Some reports have described stomatitis and oral ulcerations due to low-dose MTX [38], [39], [40] and [41]. Alendronate (bisphosphonate). Alendronate is a drug belonging to www.selleckchem.com/products/gsk2656157.html the diphosphonate family that has recently been used in the treatment of osteoporosis and other bone diseases [42]. This drug has been demonstrated to induce progressive and significant increases in bone mineral density in women
with osteoporosis [43]. Bisphosphonate-related osteonecrosis of the jaw is a well-established adverse effect of bisphosphonates [44] and [45], but oral ulceration as a result of taking alendronate has also recently been reported [46], [47], [48], [49] and [50]. These oral ulcerations are induced by incorrect use of the drugs and are caused by the drugs causing direct irritation. Topical steroids are ineffective against these ulcers
[8]. If ulcers do not show improvement despite topical steroid treatment for 1–2 weeks, and no signs of malignancy are evident, drug exposures must be carefully checked. If a medication is suspected as a cause of oral ulceration, contact must be made with the prescribing medical doctor to discuss the possibility of alternative medications or dose reduction. After cessation, change, or dose reduction of the drug, ulcerations may improve in 1–2 weeks. It is further necessary to confirm that the drug is really learn more a responsible drug, so restarting the drug may be important, but is very difficult. The patient was a 76-year-old woman who presented with ulceration of the left tongue margin. Her medical history revealed articular rheumatism, diabetes, hypertension,
and anemia. She had been treated with indomethacin (75 mg/day) Amino acid to control pain from articular rheumatism. Ulceration (20 mm × 14 mm) on the left tongue margin with no induration was observed (Fig. 1). The surface was flat and clean, with no bleeding. The ulcer margin was slightly raised. Clinically, decubitus ulcer was suspected, but no improvement was observed after application of a topical steroid. We considered the denture was not a cause and instructed the patient to stop taking indomethacin after consulting with her physician. The oral ulceration showed re-epithelialization after 2 weeks [25]. The patient was a 71-year-old man with oral mucosal ulceration of the floor of the mouth and a 6-year history of rheumatoid arthritis (RA). Medical history included RA, hypertension, prostatic hyperplasia, and cardiac disease. He had been treated with methotrexate (MTX) at 8 mg/week. Ulceration (22 mm × 18 mm) on the left floor of the mouth was seen, showing no induration (Fig. 2). The surface of the ulceration was flat and clean, with no bleeding. Ulceration did not improve with corticosteroid treatment. We considered the denture was not a cause and contacted his physician. After the dose of MTX was reduced from 8 mg/week to 2 mg/week, oral ulceration greatly improved and re-epithelialization was achieved [40].
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