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Actonel: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 9, 2020.

1. How it works

  • Actonel is a brand (trade) name for risedronate. Risedronate works by inhibiting osteoclasts which are responsible for breaking down and reabsorbing bone (by a process known as bone resorption). Risedronate strengthens bones by slowing down bone loss and allowing osteoblasts (bone-building cells) to work more effectively, improving bone mass.
  • Actonel belongs to the class of medicines known as bisphosphonates.

2. Upsides

  • Actonel may be used in the treatment and prevention of osteoporosis in postmenopausal women and men.
  • Actonel may also be used to treat glucocorticoid-induced osteoporosis and to treat Paget's disease of the bone.
  • Actonel may also be used to treat adverse skeletal effects caused by some cancers.
  • Depending on the condition being treated, Actonel may be taken once daily, once weekly, or monthly.
  • Actonel is available as a generic under the name risedronate.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Abdominal pain, back pain, belching, cough, constipation, cramping, diarrhea, difficulty swallowing, headache, heartburn, high blood pressure, skin rash, and urinary tract infections.
  • Actonel, like other bisphosphonates, may cause irritation of the esophagus and stomach. Some cases have been severe enough to warrant hospitalization. The risk is greater in people who lie down soon after taking Actonel or who don't take it with a full glass of water. Actonel should be taken with a full glass of water and the person taking it should remain upright for at least 30 minutes.
  • Severe bone, joint, or muscle pain, necessitating discontinuation of Actonel in some people, has been reported, occurring from one day to several months after starting the drug.
  • Rarely may cause other side effects including uveitis (eye inflammation).
  • May not be suitable for some people including those with kidney disease, pre-existing esophageal conditions, low blood calcium levels (hypocalcemia), or who are unable to stand or sit upright for at least 30 minutes.
  • There are concerns about the long-term safety of bisphosphonates as long-term use has been associated with atypical femur fractures, osteonecrosis of the jaw, and esophageal cancer.
  • Fracture risk reduction may also persist for years after treatment has stopped. The optimal duration of therapy with Actonel has not been established. Periodically re-evaluate the need for therapy. Discontinuation of therapy should be considered by doctors after 3 to 5 years in patients at low risk of fracture.
  • Actonel may interact with antacids or supplements containing calcium or magnesium.
  • Actonel may lower calcium levels in the blood. Pre-existing low blood calcium levels should be corrected before Actonel administration.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

4. Bottom Line

Actonel helps to reduce the risk of fracture in people with osteoporosis and some other bone conditions. Dosage instructions, including remaining upright for at least 30 minutes and taking with a full glass of water, must be strictly followed. The optimal length of therapy remains unknown.

5. Tips

  • Take Actonel at least 30 minutes before eating or drinking any food or beverages (other than water), or taking any other medication, including calcium, antacids, or vitamins for the day.
  • Take Actonel exactly as directed by your doctor. Do not increase or decrease the dosage without your doctor's advice.
  • Take Actonel with a full glass of water and remain upright for at least 30 minutes after taking Actonel. Do not lie down.
  • Avoid eating, drinking (other than water), or taking other medications for 30 minutes after taking Actonel.
  • You may need to take supplementary calcium or vitamin D if your dietary intake is inadequate. Your doctor will advise you about this. If you are taking supplemental calcium, iron, magnesium, or antacids, take them at a different time of day to Actonel (for example at lunchtime), because they may interfere with the absorption of Actonel. Note that mineral water may contain a higher concentration of calcium than tap or bottled water, and you should only drink it if your doctor has confirmed it is compatible with Actonel.
  • Talk to both your dentist and doctor if you require dental surgery or tooth extraction and you have been on Actonel long-term. Your doctor may advise discontinuation of Actonel.
  • Tell your doctor if you experience any thigh or groin pain, muscle cramps or twitches, severe or debilitating muscle pain, eye inflammation, or any other adverse effects of concern while you are taking Actonel.

6. Response and Effectiveness

  • Actonel starts to affect markers that reflect bone resorption within 14 days of treatment, reaching a maximal effect on all markers reflecting bone turnover within six months. Effects remain stable following continued treatment for up to three years.
  • Food can decrease the absorption of Actonel by up to 55%.

7. Interactions

Medicines that interact with Actonel may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Actonel. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Actonel include:

  • aluminum salts
  • amikacin
  • angiogenesis inhibitors, such as bevacizumab or everolimus
  • aspirin
  • calcium supplements
  • chemotherapy agents for cancer
  • diuretics, such as bumetanide and furosemide
  • hormone replacement therapy
  • iron salts
  • lithium
  • magnesium salts
  • NSAIDs, such as ibuprofen, diclofenac, and naproxen
  • olsalazine
  • oral steroids, such as dexamethasone, prednisone, and methylprednisone
  • sirolimus and tacrolimus
  • zinc salts.

Note that this list is not all-inclusive and includes only common medications that may interact with Actonel. You should refer to the prescribing information for Actonel for a complete list of interactions.


Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Actonel only for the indication prescribed.

Copyright 1996-2020 Revision date: November 8, 2020.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.