Reclast (Zoledronic Acid) vs. Fosamax, Boniva and Actonel

my wife is has having the same side effects---only they have lasted now almost 8 months.  Did your side effects eventually stop, or just lessen?

How long was your wife on it? I have been on it for 26 months and at l6 months started having muscle pain , then face pain 8 months later and now so stiff cannot go upstairs without holding on to the railing. Has your wife's side effects decreased?

Have your symptoms cleared up now?

 

 

   Did you get an answer to your concern? I have been prescribed to receive an injection of reclasp, but like you I don't know if I want to risk it. I would like some answers. 

 

   I would like to know the answer to this question.

I have been advised to take reclast and I have the same concern about it in my body for a year and what if I get sick, how do they treat the side effects or get the stuff out of my body? I just came off of Forteo for 2 years and there wasn't much improvement. I am 65. I currently developed some kind of a headache and will have an MRI and I put off the reclast injection. I want to try something else. I don't feel good about this at all. I sympathize with everyone making this decision. There has to be something better. I can't take fosamax, etc. I got an ulcer and think it was from that stuff. Good Luck everyone.

did you have any improvement at all with forteo? did you have any side effects.?

You can't get relast out of your body,you would be treated for the side effects and

probably have to deal with it for the year.  I am only 55 and healthy, active and look

about 40 according to everyone and my bone density is very low.  I have to decide what

action to take.  I take vitamins and exercise.  I think it's all still experimental and we are

being used for treatment.  THere has to be another way.  Please responsed.

You should really talk to your Doctor about your concerns.  Reclast is a bisphosphonate just like Fosamax and Actonel and Boniva.  Reclast not detectable in the blood after 24 hours.  61% of the Reclast dose goes to your bones.  Bisphosphonates stay in your bones for a long time.  For example the terminal half life of fosamax is 10.5 years.  That means that the amount of each fosamax pill that gets to your bones will reduce in size by 1/2 every 10.5 years.   SO the first fosamax pill that you ever take will be in your bones to some degree until you die.  That is just how bisphosphonates work.  Reclast side effects are very similar to fosanmax side effects.  The Reclast has an acute phase reaction, or post dose syndrome.  What that means is that within 2 to 3 days of the infusion about 15% of people in the clinical trials had flu-like symptoms.  Aches, and pains, generally describes as feeling under the weather.  These symtoms usually lasted no longer than 2 or 3 days.  My wife's aunt received Reclast and felt "icky" for 1 day.  The day following the infusion.  She felt well enough to go to work and felt perfect the day after. 

* In year 2 of the clinical trials the acuste phase reaction was down to 2% of the people, and in year three it was down to 1%.

Started Actonel at age 50.  Had esophageal spasms for a short time. After 6 years bone mass decreased.  Switched to Boniva.  No side effects.  After one year still had 6% bone loss.  Had reclast infusion.  Took tylenol to counteract possible flu like symtoms.  I had no symptoms.  Will get follow up bone scan in one year.  Hopefully it helps.

 

I appreciate your knowledge. You appear to be in the medical profession and have explained this medication well. I took my first Reclast dose this past Monday and so far have exhibited no symptoms. I had the two glasses of water and two Tylenol before my tx as prescribed by my doctor. Piece of cake. 

My Doctor has been trying to get me on reclast and after viewing everyone's report I've decided not to do it.  I take Strontium Bone Strengthener & my bone density have improved.  I also have been taking calcium with magnesium, vit. d-3 andvit.k. which are supposed to work together.  I amgoing to keep on what i'm doing.  i kno9w vitamins are expensive, but I went through hell from fosamax with a huge uilcer for 6 months before i changed doctors & was told that I had a huge ulcer which took years to overcome it.

How have you been doing up till now?  What Strontium are you taking? I have osteoporosis and dont know what to do.  I took Actonel for a year and had bad pain in throat neck shoulders and back.  Still trying to heal.  Joyce

May I ask where you bought the Strontium?  I have done a lot of reading and it claims to work the best. I was told it wasn't available in the US.

 

Thanks,

DJ, Oklahoma

Patricia S:

I am VERY interested in the Strontium Bone strenghthener.  I havd one infusion of Reclast and should be getting the second one.  I am NOT excited about receiving it.  Where do you purchase it?  What's the concentration, mg? What's the dosis?

