Actonel (Risedronate) - Oral

Warning:

What Is Actonel?

Actonel (risedronate) is a medicine that treats bone disorders, including different types of osteoporosis and Paget’s disease. These conditions result in weaker bones and can lead to falls and fractures.

There are cells in your body called osteoclasts that break down bone. These cells are typically balanced out by osteoblasts, cells that build new bone. Actonel works by inhibiting osteoclasts. This way, the activity of osteoblasts wins out, which creates new bone and results in an overall increase in bone density. Actonel belongs to a class of drugs called bisphosphonates.

Actonel comes as a tablet. It is available as both the brand name product and generically as risedronate. It is a prescription product, so you can’t purchase it over the counter. You’ll receive a prescription from your healthcare provider and pick up the medication from your pharmacy.

Drug Facts

Generic Name: Risedronate

Brand Name: Actonel, Atelvia

Drug Availability: Prescription

Therapeutic Classification: Bisphosphonate

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Oral

Active Ingredient: Risedronate

Dosage Form: Tablet, delayed-release tablet

What Is Actonel Used For?

The Food and Drug Administration (FDA) approved Actonel to treat the following bone conditions:

  • Postmenopausal osteoporosis: Bone density often decreases in the years following menopause, making this the most common type of osteoporosis.
  • Osteoporosis in men: While the disease is much more common in women, men can also experience low bone density from osteoporosis.
  • Glucocorticoid-induced osteoporosis: Low bone density can sometimes be caused by long-term use of glucocorticoids, also called corticosteroids, or just steroids, such as prednisone. 
  • Paget’s disease: This condition occurs when new bone is grown too quickly, resulting in deformities and increased fracture risk.
Actonel (Risedronate) Drug Information - Illustration by Zoe Hansen

Verywell / Zoe Hansen

How to Take Actonel

Take Actonel first thing in the morning with 6 to 8 ounces of plain water. After you take Actonel, wait at least 30 minutes before you take your other morning medications and before you have breakfast or other beverages like coffee or juice.

You should also avoid lying down for 30 minutes after taking Actonel to prevent irritation of the esophagus.

Storage

Store Actonel at room temperature (between 68 degrees to 77 degrees Fahrenheit) in the original container with the lid on, out of reach of children and pets. Avoid storing your medication in an area with a lot of heat and moisture, like the bathroom.

If you’re traveling by plane, you’ll want to keep Actonel in your carry-on luggage so that you aren’t separated from it if your checked baggage goes missing. If you’re traveling by car, take care not to leave your medication in especially hot or cold temperatures for long periods, like overnight in the car.

How Long Does Actonel Take to Work?

You will likely be on a bisphosphonate drug, like Actonel, for a few years to build up enough bone.
But if you are at low risk of fractures, you may not need to take it for longer than three to five years. One way of measuring your fracture risk is by measuring your bone mineral density (BMD). You will get a T-score from this test, which compares your bone density to that of young and healthy adults. The lower this score, the higher your risk of fracture, and the longer you may need to take Actonel.

What Are the Side Effects of Actonel?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Some more common side effects that you may experience while taking Actonel include the following. If any of these side effects do not go away or feel severe, contact your healthcare provider on how to proceed:

  • Back pain
  • Arthralgia, which is soreness, stiffness, or pain in the joints
  • Abdominal pain
  • Dyspepsia, or indigestion, which can feel like heartburn, gas, or bloating
  • Diarrhea
  • Nausea

Severe Side Effects

These are some more serious side effects that you and your healthcare provider as a team should watch out for:

  • Upper gastrointestinal side effects, such as inflammation or even erosions on the surface of the esophagus: This is why it is essential to avoid lying down for 30 minutes to an hour after you take Actonel. 
  • Hypocalcemia, or low calcium: Your calcium levels should be checked before you start taking Actonel and corrected if it’s low.
  • Osteonecrosis of the jaw (when bone tissue around your jaw dies): This can result in an infection around your jaw that takes a long time to heal or leads to the need for tooth extraction. If you need to have an invasive dental procedure or surgery, you may need to discontinue Actonel until the process is complete.
  • Atypical femur fractures with no or minimal trauma to this area: Your femur is the bone in your thigh. If you experience new thigh or groin pain, let your healthcare provider know right away to rule out a femur fracture.

