Alendronate and naproxen are synergistic for development of gastric ulcers

Background: Both alendronate sodium use and nonsteroidal anti-inflammatory drug use are associated with gastric ulcers. The aim of this study was to i nvestigate whether alendronate and naproxen are synergistic as causes of ga stric ulcers. Methods: We performed an endoscopist-blind, randomized, crossover, single-c enter comparison of 10 mg/d of alendronate sodium, 500 mg of naproxen sodiu m twice daily, or the combination taken orally for 10 days in volunteers ag ed 30 years or older. Videoendoscopy was used to evaluate the presence and degree of mucosal damage to the esophagus, stomach, or duodenal bulb before and after each treatment. There was a 1- to 4-week washout between evaluat ions. Results: Twenty-six healthy volunteers participated (18 women and 8 men), a ged 30 to 50 years. Gastric ulcers were present in 2 subjects receiving ale ndronate (8%), in 3 receiving naproxen (12%), and in 10 receiving both (38% ) (P<.05 for the combination vs either drug alone). Conclusions: Both alendronate and naproxen can cause gastric ulcers. The co mbination appears synergistic. Alendronate should be used with caution in t hose who simultaneously require nonsteroidal anti-inflammatory drugs.