I TOOK THIS MEDICATION 1 YEAR AGO AND RECOMMEND IT HIGHLY! I HAD FLU LIKE SYMPTOMS FOR ABOUT 3 DAYS BUT THEY WERE NOT THAT BAD. THAT'S THE ONLY TIME I HAVE HAD ANY SYMPTOMS AT ALL FROM THIS INJECTION. VERY SMALL IV USED AND TOOK ABOUT 15 MINUTES TO COMPLETE. I JUST TOOK MY SECOND INJECTION TODAY AND FEEL FINE. IF I HAVE FLU SYMPTOMS FOR A COUPLE OF DAYS THE RELIEF I FEEL IN MY UPPER BACK AND SPINE IS WELL WORTH A COUPLE OF DAYS OF VERY MILD FLU SYMPTOMS.  THESE ARE THE RESULTS I EXPERIENCED LAST YEAR AND I ASSUME IT WILL BE THE SAME THIS TIME.

First of all check out the book : Bisphosphonates in medical Practice in page 40 where it says :

Binding With Plasma Proteins : Ibandronate 87% , Aledronate 78% , Zoledronate 22%

especially albumin and check the clearence times below

 

 

 

Bill`

 

   Thinking about Reclast...what does your statement mean?

I was hoping for your opinion on the safety of the Reclast treatment, its side effects and interaction with my meds (insulin, caduet, diovan, levoxyl, travatan eye drops.

My physician has advised me to stop the Actonel, as I was having some problems swallowing.

I  received an email to go to this page for an answer to my question, however, I do not see the reply to my answer

Hi,  I have been taking the bone stregthener for a year or so.  I went for a bone density test and found that my bones have improved in density.  I have read many a health report that says that Strontium helps your bones better than anything.  I do also take calcium, vitamin k, and magnesium that all work together too. 

Strontium is a prescription drug that is used in Europe for osteo.  According to my doctor..., we cannot get it in US.  If we could he says he would love to be prescribing it.  Per this doctor, any Strontium product you obtain in US is not anything like the one used in other countries and will do nothing for your bones.  If anyone has better info I would love to know as I'm taking Actonel...

I'm glad you had no adverse effects so far.  The only thing that concerns me is that if there is ever a time when there is a need for dental surgery, (ie: root canal), I'll have to wait a year before the drug (reclast) gets out of my body.   My dentist doesn't like this drug because it has problems with ONJ (osteo-necrosis of the jaw).  The drug requires an oral exam by a dentist before getting the infusion (this is in the package insert). I'm interested to see how you are responding to this medicine.

It would be a good idea for your dentist to read the JADA cover article from May 2008 on ONJ and bisphosphonates. The article concludes that the vast majority of patients that have been diagnosed with ONJ have been cancer patients that were very very sick (dying), immunocompromised, patients on corticosteroids, pain mangement drugs, and chemo. These patients were also taking bisphospphonates 4mgs once every 4-6 weeks instead of 5mg once per year. ONJ is diagnosed by delayed healing after a tooth extraction. All of the above factors cause delayed healing. The annuls of internal medicine had the number of confirmed cases of ONJ to be 168 cases out of two-hundred million prescritptions written for bisphos. 163 of those patients were cancer patients and 5 were osteoporotic patients with no other ailments. Just a point of clarification. In the PI, It is recommended that the prescribing physician do a routine examination of the mouth before giving Reclast. There is no mention of a dentist.

"The only thing that concerns me is that if there is ever a time when there is a need for dental surgery, (ie: root canal), I'll have to wait a year before the drug (reclast) gets out of my body"

 

The problem is, it doesn't get out of your body in a year.  Read above the post about how long this class of drugs stays in you.  You may wait a year for dental surgery, but, you will still have the risk of bone necrosis.

