Alendronate + vitamin D

• The usual dose of alendronate plus vitamin D is 1 tablet ONCE A WEEK (every 7 days).
• Always take your alendronate plus vitamin D exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.

It is very important that you carefully follow the instructions of how to take alendronate safely. If not taken properly, alendronate can irritate or burn your food pipe (or oesophagus).  

Timing

• Take alendronate + vitamin D on the same day each week. To help you remember, choose a day that best suits your routine, eg, every Monday.
• Take alendronate first thing in the morning, before eating or drinking anything else, including other medicines. Do not take your dose at bedtime or while lying in bed.
• Take your tablet with a full glass of water. Do not take it with mineral water, tea, coffee, milk or juice, as these interfere with the absorption of alendronate into your body. 

Stay upright for at least 30 minutes after taking your dose

• Swallow the tablet whole – do not crush or chew. You may get mouth ulcers if you chew or dissolve the tablet in your mouth.
• Stay upright for at least 30 minutes after taking your dose. Do not lie down for at least 30 minutes, and do not have any food, drinks or medicines during this time. 
• If you are unwell and cannot sit or stand upright for 30 minutes after taking your dose, skip that day’s dose and do not take it until you are feeling better. Contact your doctor or pharmacist if you need to miss more than 2 or 3 doses.

Missed dose

If you forget to take your dose, just take it the next morning. Then take 1 tablet once a week, as before.

Here are some things to know when you're taking alendronate + vitamin D. Other things may be important as well, so ask your healthcare provider what you should know about.

• Other medicines: Alendronate + vitamin D interacts with some medications, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting alendronate + vitamin D and before starting any new products.
• Some medicines available without a prescription may interact with alendronate, such as calcium supplements, iron supplements and antacids. 
• Maintain good oral hygiene (such as brushing your teeth twice a day and regular flossing between your teeth). Read more about this in the section on possible side effects below.

Like all medicines, alendronate + vitamin D can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Problems with your jaw

Alendronate + vitamin D can cause osteonecrosis of the jaw. This can be caused by delayed healing in your mouth after some dental procedures. This is quite rare. To reduce the risk of this problem, it is best to take the following steps:

• Take good care of your teeth and mouth (such as brushing your teeth twice a day and regular flossing between your teeth).
• Have regular dental check-ups.
• If you need any dental treatment, it is best that you have this done before you start treatment with alendronate.
• Let your dentist know that you are taking alendronate.
• Talk to your doctor or dentist if you have any loose teeth, tooth pain, swelling or numbness in your jaw.

Fractures

Alendronate + vitamin D can rarely cause fractures (breaks) in your thigh bone (upper leg bone). These are called atypical fractures because they appear as cracks on the bone and are not usually related to an injury. If you have pain, weakness or discomfort in your thigh, hip or groin, tell your doctor. These may be warnings that there is some weakness in your bones. You may need x-rays of your legs.

Other side effects