title: Alendronate and naproxen are synergistic for development of gastric ulcers.
abstract: BACKGROUND
  Both alendronate sodium use and nonsteroidal anti-inflammatory drug use are associated with gastric ulcers. The aim of this study was to investigate whether alendronate and naproxen are synergistic as causes of gastric ulcers.
  
  
  METHODS
  We performed an endoscopist-blind, randomized, crossover, single-center comparison of 10 mg/d of alendronate sodium, 500 mg of naproxen sodium twice daily, or the combination taken orally for 10 days in volunteers aged 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 evaluations.
  
  
  RESULTS
  Twenty-six healthy volunteers participated (18 women and 8 men), aged 30 to 50 years. Gastric ulcers were present in 2 subjects receiving alendronate (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 combination appears synergistic. Alendronate should be used with caution in those who simultaneously require nonsteroidal anti-inflammatory drugs.
authors.affiliation: Veterans Affairs Medical Center (111D), 2002 Holcombe Blvd, Houston, TX 77030, USA.
authors.forename: D Y
authors.initials: DY
authors.lastname: Graham
authors.forename: H M
authors.initials: HM
authors.lastname: Malaty
mesh_terms: D000328:Adult; D019386:Alendronate / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D018592:Cross-Over Studies; D004357:Drug Synergism; D004381:Duodenal Ulcer / Q000139:chemically induced; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009288:Naproxen / Q000009:adverse effects*; D016037:Single-Blind Method; D013276:Stomach Ulcer / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009288:Naproxen; D019386:Alendronate