Acetazolamide Sodium and Alendronate Sodium

• Generic Name: acetazolamide
• Dosage Forms: n.a.
• Other Brand Names: Diamox, Diamox Sequels

Adjunctive treatment of open-angle or secondary glaucoma.

Short-term use in acute angle-closure glaucoma to lower intraocular pressure (IOP) before surgery. Should not be used for long-term treatment of angle-closure glaucoma. (See Contraindications under Cautions.)

Prevention or amelioration of symptoms (e.g., headache, lassitude, insomnia, nausea, shortness of breath, dizziness) associated with acute mountain sickness.

Shortens the time of acclimatization. If acute mountain sickness develops, shortens duration; does notobviate need to stop ascent or to descend.

Also used in the treatment and prevention of high-altitude sleep disorders. Decreases periodic breathing and apnea and improves oxygenation.

Management (in combination with other anticonvulsants) of centrencephalic epilepsies (e.g., petit mal, unlocalized seizures); may be ineffective for prolonged therapy. Has not been evaluated in controlled clinical studies in specific seizure types.

Adjunctive treatment of edema due to CHF or drug therapy. Less potent diuretic than thiazide diuretics; metabolic acidosis resulting in loss of diuretic effect occurs after 2–4 days of continuous therapy.

Has been used in the treatment of hyperkalemic and hypokalemic forms of periodic paralysis.

• Generic Name: alendronate
• Dosage Forms: n.a.
• Other Brand Names: Binosto, Fosamax

Prevention of osteoporosis in postmenopausal women. Risk factors for postmenopausal osteoporosis and related fractures include early menopause, advanced age, low bone mineral density (BMD), low body mass index (BMI), previous fracture or family history of fracture/osteoporosis, excessive alcohol intake, smoking, inadequate physical activity, low calcium and vitamin D intake, certain drugs (e.g., glucocorticoids), and medical conditions or diseases (e.g., rheumatoid arthritis, diabetes mellitus, Cushing syndrome, hyperparathyroidism).

Used alone or in fixed combination with cholecalciferol (vitamin D3) for treatment of osteoporosis in postmenopausal women.

Used alone or in fixed combination with cholecalciferol to increase bone mass in men with osteoporosis.

In addition to adequate intake of calcium/vitamin D and other lifestyle modifications (e.g., exercise, avoidance of excessive alcohol and tobacco use), experts recommend that pharmacologic therapy for osteoporosis be considered in postmenopausal women and men (≥50 years of age) with previous hip or vertebral fractures or low BMD; pharmacologic therapy also may be considered in postmenopausal women and men (≥50 years of age) with low bone mass, although there is less evidence supporting overall fracture risk reduction in such patients.

Use of a drug with proven efficacy in reducing fracture risk is recommended; bisphosphonates (e.g., alendronate, risedronate, zoledronic acid, ibandronate) are recommended as one of several first-line drugs.

Individualize choice of therapy based on potential benefits (with respect to fracture risk reduction) and adverse effects of therapy, patient preferences, comorbidities, and risk factors.

Alendronate/cholecalciferol fixed combination is not recommended for treatment of vitamin D deficiency.

Alendronate has been used concomitantly with hormone replacement therapy (HRT) in postmenopausal women.

Treatment of glucocorticoid-induced osteoporosis in men or women receiving glucocorticoids at a daily dosage equivalent to ≥7.5 mg of prednisone who have low BMD. Risks versus benefits in patients receiving a lower dosage of glucocorticoids not established.

Also used for prevention of glucocorticoid-induced osteoporosis.

American College of Rheumatology (ACR) recommends optimizing calcium and vitamin D intake and lifestyle modifications (e.g., diet, smoking cessation, weight-bearing or resistance-training exercise) in all patients receiving long-term glucocorticoid therapy; in addition, pharmacologic therapy with an oral bisphosphonate is recommended in patients who are considered to be at moderate-to-high risk of fracture. Oral bisphosphonates are preferred because of their demonstrated antifracture benefits, safety, and low cost.

Treatment of moderate to severe Paget disease of bone (osteitis deformans) in patients with serum alkaline phosphatase concentrations ≥ twice ULN or who are symptomatic or at risk for future complications.