No GERD with Reclast

Bisphosphonates are often associated with Gastro Esophageal Reflux Disease (GERD).  When GERD cannot be adequately controlled by medication, we cannot use oral bisphosphonates.  Yet there is an advantage to taking a medication which will accumulate in bone and last well beyond the last dose.  That is where Reclast shines.

Reclast (Zolendronate in osteoporosis dose) is given IV.  Intravenous (IV) means no Gastro-Intestinal issues at all.  Therefore persons with Irritable Bowel Syndrome (IBS), or Crohn’s, or Colitis can take Reclast.  The once a year dosing is convenient.  But giving a whole year of medication all at one time requires extra care.

Bisphosphonates, including Reclast, are excreted through the kidneys.  Too high a concentration of bisphosphonate can damage older or failing kidneys.  Therefore, we are careful to infuse Reclast slowly and with lots of hydration.  Most docs avoid giving Reclast to persons with kidneys that already have problems.

Reclast’s Package Insert sets a GFR (a measure of kidney function) of 35 as the lowest recommended level. Most docs limit Reclast to patients with a GFR of 45 or better.  And you always need to drink more water than usual for the first 3 to 5 days after a dose of Reclast.  Failure to do so increases your chance of Acute Phase Reaction (flu-like symptoms), if this is your first encounter with a bisphosphonate.  More about that next time.

If you want a bisphosphonate with no GI side effects, and the convenience of once a year dosing, Reclast may be the osteoporosis medication for you.

Jay Ginther, MD

Categorised in: Medications