At what time of day should Alendronate (bisphosphonate) be taken?

From the Guidelines

Alendronate should be taken first thing in the morning, after an overnight fast, at least 30 minutes before food, drink, or other medicines, with a full glass of plain water, and the patient should remain upright for 30 minutes. This is based on the most recent and highest quality study available, which emphasizes the importance of proper timing and administration to minimize the risk of esophageal irritation and ensure optimal absorption 1. The study published in 2020 in the Annals of Oncology provides clear guidelines for the administration of alendronic acid, which is similar to alendronate, and recommends taking it after an overnight fast, at least 30 minutes before food, drink, or other medicines, and remaining upright for 30 minutes.

Key Considerations

• Taking alendronate with food, beverages, or other medications can significantly reduce its absorption and efficacy
• Remaining upright for at least 30 minutes after taking alendronate is crucial to prevent esophageal irritation and ulceration
• The use of a full glass of plain water helps the medication reach the stomach quickly and reduces the risk of esophageal irritation
• If a dose is missed, it should be taken the next morning, following the same instructions, rather than taking it later in the day or doubling up on doses

Administration Guidelines

• Take alendronate first thing in the morning, after an overnight fast
• Take it at least 30 minutes before consuming any food, beverages, or other medications
• Use a full glass of plain water to take the medication
• Remain upright (sitting or standing) for at least 30 minutes after taking the medication, and until after the first food of the day, as recommended by the study published in 2000 in the journal Gut 1 and supported by the study published in 2002 in the same journal 1.

From the FDA Drug Label

Instruct patients that the expected benefits of alendronate sodium may only be obtained when it is taken with plain water the first thing upon arising for the day at least 30 minutes before the first food, beverage, or medication of the day Take alendronate sodium tablets, USP exactly as your doctor tells you. Alendronate sodium tablets, USP work only if taken on an empty stomach Take alendronate sodium tablets, after you get up for the day and before taking your first food, drink, or other medicine.

Alendronate should be taken first thing in the morning, with plain water, at least 30 minutes before the first food, beverage, or medication of the day 2, 2.

• Do not take at bedtime or before arising for the day.
• Wait at least 30 minutes after taking alendronate before lying down, eating, or taking other medications.

From the Research

Administration of Alendronate

• The provided studies do not specify the optimal time of day for taking Alendronate 3, 4, 5, 6, 7.
• However, it is generally recommended to take bisphosphonates like Alendronate in the morning, on an empty stomach, with a full glass of water, and to remain upright for at least 30 minutes after taking the medication to reduce potential side effects.

Dosage and Frequency

• The studies discuss the efficacy of Alendronate in reducing fracture risk and increasing bone mass, but do not provide information on the optimal time of day for administration 4, 5, 7.
• One study mentions that equivalent effects on bone turnover and BMD have been reported with once-weekly dosing, using seven times the daily dose 4.

Safety and Efficacy

• The studies consistently report that Alendronate is safe and effective in the treatment and prevention of osteoporosis 3, 4, 5, 6, 7.
• However, they do not provide information on the optimal time of day for taking the medication.