Discontinue use if symptoms eg, dysphagia, odynophagia, worsening heartburn or retrosternal pain develops or in patients w/ stress fracture; if severe & occasionally incapacitating bone, joint &/or muscle pain develop; if ocular inflammatory symptoms are observed. Patients w/ active GI problems eg, dysphagia, esophageal diseases (including Barrett's esophagus), gastritis, duodenitis or ulcers, or w/ recent history (w/in previous yr) of major GI diseases eg, peptic ulcer, or active GI bleeding, or upper GIT surgery other than pyloroplasty. Consider causes of osteoporosis other than estrogen deficiency, aging & glucocorticoid use. Correct hypocalcemia & other mineral metabolism disturbances eg, vit D deficiency before initiating therapy. Paget's disease or those receiving glucocorticoids. Consider dental exam w/ appropriate preventive dentistry prior to treatment in patients w/ concomitant risk factors for osteonecrosis of the jaw. Consider possibility of osteonecrosis of external auditory canal in patients receiving bisphosphonates who present w/ ear symptoms eg, pain or discharge, or chronic ear infections. Atypical subtrochanteric & diaphyseal femoral fractures. Evaluate patients w/ suspected stress fractures. Mild & transient decreases in serum Ca & phosphate; monitor serum Ca during therapy. Increased risk of atrial fibrillation. Refer patients to an ophthalmologist for evaluation in cases of ocular events other than uncomplicated conjunctivitis. May affect ability to drive or operate machinery. Increased incidence of vomiting in patients w/ osteogenesis imperfecta. Not indicated for infants & childn. Some older individuals have greater sensitivity to alendronate.
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