Call your healthcare provider right away if you feel like you are experiencing serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Long-Term Side Effects

There is debate about whether long-term use (i.e., greater than five years) of bisphosphonates like Actonel increases the risk of the severe side effects mentioned above, like atypical femur fracture or osteonecrosis of the jaw. There is no high-quality evidence of this link, however. Make sure you discuss the plan for evaluating how long you should be on Actonel with your healthcare provider.

Report Side Effects

Actonel may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Actonel Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (delayed-release tablets):
    • For treatment of postmenopausal osteoporosis:
      • Adults—35 milligrams (mg) once a week, taken right after breakfast.
      • Children—Use is not recommended.
  • For oral dosage form (tablets):
    • For prevention and treatment of corticosteroid-induced osteoporosis:
      • Adults—5 milligrams (mg) once a day at least 30 minutes before the first food or drink of the day other than water.
      • Children—Use is not recommended.
    • For prevention and treatment of postmenopausal osteoporosis:
      • Adults—5 milligrams (mg) once a day or 35 mg once-a-week at least 30 minutes before the first food or drink of the day other than water. Alternatively, you may take one 75 mg tablet per day for two consecutive days each month or 150 mg tablet once a month.
      • Children—Use is not recommended.
    • For treatment of osteoporosis in men:
      • Adults—35 milligrams (mg) once a week at least 30 minutes before the first food or drink of the day other than water.
      • Children—Use is not recommended. .
    • For treatment of Paget's disease of the bone:
      • Adults—30 milligrams (mg) once a day at least 30 minutes before the first food or drink of the day other than water for two months. Your doctor may tell you to repeat this dose.
      • Children—Use is not recommended.

Modifications

You may need to take precautions while using or administering this medication in certain cases.

Pregnancy and Breastfeeding

Whether or not Actonel is safe to use while you’re pregnant hasn’t been well studied. Bisphosphonate drugs are incorporated into your bone matrix and could be slowly released over weeks or years into your blood circulation, potentially reaching and affecting a fetus. It’s best to avoid using this medication while you are pregnant or nursing unless the benefits of using it outweigh any risk of harm to your baby.

Age

Actonel is not indicated for use in children. There is limited data on using Actonel in people younger than 16 years old with low bone density. While the data showed that Actonel did increase bone density, Actonel did not lower the risk of fracture and also demonstrated a higher side effect risk.

Kidney Disease

Actonel is not recommended for individuals with severe kidney impairment (creatinine clearance less than 30 milliliters/minute).

Missed Dose

What you should do if you miss a dose of Actonel depends on how you’re taking it.

If you take Actonel once weekly

If you take Actonel once a week and miss a dose, take the dose in the morning after you remember and then return to taking your dose weekly as scheduled on your originally chosen day. Do not take two tablets on the same day.

If you take Actonel on two consecutive days per month and the next month’s scheduled doses are more than seven days away

If you miss both days in a row, take one tablet in the morning after the day it is remembered and then the other tablet the next morning after that. If you only miss one out of two days, take the missed tablet in the morning after the day it is remembered.

Return to taking your doses on two consecutive days per month as originally scheduled. Do not take more than two tablets in seven days. 

If you take Actonel on two consecutive days per month and the next month’s scheduled doses are within seven days

Wait until your next month’s scheduled doses and then continue taking Actonel on two consecutive days per month as originally scheduled.

Overdose: What Happens If I Take Too Much Actonel?

As long as you take Actonel as prescribed, you don’t need to be too concerned about overdosing. If you do take too much, your calcium and phosphorus levels may decrease and need to be replaced. If the overdose is substantial, you may also need to have the excess drug removed that your body hasn’t absorbed.

What Happens If I Overdose on Actonel?