 

A few years ago I began taking Fosamax.  I did well on it for about 6 months, then, without warning one evening I had an esophageal spasm that shut down my air way for about a minute and a half.  I was alone at home at the time and thinking that of all the daredevil stunts I've pulled in my lifetime THIS (?) was going to kill me.  A certain peace took over, I remember wetting myself unto the kitchen floor.  Still trying to breathe, just a touch of air suddenly slipped thru my lips and had to fight back an irresistable urge to swallow (typical esophageal spasm).  It took about ten minutes of managing to take in TINY sips of air before the spasm subsided.  My Doc and I attributed this to the Fosamax which I stopped taking that immediately.  About two weeks later, another spasm while I was driving my car.  Much weaker spasm this time, but, still had difficulty getting air and fighting a swallow urge (which I knew would shut my airway permanently this time) I got to the side of the road and let it pass, finally.

 

There is no way in you-know-where I would ever take a biphosphate again no matter how bad my osteoporosis got--and its pretty bad right now at the age of 55.  I can't take replacement estrogens, the other course recommended for thin bones, but, I have had some success with salmon calcitonin nasal spray, lotsa walking/jogging, modest sunlight and calcium, vit D and green leafy vegetables.  I've been on the calcitonin now for about 6 months, feel great (it has the added benefit of actually decreasing bone pain and is sometimes prescribed for that alone) time will tell if it actually helps.   It is not recomended for hip/wrist strengthening but does seem to be helping my spine, and the only side effect I've ever heard about it is that it can, as its a nasal spray, sometimes cause a sore throat.  I figured out how to get around that too---don't "sniff" the spray in, just spray it in.  If its starts to drip out, pinch your nose to keep it is and allow it to just absorb thru the nasal mucosa like its supposed to do.

Keep in mind Calcitonin, Evista, and Forteo have not been shown to reduce hip  fractures.  That is the number one reason Doctors treat Osteoporosis.  The number one treatment is a bisphosphonate.  The risk of experiencing a hip fracture is greater than the combined risk of Breast Cancer, Uterine Cancer, and Cervical Cancer.  The death rate of patients who experience a hip fracture is 15-25% in the first year after their hip fracture. (That is higher than the dealth rate for breast cancer)  50% of patients with a hip fracture never leave the nursing home. If I was a woman being treated for Osteoporosis, I would concentrate on the protecting my hips first.   Only Bisphosphonates have been proven to reduce hip fractures.  Fosamax, Actonel, and Reclast.- (Not Boniva)

Hi Bill,

As I peruse this blog site, your responses appear to be the best researched and substantiated---thanks for all the information you provide.  I am trying to learn if there is a paradigm or a formal recommendation made by an authoritative group/agency (ie NOF, CDC, ACOG, AMA, ACP, AAFP, etc.) regarding to whom and when to offer intravenous rather than oral bisphosphanate therapy.  Do you think it is only justified when an oral formulation has been tried and failed either due to ineffectiveness or intolerance, or is convenience a legitimate consideration? And any insight into how the insurance companies, including Medicare, view the use of the IV meds? I really appreciate your help.

-steve-

Reclast is indicated for 1st line use by the FDA.  Medicare does not require a patient to fail or have a trial of an oral bisphosphonate.  In fact around 75% of the health plans in the Country feel the same way.  In some areas of the Country the health plans require an oral trial unless the patient has a medical condition that causes oral bisphosphonate use to be contraindicated.  My feeling is use bisphosphontes whenever possible.  If fosamax works stick with it.  I feel the same for actonel.  They are both good products and they have plenty of studies that prove they are safe and effective.  The reason a drug like Reclast even makes it to market with 2 great drugs in the same class already established is that there is a vast majority of people suppossedly on the oral bisphosphonates the can't /won't/ forget to/  take their pills.

 

Studies have shown that only 45% of patients given oral bisphosphonates are still taking their pills after one year.

Patients stop for a number of reasons.  Cost- paying another co-pay for something that in the early stages has no symptoms... When people try to cut back one of their prescription meds...they usually stay on heart, blood, pain, ...ect.  Bone medicine usually is one of the first to be dropped.

Patients also stop because the oral bisphosphonate bothers them when they take it.  Some people discontinue because they don't want to delay their morning coffee or even be bothered to follow the oral bisphosphonate admin directions. 

Lets face it, in this country everything has got to be quicker and easier. 

