Alendronate | Side Effects, Dosage, Uses & More
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Generic Name:

alendronate, Oral tablet

All Brands

  • Fosamax (Discontinued)
A discontinued drug is a drug that has been taken off the market due to safety issues, shortage of raw materials, or low market demand.
SECTION 1 of 5

Highlights for alendronate

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Alendronate is used to prevent and treat osteoporosis. In this condition, your bones become thin and weak, and break easily. This drug is also used to treat Paget’s disease. In this condition, your bones are soft and weak, and may be deformed, painful, or break easily. 

2

This drug comes in the form of a tablet, solution, and effervescent tablet (a tablet that dissolves upon contact with a liquid) you take by mouth.  

3

Alendronate is available as the brand-name drugs called Fosamax and Binosto. It’s also available as a generic drug.

4

The more common side effects of this drug include stomach pain, acid reflux, constipation, diarrhea, upset stomach, nausea, and muscle and bone pain.

5

In some cases, this drug can cause serious side effects. These may include ulcers and erosions in your esophagus, severe bone, joint, or muscle pain, bone death of your jaw, and broken bones.

IMPORTANT INFORMATION

Upper gastrointestinal issues

This drug may cause ulcers and erosions in your esophagus (the tube that connects your throat to your stomach). This can sometimes be severe. Symptoms may include heartburn, trouble swallowing or pain when swallowing, chest pain, bloody vomit, or black or bloody stool. Tell your doctor right away if you have these symptoms.

Muscle and bone pain

This drug may cause severe bone, joint, and muscle pain. If you have these symptoms, stop taking alendronate and call your doctor right away.

Osteonecrosis (bone death) of your jaw

This drug can cause poor blood supply to your jaw. This may lead to bone death of your jaw. This is more likely to occur after a major dental procedure. If you need to have dental work done, tell your doctor. You may need to stop taking this drug. 

Broken bones

This drug may cause unusual breaks in your hip or leg bones. You may have dull, aching pain in your thigh(s) or groin weeks or months before the bone breaks. If you have this pain, talk to your doctor.

What is alendronate?

Alendronate is a prescription drug. It’s available as an oral tablet, oral solution, and oral effervescent tablet (a tablet that dissolves upon contact with a liquid).

Alendronate is available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version. Talk to your doctor to see if the generic version will work for you.

Alendronate may be used as part of a combination therapy with calcium and vitamin D supplements.

Why it's used

Alendronate is used to prevent and treat osteoporosis. In this condition, your bones become thin and weak, and break easily. This drug is also used to treat Paget’s disease. In this condition, your bones are soft and weak, and may be deformed, painful, or break easily.

How it works

Alendronate belongs to a class of drugs called bisphosphonates. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

See Details

How it works

Alendronate belongs to a class of drugs called bisphosphonates. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Alendronate works by preventing bone breakdown and increasing the thickness of bone. This can make your bones strong and keep them from breaking.

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alendronate Side Effects

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More common side effects

The more common side effects of alendronate can include:

  • stomach pain

  • acid reflux (when the contents of your stomach flow up from your stomach back into your esophagus, the tube that connects your throat to your stomach)

  • constipation

  • diarrhea

  • upset stomach

  • nausea

  • muscle and joint pain

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Ulcers or erosions of your esophagus. Symptoms can include:

    • new or worsening heartburn
    • trouble swallowing
    • pain when swallowing
    • chest pain
    • bloody vomit
    • black or bloody stools 
  • Bone death of your jaw. Symptoms can include:

    • painful or swollen gums
    • loosening of your teeth
    • numbness or heavy feeling in your jaw
    • poor healing of your jaw
  • Unusual bone breaks in your hip and leg bones. Symptoms can include:

    • dull, aching pain in your hips, groin, or thighs
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

Alendronate doesn’t cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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alendronate May Interact with Other Medications

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Alendronate can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. 

