Key takeaways:
Actonel (risedronate) is an oral prescription medication used for osteoporosis and Paget’s disease of bone. It’s taken daily, weekly, or 1 or 2 days a month.
Actonel can interact with food, calcium supplements, antacids, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil). Some interactions can lower how much Actonel you absorb, which may make it less effective. Others may increase the risk of side effects.
You can manage most interactions by taking Actonel with plain water first thing in the morning on an empty stomach. Wait at least 30 minutes before taking any other medications, eating, or drinking.
Save on related medications
If you have or are at risk for osteoporosis, you may be taking a bisphosphonate like Actonel (risedronate). It’s an oral prescription medication that’s taken daily, weekly, or 1 or 2 days per month. Along with osteoporosis, Actonel is also used to treat Paget’s disease of bone.
You may be wondering if it’s OK to take Actonel with other medications or supplements. After all, your prescriber may have told you to take a calcium supplement while you’re taking Actonel. Actonel interactions are possible, and there are specific steps for managing them. Here’s what you should know about four Actonel interactions.
1. Food
You may have expected this list to start with a medication. But in fact, food is one of the most important Actonel interactions. Taking your Actonel dose with food can significantly decrease how much of the medication you absorb. This can make Actonel less effective.
To manage this interaction, it’s best to take Actonel first thing in the morning on an empty stomach. Take it with a full glass (6 oz to 8 oz) of plain water. Then, wait at least 30 minutes before eating, drinking, or taking any other medications. This allows your body to absorb Actonel properly.
2. Calcium supplements and antacids
Calcium supplementation can be important for bone health, especially for people with osteoporosis. But calcium and other minerals, such as magnesium and iron, can bind with Actonel. That makes it harder to absorb. The calcium found in dairy products can also cause issues.
So just like with food, you should take Actonel at least 30 minutes before these kinds of products:
Calcium-containing supplements
These products are widely available over the counter (OTC). Your pharmacist can be a helpful resource for how to take them safely with Actonel.
3. Acid reducers, such as Prilosec
Proton pump inhibitors (PPIs) and histamine-2 (H2) blockers are two classes of acid-reducing medications. Examples of PPIs include omeprazole (Prilosec) and esomeprazole (Nexium). Examples of H2 blockers include famotidine (Zantac 360, Pepcid AC) and cimetidine (Tagamet HB).
By reducing stomach acid, PPIs and H2 blockers can interact with a delayed-release version of risedronate called Atelvia. Lower stomach acid interferes with how Atelvia is released in the body, exposing you to more medication. The manufacturer doesn’t recommend taking Atelvia with a PPI or H2 blocker.
PPIs have also been linked to an increased risk of bone fractures. So, they may offset some of the benefits of taking risedronate. Speak with your healthcare team before taking acid-blocking medications if you also take Actonel.
4. NSAIDs, such as ibuprofen
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to relieve pain and inflammation. Common examples include ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Both Actonel and NSAIDs can cause gastrointestinal (GI) ulcers.
Overall, evidence is mixed about the risk of this combination. During clinical studies, taking NSAIDs with risedronate didn’t seem to cause an increased risk of GI problems, such as ulcers. But one study found an increased risk of GI ulcers associated with bisphosphonate and long-term NSAID use in people with rheumatoid arthritis.
Comparing osteoporosis medications: Consider these factors when choosing the right osteoporosis medication for you.
Foods to avoid: Did you know that your diet can contribute to bone density loss? Here’s a list of foods to avoid or limit if you have osteoporosis.
Exercising with osteoporosis: Exercise is essential to strengthening your bones, but choosing the right exercises can help you get the most out of your workout.
So, it’s a good idea to talk to your healthcare team before combining Actonel with an NSAID. They may recommend an alternative pain relief medication, such as acetaminophen (Tylenol).
Frequently asked questions about Actonel interactions
You may have questions about taking Actonel with other medications. Let’s take a look at three frequently asked questions about Actonel interactions.
Yes, but you’ll need to follow specific directions when taking them to get the most from your dose. Similar to Actonel, you should take levothyroxine (Synthroid) on an empty stomach to maximize absorption. But you also need to separate it from other medications by at least 4 hours.
If you need to take both medications, one option is to take Actonel first thing in the morning and levothyroxine at night. Just be sure to take levothyroxine at least 2 hours after your last meal of the day, and 4 hours after other medications or supplements. Talk to your prescriber or pharmacist about their recommendations for how to manage this interaction.
Yes. Prednisone is a corticosteroid that can increase the risk of osteoporosis. Actonel is approved to treat and prevent osteoporosis from long-term corticosteroid use. So, it’s not unusual to be prescribed both medications. Just be sure to take prednisone at least 30 minutes after you take Actonel.
Prolia (denosumab) is an injectable medication for osteoporosis. Prolia is generally used as an alternative to bisphosphonates like Actonel. For example, Prolia may be a better option for people with severe kidney problems or those who are unable to tolerate Actonel.
Actonel and Prolia are typically not taken together. Combining these medications could significantly increase your risk of low calcium levels (hypocalcemia).
Yes, but you’ll need to follow specific directions when taking them to get the most from your dose. Similar to Actonel, you should take levothyroxine (Synthroid) on an empty stomach to maximize absorption. But you also need to separate it from other medications by at least 4 hours.
If you need to take both medications, one option is to take Actonel first thing in the morning and levothyroxine at night. Just be sure to take levothyroxine at least 2 hours after your last meal of the day, and 4 hours after other medications or supplements. Talk to your prescriber or pharmacist about their recommendations for how to manage this interaction.
Yes. Prednisone is a corticosteroid that can increase the risk of osteoporosis. Actonel is approved to treat and prevent osteoporosis from long-term corticosteroid use. So, it’s not unusual to be prescribed both medications. Just be sure to take prednisone at least 30 minutes after you take Actonel.
Prolia (denosumab) is an injectable medication for osteoporosis. Prolia is generally used as an alternative to bisphosphonates like Actonel. For example, Prolia may be a better option for people with severe kidney problems or those who are unable to tolerate Actonel.
Actonel and Prolia are typically not taken together. Combining these medications could significantly increase your risk of low calcium levels (hypocalcemia).
The bottom line
Actonel (risedronate) can interact with food, calcium supplements, antacids, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil). You can manage many of these interactions by taking other medications separately from Actonel. In other cases, your prescriber may suggest alternative treatments.
Take Actonel first thing in the morning on an empty stomach, at least 30 minutes before your first food or drink. You should also wait at least 30 minutes before taking other medications. You should separate some medications, such as levothyroxine, by a longer period of time. Talk to your prescriber or pharmacist about how to manage potential Actonel interactions.
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References
Allergan. (2023). Atelvia- risedronate sodium tablet, delayed release [package insert]. DailyMed.
Miyake, K., et al. (2009). Bisphosphonate increases risk of gastroduodenal ulcer in rheumatoid arthritis patients on long-term nonsteroidal antiinflammatory drug therapy. Journal of Gastroenterology.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2022). Paget’s disease of bone.
Sun Pharmaceutical Industries. (2024). Risedronate sodium tablet, film coated [package insert]. DailyMed.