    Taking an oral bisphosphonate is not the easiest pill to take correctly and to stick with.  In my opinion it is more difficult to remember to take a pill you only take once a week or month.  Lets say you put in on your calander and take it every week on schedule...are you taking it correctly?  IT must be the first thing you put in your mouth in the morning followed by a glass of water (8oz.)  It better not be well water or some mineral waters like Dasani.  Less than one percent of an oral bisphosphonate survives the digestion process and makes it to the bones; if you ingest certain minerals like magnesium in your water, what's left of your oral bisphosphone will attach to those minerals and be flushed from your body.  That is the same reason you can't take your calcium supplement with your oral bisphosphonate. 

 

There are a lot of little things that can screw up effective treatment with an oral bisphosphonate.  Effective treatment with an oral can work, but the patient has to receive this info.  In clinical trials the responder rates for Fosamax were almost identical to those of Reclast.  In clinical practice, fosamax can't claim half the efficacy as in their trials.  IT's not the drugs fault.  Reclast, on the other hand, should have the exact same results as in their clinical trials.  The only wild card is the Vit D3 and Calcium.  That is taken and monitored in every Osteoporosis trial and will have an effect on patient outcomes if they are not taken with any of the treatments. 

 

One other reason for switching to the IV would include the cost.  It is billed as a procedure, so it is not tiered like other drugs.  You can have major medical insurance with no prescription coverage and still get this drug.  The average Co pay is between $17 and $27.  If you had to pay cash for it it is around $1250 for the drug and the IV procedure itself.  That costs arounf $100-$200 less than Actonel for a year.  If you just talk co-pays Actonel and Boniva are likely to cost between $300-$600 per year in co-pays.  I would rather see someone switched to a 15 minute infusion to save money than stop taking their osteoporosis treatment.

 

I haven't read any specific recommendations from any of the organizations.  That being said I think the organizations you are referencing usually are conservative and would recommend having an oral trial first before going to an IV drug.  I read the NOF Osteoporosis treatment guidelines and they didn't specify.  Neither did the American College of Physicians in one of last years Annuls of Internal Medicine.

Bill,

I appreciate your information as it is helping me make a decision regarding a recommendation by my doctor to try Reclast. Once correction, however. I am disabled on receive medicare. I've been told I will pay approximately $240 co-insurance for the infusion. While this is still much less expensive than the co-pay for monthly Actonel. It is not the $17-$25 you mentioned.

Just wanted to clarify.

Penny,

 

Thanks for that info.  I did some more research and if you have straight medicare they will reimburse the office or hospital at 80%, leaving $240-$250 for the patient to pay.  However 95% of people with medicare have a secondary or supplemental insurance...this insurance picks up most of the $240 leaving the co-pay at around $25.  (even Medicaid)

 

 

Thanks, Bill. I know that's true. Unfortunately, that's generally for people who are on Medicare due to age. If you are on SSDI and receive Medicare, supplemental insurance is rarely available and what is available is exorbitant--I'm assuming this is because it's fairly clear that if you are on disability you are not a good insurance risk, generally speaking. I have a Medicare Advantage plan through Blue Cross and it is still 80/20 for the cost of Reclast. Again, it's still much less expensive than the weekly medications like Actonel and is not the biggest issue for me. My bigger concern is what Johns Hopkins has to say about the increased risk for atrial fibrilation. I guess the fact is there really isn't a good answer here. If you have osteoporosis you have to do something, but the options are not great. Reclast sounds really good in theory, but I am fearful, as many others have mentioned, about a drug that can be effective for a year. I know that Fosamax and Actonel also stay in your system for a very long time, but Reclast once/year seems scarier. That being said, I cannot tolerate Fosamax (joint and bone pain) and Actonel destroys my digestive tract. Given what you experienced with your mom, I know you would encourgage anyone to take a medication, but it's not an easy choice.

Thanks for your responsiveness.

I ,too, had reclast but I only had the symptoms  that you described for two days. I have esophagael problems and am taking protonic so the injection in the vein bypassed the esophagus. I am  64 and do yoga and pilates. When I broke my arm in March, my doctor wanted me to go on forteo but after researching and taking to several doctors I took the reclast. I am hoping my next bone density shows some improvement and I will take reclast again if I have to. I have read the company making forteo is investigating a spray. Let hope it works. Good luck to you.  

