How can I avoid side effects from oral bisphosphonates?

David Slovik, MD
Endocrinology Diabetes & Metabolism
The oral bisphosphonates typically prescribed for osteoporosis are alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva).
Since alendronate, risedronate, and ibandronate can be difficult to digest, people taking these medications must follow instructions carefully to avoid unpleasant side effects such as heartburn, nausea, or difficulty swallowing.
First thing in the morning, take the medication on an empty stomach with a large glass of water (at least 8 ounces) and then remain upright for at least 30 minutes (60 minutes for once-a-month Boniva). During this time, avoid eating, drinking, or taking another medication. It's important to take the medication with water, rather than coffee or orange juice, both of which can interfere with your body's ability to absorb and use the drug.
Most people tolerate these medications well when they take them as instructed. In fact, side effects are uncommon among people taking bisphosphonates in clinical studies. Perhaps these study participants are more likely to take their medications exactly as directed.

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