Tevabon

The drug Tevabon consists of two dosage forms: alendronic acid pills and alfacalcidol capsules.

To ensure normal absorption and reduce the risk of adverse reactions should strictly follow the recommendations for use and dosing.

Alendronic acid

Assign inside of 1 tab. (70 mg) once a week with a glass of water, at least 30 minutes before the first meal, drink or other medicines. They wash down only with ordinary water, since other beverages (including mineral water), food products, and some medicines may decrease the bioavailability of alendronic acid. pills can not be chewed or rassasyvat.

After taking the pill, the patient must maintain a vertical position (standing or sitting) for at least 30 minutes. You can not take a pill before bedtime or until the morning rise from the bed.

Dose adjustment is not required to elderly patients.

With impaired renal function QC> 35 ml / min, dose adjustment is not required.

Alfacalcidol

Assign the inside of 1 caps. (1 mcg) 1 time per day in the evening daily. Capsules should be swallowed whole, washed down with a sufficient amount of liquid.

The drug Tevabon intended for prolonged use.

For the use of alendronic acid
Special attention should be paid to any signs of adverse reactions in the esophagus.The patient should be informed about the need to discontinue the drug and see a doctor when developing dysphagia, pain when swallowing, pain behind the sternum, appearance or strengthening of heartburn.
In connection with the existing risk of irritation of the mucous membrane of the upper GI tract, as well as aggravation of the underlying disease, it is recommended to be careful when prescribing the drug to patients with gastrointestinal diseases in the acute phase, such as dysphagia, esophagitis, gastritis, duodenitis, peptic ulcer and duodenal ulcer, and also recently transferred (during the previous year) diseases of the gastrointestinal tract (gastric ulcer and duodenal ulcer, active bleeding from the gastrointestinal tract, surgery to the top his department of the digestive tract, except for pyloroplasty).
Cases of osteonecrosis of the jaw, usually associated with tooth extraction and / or local infection (including osteomyelitis), have been reported in cancer patients receiving treatment regimens that include bisphosphanates (primarily intravenous). Many of these patients also received chemotherapy and SCS. Osteonecrosis of the jaw has also been reported in patients with osteoporosis receiving oral bisphosphanates. Patients with concomitant risk factors (for example, cancer, chemotherapy, radiation therapy, GCS therapy, and poor oral hygiene) must be undergoing a dental examination with appropriate preventive dental treatment before using bisphosphonates. Patients undergoing treatment with bisphosphonates should avoid invasive dental procedures as much as possible. In patients with osteonecrosis of the jaw, being treated with bisphosphonates, dental surgery can lead to a deterioration. If necessary, surgical interventions should be borne in mind that data on the possibility of reducing the risk of osteonecrosis of the jaw after the abolition of bisphosphonates are not available. Appointments and recommendations of the attending physician should be based on an individual assessment of the benefit / risk ratio for each patient.
The time of appearance of pain in bones, joints and muscles in patients during therapy with bisphosphonates varied from 1 day to several months after the start of treatment. In the majority of patients, after the cessation of treatment, pain was reduced, in some patients pain reappeared when therapy with the same or another bisphosphonate was resumed.
If the patient forgot to take a pill of alendronic acid, then it should be taken the next morning. Do not take 2 tab. on one day, you must continue to take 1 tab. Once a week on the day that was selected for admission from the very beginning of treatment.
In patients with hypocalcemia, hypovitaminosis D and hypoparathyroidism, it is necessary to carry out corrective therapy of disorders of mineral metabolism prior to the start of treatment with alendronic acid. Due to the positive effects of alendronic acid on bone mineral density during treatment, a slight asymptomatic decrease in serum calcium and phosphorus concentrations may be observed. There are isolated reports of symptomatic hypocalcemia, sometimes severe, usually in patients with a predisposition to it (for example, in hypoparathyroidism, vitamin D deficiency, calcium malabsorption.
There are reports of the occurrence of stress fractures of the proximal femur with long-term treatment with alendronic acid (from 18 months to 10 years).
Fractures occurred with or without minimal injury. Some patients first had pain in the proximal femur, which persisted for several weeks or even months before this symptom ended with a fracture of the femur.Often the fractures were bilateral, so when a fracture of one femur in a patient is necessary to monitor the condition of the other femur.
In patients taking alendronic acid, especially with concomitant therapy of corticosteroids, it is extremely important to ensure adequate intake of calcium and vitamin D with food or in the form of drugs.
The absorption of bisphosphonates decreases significantly with simultaneous ingestion of food.

For the use of alfacalcidol
Alfacalcidol may intensify hypercalcemia and / or hypercalciuria when prescribed to patients with a disease associated with uncontrolled calcitriol hyperproduction (for example, in case of leukemia, lymphoma, sarcoidosis), and may also increase hyperphosphatemia. When plasma calcium concentration is more than 2.6 mmol / l, it is necessary to exclude the use of other calcium-containing drugs. If there is no effect, stop taking alfacalcidol capsules until normalization of serum calcium concentration (2.2-2.6 mmol / l). Control of the concentration of calcium and phosphate in the blood is carried out before treatment with alfacalcidol and, if necessary, carry out corrective therapy. In the treatment with alfacalcidol, the concentration of electrolytes at the beginning is determined once a week, when Cmax is reached and during the entire treatment period - every 3-5 weeks, and alkaline phosphatase activity is controlled (in case of impaired renal function (CC more than 35 ml / min) - weekly control). Peanut butter in rare cases can cause severe allergic reactions. Patients with hereditary fructose intolerance or fructose malabsorption should not be prescribed Tevabon, since the kit contains alfacalcidol capsules containing sorbitol.
Influence on ability to drive motor transport and control mechanisms
In connection with the possibility of side effects from the central nervous system during the period of treatment, care must be taken when driving vehicles, as well as other potentially hazardous activities that require increased concentration and psychomotor speed.

Alendronic acid
Symptoms: hypocalcemia, hypophosphatemia, diarrhea, heartburn, esophagitis, erosive and ulcerative lesions of the gastrointestinal mucosa are possible.
Treatment: taking milk or antacid to bind alendronic acid. Due to the risk of irritation of the esophagus should not induce vomiting. The patient should be upright.
Alfacalcidol
Early hypervitaminosis symptoms D (due to hypercalcemia): diarrhea, constipation, nausea, vomiting, dry mouth, anorexia, metallic taste in the mouth, hypercalciuria, polyuria, polydipsia, pollakiuria / nocturia, headache, fatigue, weakness, myalgia, pain in bones.
Late symptoms of hypervitaminosis D: dizziness, confusion, drowsiness, abnormal heart rhythm, pruritus, increased blood pressure, conjunctival hyperemia, nephrolithiasis, weight loss, photophobia, pancreatitis, gastralgia; rarely - a change in psyche and mood.
Symptoms of chronic vitamin D intoxication: calcification of soft tissues, blood vessels and internal organs (kidneys, lungs), renal failure, cardiovascular insufficiency, growth disorder in children.
Treatment: cancel the drug. In the early stages of acute overdose, the appointment of mineral oil may have a positive effect (which helps to reduce absorption and increase excretion of alfacalcidol with feces). In severe cases, carry out the hydration with the introduction of infusion of saline solutions, prescribed "loop" diuretics, GCS, bisphosphonates, calcitonin, conduct hemodialysis using solutions with a low calcium content. Blood levels of electrolytes, renal and cardiac function (according to ECG data) should be monitored, especially in patients receiving digoxin.There is no specific antidote.