A 65-year-old woman with dysphagia due to Parkinson's Disease; which medication is contraindicated?

• A. Risedronate
• B. Alendronate
• C. Ibandronate
• D. Zoledronic acid

Answer: (B)

The main concept is that oral bisphosphonates can irritate the esophagus and cause esophagitis or ulcers, especially in people who have difficulty swallowing or impaired esophageal motility. Because these drugs must be swallowed with a full glass of water and the patient must remain upright for about 30 minutes after taking them, a person with dysphagia from Parkinson’s cannot reliably adhere to these instructions. This makes oral bisphosphonates unsafe in this context, so they are contraindicated. An alternative that bypasses the esophagus is preferred, such as an intravenous bisphosphonate like zoledronic acid. Among the listed options, the oral bisphosphonate alendronate is the one contraindicated due to the swallowing difficulty; the IV option zoledronic acid avoids the GI tract entirely and would be the safer choice.