dysphagia and alendronic acid??

[Ama2007]

hi,

has anyone come across a patient who cant swallow and is prescribed alendronic acid70mg weekly? patient has myasthenia gravis and cant swallow anything, all medication are given via NG tube, on about 15 medications. how would you administer it if its modified release? what are the alternatives, if any?


does anyone know of any website or book I can check for drug compatibility for NG route?

any ideas?

[Nik]

Alendronic acid 70mg/wk tabs aren't modified release - they're normal immediate release, but bisphosphonates have an inherently long duration of action so no need for M/R preps of these drugs. First line resource for drugs in enteral feeding is...Drug Administration via enteral feeding tubes, easily googleable. If oral route must be avoided, could consider parenteral bisphosphonates.

[Ama2007]

so, could you give by an NG tube? and would have to be given on its own before all the other drugs?
thanks

[Nik]

Handbook of drug administration via ... - Google Books

Alendronic acid can be given via NG tubes - whether it is appropriate in your hypothetical or real patient I don't know. Also need to consider potential damage/irritation to oesophagus if NG tube sited incorrectly.

[Ama2007]

it was on the Kardex and I was wondering if it is possible to take it orally (prescribed orally) considering that the patient has dysphagia.

anyway thanks for the book.

[crit care]

if swallowing problems there are strontium granules which are available which can go through NG tube

[tinx25388]

Rosemont also make 70mg/75ml Oral Solution, however it is NOT a licensed product and is a bit pricey.

[Nik]

Yeah best to stick to licensed route where possible - if strontium ranelate granules can be used instead then would be a better option, although again would need to consider potential feed interactions.

[lamzee]

What about forsteo or zometa injections?

[Nik]

Zoledronic acid not licensed for osteoporosis. Teriparatide would be pretty much last resort I would've thought if strontium or raloxifene isn't appropriate, along with denosumab.