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Food interactions

You shouldn’t take this drug with orange juice or coffee. Doing so may reduce the amount of alendronate your body absorbs. It may also increase its side effects. You should only take this drug with a glass of water. Wait at least 30 minutes after taking alendronate before having anything to eat or drink.

Alcohol interaction

The use of drinks that contain alcohol can increase your risk of stomach side effects from alendronate. If you drink alcohol, talk to your doctor. Your doctor may monitor you closely for stomach problems.

Medications that might interact with this drug

Drugs that increase the risk of side effects

Taking alendronate with certain medications may cause more side effects. Examples of these drugs include:

  • Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). You may have more upper gastrointestinal side effects, such as ulcers in your esophagus (the tube that connects your throat to your stomach). Ask your doctor whether it’s safe for you to take these drugs together. 

Interactions that can make your drugs less effective
  • When alendronate is less effective: When alendronate is used with certain drugs, it may not work as well to treat your condition. This is because the amount of alendronate in your body may be decreased. Examples of these drugs include:
    • Calcium supplements, magnesium, iron, and antacids. These drugs may reduce how much alendronate your body absorbs. You should wait at least 30 minutes after taking alendronate before taking any other oral medications.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Alendronate warnings
esophagus problems
People with esophagus problems

If you have problems with your esophagus (the tube that connects your throat to your stomach), you shouldn’t take this drug. You’re more likely to have serious side effects, such as ulcers and erosions in your esophagus.

low calcium blood levels
People with low calcium blood levels

If you have low calcium blood levels, your doctor should give you calcium supplements before you start taking this drug. Alendronate can make your condition worse.

serious kidney problems
People with serious kidney problems

If you have severe kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. You shouldn’t take this drug.

Pregnant women
Pregnant women

Alendronate is a category C pregnancy drug. That means two things: 

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus. 

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the fetus.

breast-feeding
Women who are breast-feeding

It isn’t known if this drug passes into breast milk. If it does, it may cause side effects in a child who is breast-fed.

Talk to your doctor if you breast-feed your child. You may need to decide whether to stop breast-feeding or stop taking this medication.

seniors
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

children
For children

This medication shouldn’t be used in people younger than 18 years.

call the doctor
When to call the doctor

Call your doctor right away if you become pregnant while taking this drug.

allergies
Allergies

Alendronate can cause a severe allergic reaction. Symptoms can include: 

  • rash or hives
  • swelling of your face, lips, or tongue
  • trouble breathing

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room. 

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take alendronate (Dosage)

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All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Treatment and prevention of osteoporosis in postmenopausal women

Generic: alendronate

Form: Oral tablet
Strengths: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg
Form: Oral solution
Strengths: 70 mg/75 mL

Brand: Fosamax

Form: Oral tablet
Strengths: 70 mg

Brand: Binosto

Form: Oral effervescent tablet
Strengths: 70 mg
Adult dosage (ages 18 years and older)
  • For treatment: 70 mg taken once per week or 10 mg taken once per day.  
  • For prevention: 35 mg taken once per week or 5 mg taken once per day.
Child dosage (ages 0–17 years)

This medication shouldn’t be used in people younger than 18 years.

Warnings

You should swallow this drug with a full glass of plain water (not mineral water) to make sure that the drug is delivered to your stomach. This reduces the risk of irritating your esophagus (the tube that connects your throat to your stomach). You also shouldn’t lie down for at least 30 minutes and until after you’ve eaten your first food of the day. You should sit or stand. This will prevent irritation of your esophagus.

Treatment of osteoporosis in men

Generic: alendronate

Form: Oral tablet
Strengths: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg
Form: Oral solution
Strengths: 70 mg/75 mL

Brand: Fosamax

Form: Oral tablet
Strengths: 70 mg

Brand: Binosto

Form: Oral effervescent tablet
Strengths: 70 mg
Adult dosage (ages 18 years and older)

70 mg taken once per week or 10 mg taken once per day.

Child dosage (ages 0–17 years)

This medication shouldn’t be used in people younger than 18 years.

