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That slow ramp lets your gut adapt, so your body gradually builds tolerance to the effect

After two years of treatment, an increase in bone mineral density and a decrease in urine calcium concentration was seen with both medication regimens, but the group treated with alendronate plus hydrochlorothiazide had more improvement than the group treated with alendronate alone (Arrabal-Polo, Arias-Santiago 2013)

Blue Nevus: It is blue and characteristic pigmented melanocytes are present very deep in the skin

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Other serious side effects can include dizziness or lightheadedness, swelling in the feet or ankles, severe shortness of breath or wheezing, chest pain or a fast heart rate, and bright red blood in the stools