LENDOMAX 70 TAB

Indications

Approved Uses

Treatment and prevention of osteoporosis in postmenopausal women, Treatment to increase bone mass in men with osteoporosis, Treatment of glucocorticoid-induced osteoporosis, Treatment of Paget's disease of bone.

Off-Label Uses

Not routinely used for hypercalcemia of malignancy or bone metastases (IV bisphosphonates are preferred); off-label use exists in some settings such as osteogenesis imperfecta (more commonly with other bisphosphonates) and glucocorticoid-induced osteoporosis prevention/treatment where not explicitly labeled in some jurisdictions.

Dosage & Administration

Dosing by Condition

Postmenopausal osteoporosis treatment: 70 mg once weekly or 10 mg once daily. Osteoporosis prevention: 35 mg once weekly or 5 mg once daily. Glucocorticoid-induced osteoporosis: 5 mg once daily (10 mg once daily in postmenopausal women not on HRT). Paget's disease: 40 mg once daily for 6 months. Osteoporosis in men: 70 mg once weekly or 10 mg once daily

Initial Dose

70 mg once weekly (for osteoporosis treatment)

Maintenance Dose

70mg once weekly for osteoporosis treatment.

Maximum Dose

Osteoporosis: 70 mg once weekly (or 10 mg daily); Paget’s disease: 40 mg once daily for 6 months.

Children's Dosage

Not approved for children.

Dose Adjustment Notes

Renal: avoid/contraindicated if CrCl <35 mL/min; no dose adjustment needed if CrCl ≥35 mL/min. Hepatic: no adjustment required. Duration: reassess fracture risk periodically; consider a bisphosphonate ‘drug holiday’ after ~3-5 years in lower-risk patients.

How to Take

Take on an empty stomach first thing in the morning with a full glass of plain water (180-240 mL) at least 30 minutes before first food, drink, or other medication; swallow whole - do not crush, chew, or suck; remain upright (sitting or standing) for at least 30 minutes after taking and until after first food of the day; do not take at bedtime or before rising

Side Effects

Common Side Effects

Abdominal pain, dyspepsia/heartburn (acid regurgitation), nausea, constipation, diarrhea, flatulence, headache, and musculoskeletal (bone/muscle/joint) pain.

Side Effect Frequency

Very common (>10%): musculoskeletal pain (bone, muscle, joint). Common (1-10%): abdominal pain, dyspepsia/heartburn/acid regurgitation, nausea, constipation, diarrhea, flatulence, headache. Uncommon/rare: esophagitis/esophageal ulceration and (rare) esophageal stricture; rash/pruritus/erythema; hypocalcemia; ocular inflammation (e.g., uveitis); osteonecrosis of the jaw; atypical femoral fractures.

Safety & Warnings

Contraindications

Esophageal abnormalities which delay esophageal emptying (e.g., stricture or achalasia), Inability to stand or sit upright for at least 30 minutes, Hypocalcemia, Hypersensitivity to alendronate, Severe renal impairment (CrCl <35 mL/min), Pregnancy.

Warnings & Precautions

Take on waking with a full glass of plain water; remain upright ≥30 minutes and until after first food; avoid in patients with esophageal abnormalities or inability to sit/stand; correct hypocalcemia and ensure adequate calcium/vitamin D; use caution with active upper-GI disease; consider dental evaluation in high-risk patients (ONJ); monitor for thigh/groin pain (atypical fracture) and stop/evaluate if significant esophageal symptoms occur.

Age Restriction

Not approved/recommended for patients <18 years (pediatric safety and efficacy not established).

Drug Interactions

Drug Interactions

Multivalent cations (calcium/iron/magnesium/aluminum; antacids; supplements) and food markedly reduce absorption-separate dosing; NSAIDs may increase GI irritation/ulcer risk; IV ranitidine can increase alendronate bioavailability (clinical relevance usually limited).

Interaction Severity

Calcium/antacids/iron/magnesium and other polyvalent cations: clinically significant reduction in absorption-separate by at least 30 minutes (many references advise longer separation, e.g., 2 hours, but minimum is 30 minutes after alendronate). NSAIDs: increased risk of GI irritation/ulceration (use caution).

Food Interaction

Take on an empty stomach with plain water only, at least 30 minutes before any food, beverage (other than water), or other medicines; food/beverages markedly reduce absorption.

Special Populations

Pregnancy

Category C (FDA); contraindicated due to potential fetal harm

Children

Not approved for children.

Elderly

Standard adult dosing; no dose adjustment required based on age alone; ensure adequate calcium and vitamin D supplementation; monitor renal function

Kidney Impairment

CrCl ≥35 mL/min: no dose adjustment; CrCl <35 mL/min: not recommended (avoid).

Liver Impairment

No adjustment needed.

Storage & Patient Advice

Stopping the Medicine

Do not stop without clinician review; reassess need periodically and consider a ‘drug holiday’ after ~3-5 years in appropriate low-moderate fracture-risk patients.

Overdose

Symptoms: hypocalcemia, hypophosphatemia, and upper GI adverse effects (e.g., heartburn, esophagitis/gastritis/ulcer); Management: give milk/antacids to bind, keep upright, do NOT induce vomiting, and seek urgent medical care/supportive management.

Patient Counseling

Take first thing in the morning with a full glass of plain water only; no food/drink/other meds for at least 30 minutes; remain upright (sitting/standing) for at least 30 minutes and until after the first meal; swallow whole (do not chew/crush); separate calcium/iron/antacids; report dysphagia, chest pain, or new/worsening heartburn; inform dentist and report jaw symptoms; report thigh/groin pain suggestive of atypical femur fracture.

Monitoring Requirements

Baseline: serum calcium (and correct hypocalcemia), vitamin D status, and renal function (serum creatinine/CrCl). Follow-up: periodic calcium/vitamin D as clinically indicated; BMD (DEXA) typically every 1-2 years until stable then at longer intervals; monitor for GI intolerance and rare complications (ONJ/atypical femur fracture) based on risk/symptoms.

Pharmacology

Mechanism of Action

Nitrogen-containing bisphosphonate that binds to bone hydroxyapatite and inhibits osteoclast-mediated bone resorption primarily via inhibition of farnesyl pyrophosphate synthase in the mevalonate pathway, reducing osteoclast function/survival.

Onset of Action

Biochemical markers of bone resorption decrease within weeks (often within ~1 month); measurable BMD increases are typically seen by ~3-6 months and continue over 1-2 years.

Duration of Effect

Effects can persist months to years after stopping; alendronate has a very long terminal residence time in bone (often cited as ~10 years or more).

Half-Life

Plasma half-life ~1-2 hours; terminal half-life in bone is very prolonged and estimated to exceed 10 years.

Bioavailability

Oral bioavailability is very low, approximately 0.6-0.7% under fasting conditions and is markedly reduced by food and beverages other than water.

Metabolism

Not metabolized (no hepatic metabolism).

Excretion

Absorbed alendronate is either taken up into bone or excreted unchanged by the kidneys; unabsorbed drug is eliminated in feces.

Product Information

Available Dosage Forms

Tablet, Oral solution, Effervescent tablet.

Composition per Dose

Each tablet: 70 mg alendronic acid (as alendronate sodium trihydrate)

Generic Availability

Yes

OTC Alternatives

No OTC alternative

Primary Use

Treatment and prevention of osteoporosis and Paget's disease of bone by reducing bone resorption

Reviewed by Al Mujtama Pharmacy Medical Review Team. Last reviewed 28-06-2026