Arsenic acid sodium is a bisphosphonate medication primarily used to treat and prevent osteoporosis, effectively increasing bone density and reducing fracture risk. This drug works by inhibiting osteoclast activity, slowing bone resorption, and is commonly prescribed for postmenopausal women and men with osteoporosis due to hormonal changes.
Additionally, arsenic acid sodium is suitable for treating metabolic bone diseases such as Paget's disease, aiding in the repair of abnormal bone regeneration. Its pharmacological action penetrates bone tissue, and long-term use can improve bone structure, but it must be used under medical supervision to avoid gastrointestinal or skeletal side effects.
The generic name of this medication is "Arsenic Acid Sodium." In Taiwan, common trademarks include Fosamax® and Fosavance®. Different formulations may be combined with vitamin D or calcium supplements to enhance therapeutic effects.
Arsenic acid sodium belongs to the bisphosphonate class of drugs. These drugs selectively bind to the surface of bones, directly affecting osteoclasts and blocking the process of bone resorption. The phosphonate group in its chemical structure is key to its mechanism of action.
This class of drugs has played an important role in treating metabolic bone diseases, with clinical use exceeding 30 years and supported by evidence demonstrating long-term efficacy and safety data.
Main indications include primary osteoporosis, steroid-induced osteoporosis, Paget's disease, and preventive treatment for patients at high risk of fractures. For patients with vertebral fractures or severely reduced bone density, this medication can significantly reduce the risk of vertebral and hip fractures.
Physicians may also prescribe it for secondary osteoporosis (such as thyroid disease or hyperparathyroidism), but this should be based on individual risk-benefit assessments.
Contraindications include esophageal motility disorders (such as esophageal spasm or reflux esophagitis) and insufficient calcium intake. Before taking this medication, ensure daily calcium intake of at least 1200 mg and vitamin D of 800-1000 IU to prevent poor absorption and side effects.
Use is prohibited during pregnancy due to potential fetal skeletal abnormalities. If invasive dental procedures are needed during treatment, inform the dentist to reduce the risk of osteonecrosis of the jaw.
Concurrent use with calcium, iron, zinc supplements, or antacids can impair absorption; these should be taken at least 1 hour apart. Combining with NSAIDs may increase gastrointestinal irritation risk.
When used with other bone metabolism drugs such as denosumab or other osteoporosis medications, dose adjustments and renal function monitoring are necessary. Avoid drinking milk, coffee, or tea within 30 minutes after taking the medication to prevent absorption interference.
The standard dose is 70 mg daily or 10 mg/70 mg weekly, taken with 200 mL of warm water. Do not lie down within 30 minutes after taking the medication, and remain upright for at least 1 hour.
The oral tablet should be swallowed whole, not crushed or chewed. If nausea or vomiting occurs within 30 minutes of taking the medication, seek medical advice immediately to adjust the administration method. Special formulations such as patches or injections should be administered by healthcare professionals.
If a dose is missed, take it as soon as possible the next day. Do not double the dose to make up for missed doses. If close to the next scheduled dose, take it immediately; if not, skip the missed dose and resume the normal schedule.
Oral overdose may cause esophageal ulcers or gastrointestinal bleeding; seek immediate medical attention. Currently, there is no specific antidote; treatment involves gastric lavage, fluid replacement, and supportive care for symptoms.
Long-term overdose may lead to renal impairment; regular monitoring of serum creatinine and urine tests are recommended. If unexplained bone pain or mobility issues occur, discontinue the medication and seek medical attention.
This medication can irritate the esophagus. Patients should remain upright (sitting or standing) for 30 minutes after taking it, with a glass of water, and avoid eating or drinking milk, juice, etc., within 30 minutes to ensure proper absorption and reduce esophageal irritation.
Is regular bone density monitoring necessary during long-term use of arsenic acid sodium?It is recommended that patients undergo bone density scans every 1 to 2 years to evaluate the drug's efficacy and changes in bone quality. The physician may adjust the frequency based on age, rate of bone loss, or fracture risk, and monitor calcium and vitamin D levels through blood tests.
How can patients avoid fracture risk while taking arsenic acid sodium?In addition to regular medication, ensure adequate daily intake of calcium and vitamin D (e.g., 1200 mg calcium and 800-1000 IU vitamin D daily), and engage in weight-bearing exercises such as walking or gymnastics. Remove fall hazards at home, such as slippery floors or clutter, to reduce the risk of falls and fractures.
If back pain or muscle pain occurs, should the medication be stopped?Some patients may experience musculoskeletal discomfort due to drug-induced myalgia syndrome. If symptoms are severe or persistent, consult a doctor immediately. The medication should not be stopped independently; any adjustments should be made under professional supervision.
What are the advantages and disadvantages of arsenic acid sodium compared to other osteoporosis drugs (e.g., denosumab)?Arsenic acid sodium is an oral medication, convenient for daily use and lower in cost, but requires strict adherence to administration instructions to avoid esophageal issues. Denosumab and other injectable drugs have high absorption rates and fewer side effects but require regular injections and are more expensive. The choice should be based on patient absorption capacity, side effect tolerance, and healthcare resources.
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