If you think you or someone else may have overdosed on Actonel, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Actonel, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is important that your doctor check your progress at regular visits to make sure this medicine is working properly and watch for unwanted effects.

You should not take Actonel® tablets if you are also using Atelvia®. delayed-release tablets. These medicines should not be taken together because both medicines contain risedronate. Ask your doctor if you have any questions.

This medicine can irritate your esophagus. If you think this medicine has started to damage your esophagus, stop taking this medicine and call your doctor. Some symptoms of damage to the esophagus are heartburn (either new or worse than usual), pain when swallowing, pain in the center of your chest, trouble swallowing, or feeling that food gets stuck on the way to your stomach.

It is important that you tell all of your health care providers that you are taking risedronate. If you are having dental procedures done while taking risedronate you may have an increased chance of getting a severe problem of your jaw.

Make sure you tell your doctor about any new medical problems, especially with your teeth or jaws. Tell your doctor if you have severe bone, joint, or muscle pain while using this medicine.

This medicine could lower the amount of calcium in your blood. Call your doctor right away if you develop any signs of low calcium levels, such as muscle spasms or twitching, or numbness or tingling in your fingers, toes, or lips.

This medicine may increase your risk of developing fractures of the thigh bone. This may be more common if you use it for a long time. Check with your doctor right away if you have a dull or aching pain in the thighs, groin, or hips.

This medicine may interact with the dye used for bone scans.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Actonel?

Actonel may not be a good choice for you if you have:

  • Abnormalities of your esophagus that delay esophageal emptying, such as stricture (abnormal tightening) or achalasia (damaged nerves)
  • An inability to stand or sit upright for at least 30 minutes
  • Hypocalcemia, or low calcium levels

What Other Medications Interact With Actonel?

Antacids, such as TUMS (calcium carbonate) and Gaviscon (aluminum hydroxide and magnesium carbonate), plus laxatives, such as Milk of Magnesia (magnesium hydroxide) or Citroma (magnesium citrate), can interfere with the absorption of Actonel. You do not have to avoid these drugs at all times, but avoid taking them for at least an hour after you take your dose of Actonel.

What Medications Are Similar?

Other bisphosphonates exist that are similar to Actonel, such as:

  • Fosamax (alendronate): A tablet taken by mouth
  • Boniva (ibandronate): A tablet taken by mouth
  • Reclast and Zometa (zoledronic acid): Both are infused intravenously once per year

This is NOT a list of drugs recommended to take with Actonel. In fact, you should not take these drugs together. Ask your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Actonel used for?

    Actonel is used to treat different bone disorders including postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, osteoporosis in men, and Paget’s disease. These diseases all result in weaker bones that are prone to fractures or falls.

  • How does Actonel work?

    Actonel works by inhibiting the cells that break down your bone, called osteoclasts. This way, the activity of osteoblasts wins out, which creates new bone and results in an overall increase in bone density.

  • What are the side effects of Actonel?

    The most common side effects of Actonel include back pain, joint or muscle pain, and dyspepsia (heartburn). To prevent heartburn, try to avoid lying down for 30 minutes after you take Actonel.

How Can I Stay Healthy While Taking Actonel?

Osteoporosis is the most common bone disorder. An estimated 1 in 3 women and 1 in 5 men over the age of 50 will experience a fracture related to osteoporosis at some point in their life.

Doing activities and maintaining a lifestyle that promotes healthy bone growth at any age can help prevent osteoporosis or further bone loss. Stay active to keep your bones strong and flexible. Strength training is an essential part of this. Make sure to get enough calcium and vitamin D in your diet.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Actonel (risedronate) package insert.

  2. Alswat KA. Gender disparities in osteoporosis. J Clin Med Res. 2017;9(5):382-387.

  3. Lu L, Lu L, Zhang J, Li J. Potential risks of rare serious adverse effects related to long‐term use of bisphosphonates: an overview of systematic reviews. J Clin Pharm Ther. 2019;45(1):45-51.

  4. Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46–56.

By Sara Hoffman, PharmD
Sara is a clinical pharmacist that believes everyone should understand their medications, and aims to achieve this through her writing.