Warnings

You should swallow this drug with a full glass of plain water (not mineral water) to make sure that the drug is delivered to your stomach. This reduces the risk of irritating your esophagus (the tube that connects your throat to your stomach). You also shouldn’t lie down for at least 30 minutes and until after you’ve eaten your first food of the day. You should sit or stand. This will prevent irritation of your esophagus.

Treatment of glucocorticoid-induced osteoporosis

Generic: alendronate

Form: Oral tablet
Strengths: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg

Brand: Fosamax

Form: Oral tablet
Strengths: 70 mg
Adult dosage (ages 18 years and older)

One 5-mg tablet taken once per day. If you’re a postmenopausal woman who isn’t receiving estrogen, the recommended dose is one 10-mg tablet taken once per day.

Child dosage (ages 0–17 years)

This medication shouldn’t be used in people younger than 18 years.

Warnings

You should swallow this drug with a full glass of plain water (not mineral water) to make sure that the drug is delivered to your stomach. This reduces the risk of irritating your esophagus (the tube that connects your throat to your stomach). You also shouldn’t lie down for at least 30 minutes and until after you’ve eaten your first food of the day. You should sit or stand. This will prevent irritation of your esophagus.

Treatment of Paget’s disease

Generic: alendronate

Form: Oral tablet
Strengths: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg

Brand: Fosamax

Form: Oral tablet
Strengths: 70 mg
Adult dosage (ages 18 years and older)

40 mg taken once per day for 6 months.

Child dosage (ages 0–17 years)

This medication shouldn’t be used in people younger than 18 years.

Warnings

You should swallow this drug with a full glass of plain water (not mineral water) to make sure that the drug is delivered to your stomach. This reduces the risk of irritating your esophagus (the tube that connects your throat to your stomach). You also shouldn’t lie down for at least 30 minutes and until after you’ve eaten your first food of the day. You should sit or stand. This will prevent irritation of your esophagus.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

Alendronate comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

If you don’t take this drug, you may have a higher risk for bone breaks.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms can include:

  • upset stomach
  • heartburn
  • ulcers

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose

Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working

You may not be able to tell if alendronate is working since it increases the thickness of your bones.  Your doctor may scan your bones with a machine to tell if the medication is working.

Alendronate is used for long-term treatment.

Don’t take this drug with food

Food can reduce how much alendronate you absorb. Take it with a full glass of plain water.

Take alendronate the first thing in the morning

Take it at least 30 minutes before any foods, beverages (except plain water), or other drugs.

Store this drug carefully

  • Store alendronate oral tablets at room temperature between 59°F and 86°F (15°C and 30°C).
  • Store alendronate solution at 77ºF (25ºC). You can store it briefly between 59°F and 86°F (15°C and 30°C).  Don’t freeze this drug.
  • Store alendronate effervescent tablets in their original package until you’re ready to use them. Keep them from 68ºF to 77ºF (20ºC to 25ºC). You can store it briefly between 59°F and 86°F (15°C and 30°C). Keep the effervescent tablets in the packaging they come in until you’re ready to use them.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

After you take this drug, you shouldn’t lie down for at least 30 minutes and until after you’ve eaten your first food of the day. You should sit or stand. This will prevent irritation of your esophagus.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Kidney function. Your doctor may do blood tests to check how well your kidneys are working. If your kidneys aren’t working well, your doctor may have you stop taking this drug.

Sun sensitivity

Alendronate can make your skin more sensitive to the sun. This increases your risk of sunburn. You should avoid being in the sun. If you must be outside, wear protective clothing and sunscreen.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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How Much Does alendronate Cost?

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Lowest price for alendronate

Walmart $6.45
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Kroger Pharmacy $8.66
These prices represent the lowest priced national pharmacies for alendronate on GoodRx. They may be lower than your insurance.

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These prices represent the lowest priced national pharmacies for alendronate on GoodRx. They may be lower than your insurance.

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on November 9, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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