What action is appropriate when a patient reports heartburn after starting alendronate?

• A. Ask the patient to describe her alendronate administration method
• B. Advise the patient to go to the emergency department
• C. Reassure that heartburn is common and ignore
• D. Instruct to take an antacid 2 hours after dose

Answer: (A)

The key action is to ask how the patient is taking alendronate. Bisphosphonates like alendronate can irritate the esophagus if the tablet isn’t taken correctly, so heartburn after starting therapy often points to improper administration rather than a need to stop treatment outright. The critical questions are whether she took the pill with a full glass of water and remained upright for at least 30 minutes before eating or taking any other meds. If the technique isn’t correct, correcting it can resolve the irritation and prevent further esophageal damage without changing therapy. If the administration method is appropriate and symptoms persist or worsen, then further assessment for esophagitis or other strategies can be considered.

Avoid jumping to emergency care or ignoring the symptom, since heartburn with a bisphosphonate signals a need to verify dosing technique first. Giving an antacid after the dose doesn’t address the underlying risk and can interfere with the medication’s absorption.