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Home / Drugs / Starting with A / Alendronate

Alendronate is a nitrogen-containing, second generation bisphosphonate. Bisphosphonates were first used to treat Paget’s disease in 1971. This class of medications is comprised of inorganic pyrophosphate analogues that contain non-hydrolyzable P-C-P bonds. Similar to other bisphosphonates, alendronate has a high affinity for bone mineral and is taken up during osteoclast resorption. Alendronate inhibits farnesyl pyrophosphate synthetase, one of the enzymes in the mevalonic acid pathway involved in producing isoprenoid compounds that are essential for post-translational modification of small guanosine triphosphate (GTP)-binding proteins, such as Rho, Ras and Rab. Inhibition of this process interferes with osteoclast function and survival. Alendronate is used for the treatment of osteoporosis and Paget’s disease.
Fosamax Plus D
CategoriesAntihypocalcemic Agents
Bone Density Conservation Agents
ManufacturersMerck and co inc
Apotex inc
Aurobindo pharma ltd
Austarpharma llc
Barr laboratories inc
Cadista pharmaceuticals inc
Dr reddys laboratories ltd
Genpharm ulc
Mylan pharmaceuticals inc
Sandoz inc
Sun pharma global inc
Teva pharmaceuticals usa
Watson laboratories
Watson laboratories inc
PackagersAmerisource Health Services Corp.
Apotex Inc.
Arrow Pharm Malta Ltd.
A-S Medication Solutions LLC
Aurobindo Pharma Ltd.
Barr Pharmaceuticals
Cipla Ltd.
Cobalt Pharmaceuticals Inc.
Dispensing Solutions
Diversified Healthcare Services Inc.
Doctor Reddys Laboratories Ltd.
Lake Erie Medical and Surgical Supply
Merck & Co.
Murfreesboro Pharmaceutical Nursing Supply
Northstar Rx LLC
Nucare Pharmaceuticals Inc.
Physicians Total Care Inc.
Rebel Distributors Corp.
Southwood Pharmaceuticals
Sun Pharmaceutical Industries Ltd.
Teva Pharmaceutical Industries Ltd.
UDL Laboratories
Watson Pharmaceuticals
SynonymsAcide Alendronique [INN-French]
Acido Alendronico [INN-Spanish]
Acidum Alendronicum [INN-Latin]
Alendronate Sodium
Alendronic acid


For the treatment and prevention of osteoporosis in women and Paget's disease of bone in both men and women.


Alendronate, a second-generation bisphosphonate is the first member of a group of drugs which strengthens bone. Alendronate is used to reduce hypercalcemia in tumor-induced bone disease, to treat corticosteroid-induced osteoporosis and Paget's disease, and to prevent osteoporosis in postmenopausal women.

mechanism of action

The action of Alendronate on bone tissue is based partly on its affinity for hydroxyapatite, which is part of the mineral matrix of bone. Alendronate also targets farnesyl pyrophosphate (FPP) synthase. Nitrogen-containing bisphosphonates (such as pamidronate, alendronate, risedronate, ibandronate and zoledronate) appear to act as analogues of isoprenoid diphosphate lipids, thereby inhibiting FPP synthase, an enzyme in the mevalonate pathway. Inhibition of this enzyme in osteoclasts prevents the biosynthesis of isoprenoid lipids (FPP and GGPP) that are essential for the post-translational farnesylation and geranylgeranylation of small GTPase signalling proteins. This activity inhibits osteoclast activity and reduces bone resorption and turnover. In postmenopausal women, it reduces the elevated rate of bone turnover, leading to, on average, a net gain in bone mass.


Alendronate can damage the esophagus both by toxicity from the medication itself and by nonspecific irritation secondary to contact between the pill and the esophageal mucosa, similar to other cases of "pill esophagitis."


There is no evidence that alendronate is metabolized in humans or animals.


Relative to an intravenous (IV) reference dose, the mean oral bioavailability of alendronate in women was 0.7% for doses ranging from 5 to 40 mg when administered after an overnight fast and two hours before a standardized breakfast. Oral bioavailability of the 10 mg tablet in men (0.59%) was similar to that in women (0.78%) when administered after an overnight fast and 2 hours before breakfast.

half life

>10 years

route of elimination

Following a single IV dose of [14C]alendronate, approximately 50% of the radioactivity was excreted in the urine within 72 hours and little or no radioactivity was recovered in the feces.

drug interactions

Calcium: Formation of non-absorbable complexes

Calcium Acetate: Calcium Salts may decrease the serum concentration of Bisphosphonate Derivatives such as alendronate. Avoid administration of oral calcium supplements within 30 minutes after alendronate.

Calcium Chloride: Calcium salts may decrease the serum concentration of bisphosphonate derivatives. Avoid administration of oral calcium supplements within 30 minutes after alendronate/risedronate.

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Diflunisal: Increased risk of gastric toxicity

Etodolac: Increased risk of gastric toxicity

Fenoprofen: Increased risk of gastric toxicity

Flurbiprofen: Increased risk of gastric toxicity

Ibuprofen: Increased risk of gastric toxicity

Indomethacin: Increased risk of gastric toxicity

Iron Dextran: Formation of non-absorbable complexes

Ketorolac: Increased risk of gasrtic toxicity

Magnesium: Formation of non-absorbable complexes

Mefenamic acid: Increased risk of gastric toxicity

Nabumetone: Increased risk of gastric toxicity

Naproxen: Increased risk of gastric toxicity

Oxaprozin: Increased risk of gastric toxicity

Oxyphenbutazone: Increased risk of gastric toxicity

Piroxicam: Increased risk of gastric toxicity

Tenoxicam: Increased risk of gastric toxicity