The Forteo nasal spray trial failed and was pulled by Lilly

Bill,

 

Your comments sound like you are a sales rep for Reclast.  Until you walk the walk, and personally understand the risks, I don't think that you can know what I or other patients go through.  The "data" is important, I know, but my doctor asked me to go to my dentist for an exam.  My dentist has seen similar issues with a drug called Zomid and wanted me to stay away from the long term drugs.

Donna,

 

I am sorry it has taken me so long to get back to you, I hadn't seen your note.  I just wanted you to know that I am actually a musician, not a Sales Rep.  The reason for all my research is that my mother died within a year of her hip fracture at 58 years old.  My sister is in her forties and has all the same risk factors.  My Mother could not take Fosamax because she had tolerability issues.  At the time Reclast wasn't being marketed for Osteoporosis.  I researched all the treatment options and spoke to three Rheumatologists in my area so I would be informed when I spoke to my sister.  Her and my mother also shared a lacksadasical approach to life and I knew I would need to be persuasive and persistant.

 

My sister was already osteopenic when she had her first Dexa-scan.  She takes fosamax.  Reclast is not indicated for osteopenia.  I hope she never needs Reclast.

thanks for your thoughtful and in-depth answers to questions.  You have taken an awful event in your life and turned it into offering something good to many others...bless you!  I am debating taking forteo and that is how I stumbled on this site.  It makes me a bit nervous to take something relatively new to the market.  Was on fosomax for a few years, off for one and dexa showed regression.  Was to go back on fosamax but another medical issue had me seeing an endocrinologist, who believes in forteo and is recommending it.  the marketing of forteo is another reason I have concerns...Issues I was having while taking fosamax have disappeared since going off med, but I never made the connection til reading these posts.  I pray for wisdom...

Bill,

I truly appreciate all the research you've done, and the reasons you've done it. I can not take Fosamax because of the esophageal problems, chest pain, heartburn. My recent bone density showed significant worsening of the lumbar spine; however I still have only osteopenia. My doctor suggested the once a month Boniva, but I'm afraid of taking it. My gynecologist suggested Reclast. I noticed you said this wasn't for people with osteopenia (just oseoporosis?). What is the reason for this? I'm so confused as to what I should do; right now Im opting for nothing.

Bill, I have been reading over some of your posts, sounds like you know an awful lot about reclast. Here is my story... My mother is 80 yrs young, a vibrant, intelligent, woman. Her dr. prescribed for her reclast, I took her to the hospital for the infusion, the next day she was in the emergeny room, she surpassed flu like symptons, she didn't know who she was, incoherent, and just out of it. She spent 4 days in there, the drs would only say that she was 'one in a million' to have this reaction. Seems that since then everything that may have been going on with her was magnified. CHF, COPD, it took many weeks for her to get her energy back, all of sudden she had alot of water weight gain, then she had lasix treatments, the facility dried her out to much. She suffered two strokes, dehydration and once again in the hospital, each time we have a set back she seems to get worse. Now they say she has a slight dementia  poblem . Today I took her to the dr, they say she is bleeding out in the stomach, her iron, and B-12 are good, but has anemia. Tomorrow we go see the Gastro Dr.

I honestly believe that the reclast has progressed all of this, but there is no way she will ever take that again. I work in the medical field I know some people do well, but not my Mom. Just my 2 cents worth.

MY SISTER IS SUPPOSE TO RECIEVE THE RECLAST I.V NEXT MONTH...AFTER READING ALL THE INPUT FROM YOU ALL...I DON'T THINK THIS WOULD BE GOOD FOR HER..THANKS FOR BEING UP FRONT AND TELLING ALL THE SYMPTOMS FROM THE I.V. MY SISTER HAS HEART IRREGULARITIES AND THIS IS ONE ONE THOSE SIDE EFFECTS SHE DOESN'T NEED....HER ONE FEAR IS HAVING THE PAIN ALL YEAR,AND NOT JUST ONE OR TWO DAYS. THANK YOU ALL AGAIN...I'VE READ ALL OF YOUR COMMENTS TO HER......NANCY

Bill, thanks for all of your post. This is my first time to check this site. I am having infusion of reclast on Oct. 19, 20009. A little fearful since I had problems with fosomax(bleeding from rectum) and digestive tract problems from other osteoporosis meds. I think I will go through with the therapy. I don't understand the information about the medication staying in our body for years that I have read on some postings. Maybe ignorance is bliss or not. But I do appreciate all the things you had to say. GM

My mom just got out of the hospital with bleeding ulcers in her stomach. she has a massive ulcer at the base of her stomach and six ulcers in her esophogus, we all feel is a direct result of the oral Actinel. She was rushed to the hospital vomiting blood - I wouldn't recommend the stuff!

