Discontinue use if signs or symptoms of possible oesophageal reaction occurs; in patients suspected w/ atypical femur fracture. Severe skin reactions including SJS & TEN. Patients w/ active upper GI problems, eg, dysphagia, oesophageal disease, gastritis, duodenitis, ulcers, or w/ recent history (w/in previous year) of major GI disease eg, peptic ulcer, or active GI bleeding, or upper GI tract surgery other than pyloroplasty; known Barrett's oesophagus. Bone, joint, &/or muscle pain; atypical subtrochanteric & diaphyseal femoral fractures; symptomatic hypocalcaemia in patients w/ predisposing conditions (eg, hypoparathyroidism, vit D deficiency & Ca malabsorption). Osteonecrosis of the jaw & external auditory canal. Perform dental exam w/ appropriate preventive dentistry prior to treatment in patients w/ poor dental status. Maintain good oral hygiene, receive routine dental check-ups, & any oral symptoms eg, dental mobility, pain, or swelling. Examine contralateral femur in bisphosphonate-treated patients who have sustained a femoral shaft fracture. Correct hypocalcaemia before initiating therapy. Monitor serum Ca & symptoms of hypocalcaemia during therapy. Ensure adequate Ca & vit D intake. Avoid invasive dental procedures. May affect ability to drive & operate machinery. Not recommended for patients w/ renal impairment CrCl <35 mL/min. Not to be used during pregnancy & lactation. Not recommended in childn <18 yr.
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