Paget Paget
Paget Paget
  Pain and Paget's Disease    
  Diagnosing Paget's Disease of Bone    
  Paget's Disease and Osteoarthritis    
  Update on Medical Theraphy    
  Update On Paget's Disease Therapy  
 
Instructions for taking oral bisphosphonates: Actonel™, Didronel®, Fosamax®, Skelid®
All oral bisphosphonates except Didronel® must be taken on an empty stomach with 6-8 oz. of tap water. Patients taking Didronel® can drink less than 6-8 oz. of water. Adequate calcium (1000-1500 mg daily) and vitamin D intake (400 units) are recommended during bisphosphonate use, except if there is a history of calcium-containing kidney stones.

Actonel™
Patients should wait at least 30 minutes after taking Actonel™ before eating any food, drinking anything other than tap water, or taking any medication, and should not lie down for at least 30 minutes after taking the drug (patient may sit).


Take Actonel™ in the a.m., after an overnight fast.

Didronel®
No food, beverages, or medications for 2 hours before and after taking the drug.

Fosamax®
Patients should wait at least 30 minutes after taking Fosamax® before eating any food, drinking anything other than tap water, or taking any medication, and should not lie down for at least 30 minutes after taking the drug (patient may sit).

Take Fosamax® in the a.m., after an overnight fast.

Skelid®
Skelid® may be taken at any time of day, as long as there is a period of 2 hours before and after resuming food, beverages, and medications.

Re-treatment with new bisphosphonates:
Though every patient is an individual case, there are certain methods to use in determining if and when a patient needs to be re-treated. These drugs can cause long periods of remission in many patients. Others may need to be re-treated several months after the end of the first course of treatment.

Elevation of alkaline phosphatase and reoccurrence of bone pain are possible indications for re-treatment. (Please see chart below.)
 
   
Patient assistance programs
Most pharmaceutical companies offer patient assistance programs for patients in need of financial assistance for prescription drugs. Some companies require limited income or no insurance, while others require a doctor's referral. Following are patient assistance telephone numbers for companies that market approved therapies for Paget's disease in the U.S.

(Source: Free and Low-Cost Prescription Drugs, 1998)
Actonel™/Didronel®      Procter & Gamble 800-448-4878
Fosamax®                    Merck 800-994-2111
Aredia®                        Novartis 800-257-3273

The following chart suggests timelines for evaluation of patients taking the new bisphosphonates:
Drug Course of treatment Evaluation by physician
Actonel™ 30 mg tablet once daily for 2 months 1-2 months after completion of treatment
Aredia® Approved: 30 mg intravenous infusion over 4 hours on 3 consecutive days. More commonly used: 60 mg infusion over 2-4 hours for 2 or more consecutive or non-consecutive days 1-2 months after last infusion
Fosamax®

40 mg tablet once daily for 6 months

Immediately after completion of treatment

Immediately after completion of treatment
Skelid®    Two 200 mg tablets (400 mg) once daily for 3 months 2-3 months after completion of treatment

After the first evaluation, patients should be monitored every 4-6 months by measurement of alkaline phosphatase.

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Fosomax 40mg is available ONLY through the Merck Paget's Patient Support Program, which is administered by CVS ProCare. Physicians can prescribe Fosomax 40mg by mail, fax, or telephone to:

CVS ProCare Direct Pharmacy
The Page's Patient Support Program
600 Penn Center Boulevard
Pittsburgh, PA 15235
Tel (888) 900-3232
Fax (888) 776-5722

Upon enrollment, patients with Paget's disease of bone will receive medication directly by mail.

   
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