Alendronate Sodium and Sertraline Oral Concentrate

• 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.

• Generic Name: sertraline
• Dosage Forms: oral solution, concentrate
• Other Brand Names: Zoloft

Management of major depressive disorder.

Efficacy in hospital settings not established.

APA states that effectiveness of antidepressants is generally comparable between and within classes of medications, including SSRIs, SNRIs, TCAs, MAOIs, and other antidepressants (e.g., bupropion, mirtazapine, trazodone). Choose antidepressant based mainly on patient preference; nature of prior response to medication; safety, tolerability, and anticipated adverse effects; concurrent psychiatric and medical conditions; and specific properties of the medication (e.g., half-life, actions on CYP450 enzymes, other drug interactions). For most patients, an SSRI, SNRI, mirtazapine, or bupropion is considered optimal. Consult APA’s Practice Guidelines for the Treatment of Patients with Major Depressive Disorder for additional information.

Management of OCD; reduces but does not completely eliminate obsessions and compulsions.

Management of panic disorder with or without agoraphobia.

Management of PTSD; more effective in women than in men.

Not effective for combat- or war-related PTSD.

Management of PMDD; improves symptoms (e.g., depressed mood, premenstrual anger/irritability) and functional impairment (e.g., difficulty in concentrating, lethargy) associated with this disorder.

Efficacy when used in conjunction with oral contraceptives for the treatment of PMDD is unknown.

Management of social phobia (social anxiety disorder).

Has been used in the management of premature ejaculation.

Has been used in the management of vascular headaches with equivocal efficacy.