4 Actonel (Risedronate) Interactions: Calcium, Ibuprofen, and More

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. 

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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

• Antacids 

• Magnesium laxatives

• Iron 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.

EXPERT PICKS: WHAT TO READ NEXT

• 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.

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.

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. 

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Written by:

Brian Leonard, PharmD, BCACP, BCGP

Brian Leonard earned his doctorate in pharmacy from the University of Florida College of Pharmacy and is board certified in Ambulatory Care and Geriatric Pharmacy.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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