• Binosto is a brand (trade) name for alendronate which may be used for the treatment or prevention of osteoporosis.
• Binosto (alendronate) works by inhibiting osteoclasts which are responsible for breaking down and reabsorbing bone (by a process known as bone resorption). Alendronate strengthens bones by slowing down bone loss and allowing osteoblasts (bone-building cells) to work more effectively, improving bone mass.
• Binosto belongs to a group of medicines known as bisphosphonates.

• Binosto may be used to treat osteoporosis in postmenopausal women and to increase bone mass (bone mineral density) in men.
• Binosto is an effervescent tablet that dissolves in water and is usually taken once weekly.
• Strengthens bones.
• Binosto is available as a generic under the name alendronate.

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Abdominal pain, bone muscle or joint pain, dyspepsia, hair loss, itch, constipation, diarrhea, flatulence, dizziness, headache, vertigo, and swelling of the ankles or feet are the most common side effects.
• Binosto, like other bisphosphonates, may irritate the esophagus and stomach. Some cases have been severe enough to warrant hospitalization. The risk is greater in people who lie down soon after taking Binosto or who don't take it with a full glass of water. Take exactly as directed. Binosto should be taken with a full glass of water and the person taking Binosto should remain upright for at least 30 minutes after taking it.
• Severe bone, joint, or muscle pain, necessitating discontinuation of Binosto in some people, has been reported, occurring from one day to several months after starting the drug.
• Rarely may cause other side effects including uveitis (eye inflammation).
• May not be suitable for some people including those with kidney disease, pre-existing esophageal conditions, low blood calcium levels (hypocalcemia), or who are unable to stand or sit upright for at least 30 minutes.
• There are concerns about the long-term safety of bisphosphonates (such as Binosto) as long-term use has been associated with atypical femur fractures, osteonecrosis of the jaw, and esophageal cancer.
• Fracture risk reduction may also persist for years after treatment has stopped. The optimal duration of therapy with Binosto has not been established. Periodically re-evaluate the need for therapy. Discontinuation of therapy should be considered by doctors after 3 to 5 years in patients at low risk of fracture.
• Binosto may interact with antacids or supplements containing calcium or magnesium.
• Binosto may lower calcium levels in the blood. Pre-existing low blood calcium levels should be corrected before Binosto is administered.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

• Take Binosto when you get up in the morning, at least 30 minutes before eating or drinking any food or beverages (other than water), or taking any other medication, including calcium, antacids, or vitamins for the day.
• Allow Binosto to dissolve in room temperature water for at least five minutes until all effervescence has stopped. Do not substitute water with mineral water, coffee, soda, juice, or tea. Stir the mixture and then drink. Remain upright for at least 30 minutes. Do not lie down. Never take Binosto at bedtime, take it exactly as directed by your doctor. Do not increase or decrease the dosage without your doctor's advice.
• You may need to take supplementary calcium or vitamin D if your dietary intake is inadequate. Your doctor will advise you about this. If you are taking supplemental calcium, iron, magnesium, or antacids, take them at a different time of day to Binosto (for example at lunchtime), as they may interfere with the absorption of Binosto. Note that mineral water may contain a higher concentration of calcium than tap or bottled water, and you should only drink it if your doctor has confirmed it is compatible with Binosto.
• Talk to both your dentist and doctor if you require dental surgery or tooth extraction and you have been on Binosto long-term. They may advise discontinuation of Binosto.
• Tell your doctor if you experience any thigh or groin pain, muscle cramps or twitches, severe or debilitating muscle pain, eye inflammation, or any other adverse effects of concern while you are taking Binosto.

• Binosto starts to affect markers that reflect bone resorption within one month of treatment and reaches a plateau by three to six months. Effects remain stable following continued treatment for up to three years.
• Food can significantly decrease the absorption of Binosto.

Medicines that interact with Binosto may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Binosto. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Binosto include:

• aluminum salts
• amikacin
• angiogenesis inhibitors, such as bevacizumab or everolimus
• aspirin
• calcium supplements
• chemotherapy agents for cancer
• diuretics, such as bumetanide and furosemide
• hormone replacement therapy
• iron salts
• lithium
• magnesium salts
• NSAIDs, such as ibuprofen, diclofenac, and naproxen
• olsalazine
• oral steroids, such as dexamethasone, prednisone, and methylprednisone
• sirolimus and tacrolimus
• zinc salts.

Note that this list is not all-inclusive and includes only common medications that may interact with Binosto. You should refer to the prescribing information for Binosto for a complete list of interactions.