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15Levine JNelson DEsophageal stricture associated with alendronate therapyAm J Med 1021997489-91.

Instruct patients to take supplemental calcium if dietary intake is inadequatesee Warnings and Precautions5.2Patients at increased risk for vitamin D insufficiencye.gover the age of 70 yearsnursing home-boundor chronically illmay need vitamin D supplementationPatients with gastrointestinal malabsorption syndromes may require higher doses of vitamin D supplementation and measurement of 25-hydroxyvitamin D should be considered.

Signs of an allergic reactionlike rashhivesitchingredswollenblisteredor peeling skin with or without feverwheezingtightness in the chest or throattrouble breathingswallowingor talkingunusual hoarsenessor swelling of the mouthfacelipstongueor throatSigns of low calcium levels like muscle cramps or spasmsnumbness and tinglingor seizuresBlacktarryor bloody stoolsChest painCoughing up bloodVery bad belly painHeartburnTrouble swallowingVery bad pain when swallowingSore throatVery upset stomach or throwing upThrowing up blood or throw up that looks like coffee groundsVery bad bonejointor muscle painAny new or strange groinhipor thigh painMouth soresThis medicine may cause jawbone problemsThe chance may be higher the longer you take Fosamaxalendronate oral solutionThe chance may be higher if you have cancerdental problemsdentures that do not fit wellanemiablood clotting problemsor an infectionThe chance may also be higher if you are having dental workgetting chemo or radiationor taking other drugs that may cause jawbone problems like some steroid drugsThere are many drugs that can do thisAsk your doctor or pharmacist if you are not sureCall your doctor right away if you have jaw swelling or pain.

Store at room temperatureStore in a dry placeDo not store in a bathroomKeep all drugs in a safe placeKeep all drugs out of the reach of children and petsThrow away unused or expired drugsDo not flush down a toilet or pour down a drain unless you are told to do soCheck with your pharmacist if you have questions about the best way to throw out drugsThere may be drug take-back programs in your areaDo not freeze.

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