Стриктуры или ахалазии пищевода и другие состояния, приводящие к замедлению продвижения пищи по пищеводу;
Неспособность пациента стоять или сидеть на протяжении 30 мин
Гипокальциемия
Почечная недостаточность тяжелой степени (КК менее 35 мл/мин)
Тяжелые нарушения минерального обмена
Беременность
Период лактации (грудного вскармливания)
Детский возраст (эффективность и безопасность применения не установлены)
Повышенная чувствительность к алендронату или другим компонентам препарата. С осторожностью следует назначать препарат пациентам с заболеваниями ЖКТ (дисфагия, гастрит, дуоденит, язвенная болезнь в стадии обострения, активное желудочно-кишечное кровотечение или хирургическая операция на верхних отделах ЖКТ в анамнезе), гиповитаминоз D. Применение при нарушениях функции почекДля пациентов с умеренным нарушением функции почек (КК более 35 мл/мин) коррекции дозы не требуется. При КК менее 35 мл/мин применение препарата противопоказано. Применение у пожилых пациентовДля пожилых пациентов коррекции дозы не требуется
Применение при беременности и в период грудного вскармливания
Противопоказано
Способ применения и дозы
Таблетки следует принимать утром, не позднее, чем за 30 мин до первого приема пищи, напитка или другого лекарственного препарата, запивая полным стаканом обычной воды (не менее 200 мл). Таблетки нельзя разжевывать. Не следует принимать горизонтальное положение тела, по крайней мере, в течение 30 мин после приема препарата. Нельзя принимать препарат перед сном или до утреннего подъема с постели. Рекомендуемая доза составляет 70 мг (1 таб.) 1 раз в неделю. Для пожилых пациентов и пациентов с умеренным нарушением функции почек (КК более 35 мл/мин) коррекции дозы не требуется
Побочное действие
При приме таблеток Фороза могут наблюдаться следующие Побочное реакции: абдоминальные боли; жидкий стул или запор; вздутие живота; нарушение глотания; изжога; воспаление слизистой желудка; тошнота и рвота; стеноз и перфорация пищевода; язвы на слизистых ЖКТ; эзофагит; кровотечение из верхних участков пищеварительного тракта; дегтеобразный стул; головные боли; головокружение; изменение вкуса; раздражительность; склерит; увеит; конъюнктивит; кожная аллергия; выпадение волос; фоточувствительность; миалгия; боль в костях; артралгия; остеонекроз челюсти; атипичные переломы бедра; отечность суставов; понижение уровня кальция и фосфора в крови
Передозировка
Симптомы: боли в животе, диспептические расстройства, дисфагия, изжога, эзофагит, гастрит; могут развиться гипокальциемия и гипофосфатемия. Лечение симптоматическое. Показано применение молока и антацидных препаратов для связывания алендроната. В связи с риском поражения пищевода не следует вызывать рвоту, пациент должен находиться в вертикальном положении
Особые указания
Таблетки следует запивать только обычной водой, т.к. другие напитки (включая минеральную воду, чай, кофе, фруктовые соки) ухудшают всасывание препарата. Прием алендроната перед сном или в горизонтальном положении увеличивает риск развития эзофагита. До начала терапии препаратом Фороза необходима коррекция гипокальциемии и других нарушений метаболизма (таких как дефицит витамина D). В связи с увеличением на фоне терапии алендронатом минеральной плотности костной ткани возможно незначительное клинически бессимптомное снижение уровней кальция и фосфатов в сыворотке крови, в особенности у пациентов, получающих ГКС, у которых всасывание кальция может быть снижено. Поэтому обеспечение поступления досточного количества кальция и витамина D в организм, особенно важно у пациентов, получающих ГКС. Пациентов следует предупредить, что при случайном пропуске приема препарата в дозировке 1 раз в неделю они должны принять 1 таб. утром ближайшего дня (недопустимо принимать 2 таб. в один день). В последующем следует продолжать принимать по 1 таб. в тот день недели, который был выбран в начале терапии. При назначении других бисфосфонатов редко отмечался остеонекроз челюсти. Большинство случаев зарегистрировано у онкологических пациентов во время стоматологических процедур, несколько случаев - у пациентов с постменопаузным остеопорозом или другими заболеваниями. Факторы риска развития остеонекроза челюсти включают установленный диагноз рака, сопутствующую терапию (химиотерапию, лучевую терапию, кортикостероиды) и другие нарушения (анемию, коагулопатию, инфекцию, заболевания десен). Большинство случаев отмечено при в/в назначении бисфосфонатов, но отдельные случаи наблюдались у пациентов, получавших препараты внутрь. Хирургическое стоматологическое вмешательство на фоне терапии бисфосфонатами может усилить проявления остеонекроза челюсти. Неизвестно, снижает ли риск возникновения остеонекроза челюсти отмена бисфосфонатов. Решение о проведении лечения необходимо принимать для каждого пациента индивидуально после оценки соотношения риск/польза
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