEM could not be undertaken. We would also like to thank Mrs Gill Pearce, Data Processing Manager, Mr Shayne Freemantle, IT Manager for their input into this study, and Mrs Lesley Flowers for preparing the manuscript. The DSRU is a medical charity that receives unconditional grants from many pharmaceutical companies for PEM studies, including the manufacturers of alendronate. The organizations have no control over the decision to undertake a study, or the conduct and reporting of the studies.
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Biswas, P.N., Wilton, L.V. & Shakir, S.A.W. Pharmacovigilance study of alendronate in England. Osteoporos Int 14, 507–514 (2003). https://doi.org/10.1007/s00198-003-1399-y
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DOI: https://doi.org/10.1007/s00198-003-1399-y