Alendronic Acid has been short in supply in recent weeks. Larger pharmacy chains were unable to supply alendronic acid to patients. Some pharmacies had a continuous supply of alendronic acid 70mg tablets, whereas others decided not to supply any, most like due to a change in the price of this drug. At its peak, some suppliers were charging pharmacies over £30 per box of 4 tablets, which cost around £1 a few weeks earlier. Since NHS has an outdated pricing scheme, which reacts to those prices too slow, the supply of alendronic acid to patients has been problematic. Today I will review alendronic acid alternative drugs.
What is alendronic acid?
Alendronic acid belongs to a group of drugs called bisphosphoBnates. Alendronic acid is absorbed into the bones, reducing the rate of bone turnover. Alendronic acid and other bisphosphonates are therefore very useful in the treatment of conditions characterised by a bone ‘loss’, for example, osteoporosis (both treatment and prevention).
In the UK, the most commonly used alendronic acid comes in form of 70mg tablets, with one tablet taken once a week.
Alendronic Acid Alternatives
The next four paragraphs describe different forms of alendronic acid, which may be considered alternatives to 70mg tablets.
1. Alendronic Acid 10mg tablets
As I previously wrote, most commonly, alendronic acid is prescribed in a form of 70mg tablets. However, alendronic acid is also available in a form of 10mg tablets. This form of alendronic acid is rarely prescribed. Nevertheless, 10mg tablets were not affected by the ‘shortage’ and offer a great alternative to alendronic acid 70mg tablets. Taking alendronic acid 10mg tablets would require a daily dose, rather than a weekly dose with 70mg tablets which is a big shift in the patient’s treatment.
2. Alendronic Acid Solution
Alendronic Acid is also available in a form of a solution. The solution of alendronic acid comes as a pack of 4 x 100ml solution. Each bottle of 100ml solution contains 70mg of alendronic acid, which corresponds to a weekly dose of alendronic acid 70mg tablets.
3. Alendronic acid alternative: Fosamax Once Weekly 70mg tablets
Fosamax Once Weekly tablets are branded tablets of alendronic acid 70mg tablets. Currently, this brand is also affected by a ‘shortage’. The reimbursement price (price paid by NHS to pharmacies) for Fosamax Once Weekly tablets is under £1, therefore making it unreasonable for pharmacies to supply this brand of alendronic acid to patients (due to its price tag of over £20 for four tables).
4. Alendronic acid 70mg effervescent tablets
Alendronic acid 70mg is available in form of effervescent tablets, which are dissolved in water before administration.
Alendronic acid alternatives – different bisphosphonates
5. Risedronate sodium
Risedronate sodium has the same license use as alendronic acid. It belongs to the same class of drugs as alendronic acid.
Risedronate sodium comes in different strengths of tablets. Most commonly risedronate sodium is prescribed as a 35mg tablet. Risedronate sodium is usually taken once a week when 35mg tablets are prescribed (one 35mg tablet taken once a week).
Risedronate, however, is also available in a form of a 5mg tablet, which offers a daily treatment to the patients (one 5mg tablet taken each day).
30mg tablets of risedronate are usually prescribed in the treatment of Paget’s disease of bone.
Risedronate sodium was the main alternative medication, prescribed when alendronic acid was out of stock.
6. Alendronic acid alternative – Ibandronic acid
Although ibandronic acid belongs to the same class of drugs as alendronic acid, its use is limited to reduction of bone damage in bone metastases in breast cancer, hypercalcaemia of malignancy (high calcium level in patients with cancer) and treatment of postmenopausal osteoporosis (BNF, 2022).
7. Zoledronic Acid
Zoledronic acid is another bisphosphonate, somehow irrelevant to community pharmacy for patients seeing alendronic acid alternatives, as the supply of this drug is restricted to hospitals by intravenous infusion.
Moving away from bisphosphonates the next few drugs can be considered an alternative treatment to alendronic acid only in specific situations.
8. Strontium ranelate
Strontium ranelate can be used by postmenopausal women and men when other treatments are not tolerated. Strontium ranelate is usually prescribed under a care of a specialist.
9. Denosumab
Denosumab (brand names: Prolia® and Xgeva®) works differently from bisphosphonates. Denosumab is classified as a human monoclonal antibody. Both brands of denosumab are administered by subcutaneous injection. Prolia® is only injected every 6 months. Prolia can be used to treat osteoporosis in postmenopausal women, but also men at increased risk of fractures, bone loss caused by hormone changes in men with prostate cancer or bone loss caused by long-term treatment with ‘steroid’ medicines.
10. Raloxifene for post menopausal women
The use of raloxifene is limited to the treatment and prevention of postmenopausal osteoporosis and prevention of breast cancer. Bisphosphonates are considered the first-line treatment of osteoporosis. NICE guidance on the management of osteoporosis, only recommends the use of raloxifene as an optional treatment, when bisphosphonates are not tolerated or contraindicated (should not be used) and after a referral to a specialist.
References:
BNF, 2022. Ibandronic acid. Available at: https://bnf.nice.org.uk/drugs/ibandronic-acid/ Accessed on 10/08/2022
