Which symptom development six weeks after starting alendronate is documented in the case?

• A. Heartburn
• B. Headache
• C. Rash
• D. Cough

Answer: (A)

Six weeks after starting alendronate, heartburn is a common and expected side effect due to irritation of the esophagus by this oral bisphosphonate. The medication can cause esophagitis when the tablet isn’t taken with a full glass of water or if the patient remains reclined after dosing, leading to a retrosternal burning sensation. This pattern fits the known adverse effect of alendronate and the timing after initiation. Headache, rash, and cough are less typical for this drug, whereas heartburn directly reflects esophageal irritation from the medication. If heartburn occurs, it’s important to review how the medication is taken (water with the dose and staying upright afterward) and consider evaluation if symptoms persist.