From the FDA Drug Label
Instruct patients to swallow each tablet of alendronate sodium with a full glass of water (6-8 ounces) to facilitate delivery to the stomach and thus reduce the potential for esophageal irritation Instruct patients not to lie down for at least 30 minutes and until after their first food of the day. Instruct patients not to take alendronate sodium at bedtime or before arising for the day. Patients should be informed that failure to follow these instructions may increase their risk of esophageal problems
To prevent pill-induced esophagitis, patients should:
- Swallow the tablet with a full glass of water (6-8 ounces) to reduce the potential for esophageal irritation 1
- Not lie down for at least 30 minutes after taking the tablet and until after their first food of the day 1
- Not take the tablet at bedtime or before arising for the day 1
- Take the tablet with plain water only, at least one-half hour before the first food, beverage, or medication of the day 1
From the Research
To prevent pill-induced esophagitis, it is crucial to take medications with at least 4-8 ounces of water while sitting upright or standing, and remain upright for at least 30 minutes after taking pills, as recommended by the most recent and highest quality study available 2. When taking medications, especially those known to cause esophageal irritation such as doxycycline, tetracycline, clindamycin, potassium chloride, and NSAIDs like aspirin and ibuprofen, extra precautions should be taken.
- Take medications with a full glass of water (at least 4-8 ounces) to help pills pass through the esophagus into the stomach.
- Remain upright for at least 30 minutes after taking pills to reduce the risk of esophageal irritation.
- Avoid taking medications immediately before bedtime; if you must take them at night, do so at least 30 minutes before lying down.
- Consider asking your healthcare provider about liquid formulations, crushable tablets, or smaller pill sizes if you have difficulty swallowing pills.
- People with existing esophageal conditions like GERD, strictures, or achalasia should be especially cautious when taking medications, as they are at higher risk of developing pill-induced esophagitis, as noted in studies 3, 4, 5. The importance of proper medication administration techniques cannot be overstated, as pill-induced esophagitis can lead to serious complications, including esophageal hemorrhage, stricture, and perforation, as reported in the literature 3, 4, 5.