Home Health 100 Questions Answers About Osteoporosis and Osteopenia
What is Actonel (risedronate)? Is it like Fosamax (alendronate)?
Actonel (risedronate) is another bisphosphonate prescribed to reduce bone turnover to treat or prevent osteoporosis. It can be taken as 5 mg daily, 35 mg weekly, 75 mg on 2 consecutive days once monthly, or as 150 mg on a single day once a month by mouth. Like other bisphosphonates, you must be conscientious about following the guidelines listed in Question 57 for taking Fosamax or any bisphosphonate medication. You must take Actonel with PLAIN water on an empty stomach and remain upright (sitting or standing) for 30 minutes. Actonel must be taken prior to the first beverage or food of the day. In other words, nothing should be consumed for 30 minutes after taking Actonel with plain water. Flex dosing (taking Actonel 2 hours after food or beverage and at least 2 hours prior to consuming more food or beverage) is approved in other countries but was not approved by the FDA in the United States because it has the potential to reduce the absorption of the medicine. Do not take calcium and other minerals or milk within 2 hours of taking Actonel.
The FDA also approved new packaging of weekly Actonel called Actonel with Calcium. This packaging includes a month's supply of medication. There are four packets, one for each week, containing seven pills—one 35 mg tablet of Actonel and six 1250 mg tablets of calcium carbonate (500 mg of elemental calcium). The manufacturer developed this packaging for individuals taking weekly Actonel to assist them in remembering to take calcium. The directions say to take Actonel 1 day according to the guidelines described above and to take one calcium tablet with food on each of the other 6 days of the week. Remember that you must also get adequate vitamin D so that the calcium is absorbed. On the day you take the Actonel tablet, it is still important to get your RDA of calcium, but you must not take calcium supplements within 2 hours after taking the Actonel tablet. The 500 mg of elemental calcium carbonate supplied in the daily calcium tablet that comes in the Actonel with Calcium package may not be enough to meet your RDA for calcium, so you may need additional calcium supplements.
Actonel is FDA-approved for the treatment or prevention of postmenopausal osteoporosis in women. It is also approved for the treatment and prevention of glucocorticoid-induced osteoporosis (GIO) in adults who are initiating or continuing oral glucorcorticoid medications at doses of >7.5 mg daily. Actonel has also been approved for the treatment of Paget's disease (see Question 60).
In a recent study that compared the effect of weekly Fosamax on bone mineral density with the effect of weekly Actonel on bone mineral density, Fosamax showed a greater increase in BMD and a greater decrease in bone turnover. But those taking Actonel had fewer fractures than those taking Fosamax. We already know that both Fosamax and Actonel are effective in reducing fracture risk, which is, after all, the point of treating osteoporosis. However, the increase in bone density did not have the expected level of reducing fracture risk in those taking Fosamax. Although Actonel users reported slightly fewer stomach and intestinal (GI) complaints, there was essentially no difference between the GI effects of Actonel and Fosamax.
This study illustrates how important it is for you to work with your clinician to find the best medication for you. For example, both medications, weekly Fosamax and weekly Actonel, are effective in decreasing bone turnover, increasing bone mineral density, and reducing fracture risk significantly more than taking a placebo, based on many years of clinical trials. But sometimes people tolerate one medication better than another. And sometimes clinicians feel more strongly about the success of one medication over another. You may even be influenced by friends who have taken medication for bone loss and experienced side effects less frequently with one medication over another. The cost of Actonel and Fosamax are about the same. But remember that each person's medical history and bones are different. You and your clinician should make your decision together, whether you choose a bisphosphonate or not.
Like Fosamax, most side effects of Actonel are related to the esophagus (usually causing heartburn), but if you are taking one of these drugs it is important to report chest pain, difficulty swallowing, or severe midline heartburn immediately. If you are taking NSAIDs such as ibuprofen, aspirin, or naproxen for pain management—which are known to increase the risk of developing acid stomach or ulcers—together with a bisphosphonate, the risk for gastrointestinal effects can be increased further. Table 9 summarizes information about Actonel.
Also like Fosamax, the long-term effects of Actonel could be a concern after it is discontinued. Although the half-life of Actonel is measured in days instead of years as in the case of Fosamax, it is not clear how a future pregnancy would be affected by the continued effects of Actonel or other bisphosphonates. Actonel is not FDA approved for use in premenopausal women
Table 9 Actonel (risedronate) and Actonel with Calcium
except those with GIO. If a premenopausal woman had a fragility fracture (see Question 74), a specialist may consider treatment with a bisphosphonate. This would only be considered if other potential causes for the fracture were ruled out and if she were on a very reliable method of birth control or unable to conceive.
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