 

Sorry to hear that!  When a woman is diagnosed with osteo, her choices are to take these dangerous drugs or fracture like cracked china and wind up in a wheel chair.  I'm now taking Actonel, 1 tablet per month, and feeling better.  Of course, I worry about the longterm effects that no one knows yet.  All the drugs offered are relatively new.

I'd caution to you pay close attention to your body - her sysmptoms were a bloated sensation for days after taking the medicine - she would sometimes throw up without warning but never had bad indigestion or discomfort, so be cautious! Also, she had mentioned this sensation to her doctors and got little or no reaction from them, so as usual you must be your own advocate, pay close attention to any changes and demand some monitoring of the situation. 

Alison D.

I have taken Fosamax, Actenol, Boniva, Malcatrin, and am now on Reclast.  I have had no side effects and love how simple it is to take.  The cost though, is something else. My insurance was billed $2800 the first year and $5300 the second year.  I have another scan scheduled for April and will know if the Reclast is successful.  The reason I was put on Reclast was that after a couple years on the other medications, I Tscores stopped improving and were in fact getting worse again.

 

I doubt anything could make me start taking the oral medications again.  I hated them and dreaded the day I was scheduled to take them.

DaisyMae  I appreciate your common sense insights here.  I am reticent to use any kind of medication unless it is absolutely necessary--and so, in an effort to better inform myself, I come to a site like this.  But instead of information, I read 'horror' stories of adverse reactions and problems.  Having gone through early menopause (began at 30), I was diagnosed with osteoporosis at 54.  I want to be wise about my over-all health and have put off taking drugs and self-treated with diet, exercise and vitamins.  My last Dexa scan showed a 6% bone density increase.  But my doctor is still pushing for pharmacological intervention, and wants me to try Reclast.  (Which makes sense from her point of view as I've been non-compliant in the past.)  Do the risks outweigh the benefits?  I'm very active and the thought of self-induced muscle and joint debilitation has really given me pause.  I'm scheduled for the infusion on Monday morning (it's now Friday) and I'm still so ambivalent!

I had aching joints and muscles also.  My new primary, an internist, prescribed a drug called Ultram ER -- 100 mg.  My aches have disappeared.  You might ask your doctor about this -- it is covered by insurance and you take a pill every day at the same time each day.

 

i agree with you. i got vry sick after the trtmnt , i have aches and pains since then in my back and my hip, also get very stiff.

I am 65 and was diagnosed with osteoporosis about five years ago. My doctor recommended Fosamax and I took it for several years before associating it with a tight feeling in my chest and "stabbing" pains in my heart. A cardiologist friend told me it was probably the Fosamax causing my symptoms. His own wife had just started on it and was already experiencing the same symptoms. He advised me to stay on it, but I got off. I tried Actonel and it immediately made my symptoms worse, so I stopped that, too.

 

My latest bone density test shows the osteo is worse and bloodwork shows that I am low in Vitamin D. My doctor, an endocrinologist, wants me to take high-dose prescription Vitamin D once a week for a month, then get on over the counter D.

 

He also wants me to take the Reclast injection. After reading an online assessment on the Johns Hopkins sight that links it with atrial fibrillation, I am very reluctant to take this drug.

 

Most of what I have read here does nothing to make me want to take it. On the other hand, I don't want a spine or back fracture either.

 

That said, I have a cousin who has had two broken hips and she's still alive and walking around. My mother had severe osteo, broke several ribs, a hip, her pubic bone, etc., and lived to be 88. So despite those scary statistics, a broken hip is not necessarily a death sentence.

 

These are very hard decisions to make because there is no predicting the ultimate outcome. But I do get the feeling that the docs are "pushing" the drugs.