Discontinue use if dysphagia, odynophagia, retrosternal pain or new or worsening heartburn; symptoms of esophageal disease eg, difficulty or pain upon swallowing develop. Consider interruption of therapy in patients w/ stress fractures. Local irritation of upper GI mucosa. Esophageal adverse experiences eg, esophagitis, esophageal ulcers & erosions. Patients who lie down after taking the drug &/or who fail to swallow it w/ full glass of water, &/or who continue to take it after developing symptoms suggestive of esophageal irritation; w/ active upper GI problems eg, dysphagia, esophageal diseases (including known Barrett's esophagus), gastritis, duodenitis, or ulcers; requiring invasive dental surgery (eg, tooth extraction, dental implants); w/ malabsorption. Localized osteonecrosis of jaw associated w/ tooth extraction &/or local infection (including osteomyelitis) w/ delayed healing. Bone, joint &/or muscle pain. Low-energy fractures of subtrochanteric & proximal femoral shaft & other bones in long-term (usually >3 yr) bisphosphonate-treated patients. Decreases in serum Ca & phosphate. Consider causes of osteoporosis other than estrogen deficiency, aging & glucocorticoid use. Correct hypocalcemia & other disorders affecting mineral metabolism (eg, vit D deficiency) before initiating therapy & monitor serum Ca & symptoms of hypocalcemia. Monitor urine & serum Ca in patients w/ diseases associated w/ unregulated overproduction of calcitriol (eg, leukemia, lymphoma, sarcoidosis). Not recommended in more severe renal insufficiency (CrCl <35 mL/min). Not to be given during pregnancy & lactation. Not to be given in childn.
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