How to take Actonel and related osteoporosis medicines

Dear Dr. Si,

I have a patient who likes to take her Actonel® with a glass of orange juice in the morning, but the administration instructions state that it should only be given with water. Does it really make a difference whether I give it with water or juice? SM, Milwaukie, WI

Dear SM,

Actonel® is a member of the bisphosphonate drug class used to increase bone mineral density in people who are osteopenic or osteoporotic, ideally strengthening bone and preventing fractures. All of the oral medications in this family, including Fosamax® (alendronate), Actonel® (risedronate), and Boniva® (ibandronate) are similar in that they can cause irritation in the esophagus and stomach, which can be extremely dangerous.

Each of these products must be given with a full glass of water and the patient must remain upright for at least 30 minutes with Fosamax® and Actonel®, and at least 60 minutes with Boniva®. The water washes the tablet down the esophagus to reduce the chance of irritation.

Another similarity between these products is that they are all very poorly absorbed into the bloodstream after oral administration. In fact, normally less than 1 percent of these products is absorbed!

Further, it has been determined that if any of these products are taken with anything other than water (such as juice or coffee), any type of food, including small amounts of apple sauce or pudding, or any other medications, the absorption will be decreased. In fact, essentially no medication will be absorbed. So you must to give Actonel®--or Fosamax® or Boniva®--with water and only water to ensure that the patient gets the full benefit of the medication. ***