Discontinue treatment if symptoms of oesophageal irritation eg, dysphagia, pain on swallowing or retrosternal pain, new or worsening heartburn develops. Active upper GI problems (eg, dysphagia, oesophageal disease, gastritis, duodenitis, ulcers) or recent history of major GI disease (eg, peptic ulcer, active GI bleeding), or surgery of upper GI bleeding or GIT other than pyloroplasty. Oesophagitis, oesophageal ulcers & erosions, oesophagitis stricture. Osteonecrosis of the jaw associated w/ tooth extraction &/or local infection in patients w/ cancer & osteoporosis receiving IV & oral bisphosphonates, respectively. Bone, joint &/or muscle pain. Symptomatic hypocalcaemia in patients w/ hypoparathyroidism, vit D deficiency & Ca malabsorption. Consider dental exam before treatment in patients w/ concomitant risk factors eg, cancer, chemotherapy, RT, corticosteroids, poor oral hygiene. Avoid invasive dental surgery while on treatment. Correct hypocalcemia before therapy. Monitor serum Ca & symptoms of hypocalcemia during therapy. Ensure adequate Ca & vit D intake in patients receiving glucocorticoids. Not recommended in renal impairment (CrCl <35 mL/min). Pregnancy. Not to be used during lactation. Childn.
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