AlendronateAlendronate Sodium

About Alendronate

Alendronate is a bisphosphonate that prevents bone breakdown and increases bone density. Its labels cover treating osteoporosis in postmenopausal women (70 mg once a week or 10 mg a day) and preventing it (35 mg once a week or 5 mg a day), increasing bone mass in men with osteoporosis (70 mg weekly or 10 mg daily), treating osteoporosis caused by glucocorticoid medicines in men and women with low bone density who take the equivalent of at least 7.5 mg of prednisone a day (5 mg a day, or 10 mg in postmenopausal women not taking estrogen), and treating Paget’s disease of bone (40 mg a day for six months). Calcium is added when the diet falls short, and some people need vitamin D. The optimal length of treatment has not been determined; the label says people at low risk of fracture may be considered for stopping after 3 to 5 years.

There is no boxed warning. Alendronate must not be taken with an esophagus problem that delays emptying, such as a stricture or achalasia, inability to stand or sit upright for 30 minutes, low blood calcium, or allergy to it; the oral solution is also not for people at increased risk of aspiration. It can irritate the esophagus, so trouble or pain swallowing, pain behind the breastbone, or new or worse heartburn means stopping it and getting medical attention. Severe bone, joint or muscle pain can occur. Osteonecrosis of the jaw has been reported, generally after tooth extraction or with local infection, and the risk may grow with longer use. Atypical low-trauma fractures of the thigh bone can occur, sometimes after weeks to months of dull, aching thigh pain, so new thigh or groin pain is checked; a February 2026 revision of the Fosamax labels adds that atypical fractures of other bones have been reported and that bone pain elsewhere should also be considered for evaluation. It is not recommended when creatinine clearance is below 35 mL/min. Common side effects include abdominal pain, acid regurgitation, constipation, diarrhea, indigestion, musculoskeletal pain and nausea.

Food, other drinks and other medicines taken within 30 minutes reduce its absorption, and not following the dosing rules may raise the risk of esophagus problems. Fosamax Plus D adds vitamin D3 to 70 mg of alendronate for treating osteoporosis in postmenopausal women and increasing bone mass in men; it is not a treatment for vitamin D deficiency. The generic oral solution is labeled for the same two uses, one 75 mL bottle a week. The label says to stop alendronate once pregnancy is recognized.

Taking Alendronate

How to take it

On rising, at least 30 minutes before the first food, drink or medicine of the day, swallow the tablet whole with 6 to 8 ounces of plain water, never tea, coffee, juice, milk, mineral water or sparkling water; do not chew or suck it. Follow the oral solution with at least 2 ounces of plain water. Stay sitting or standing for at least 30 minutes and until after your first food, and never take it at bedtime or before getting up for the day.

If you miss a dose

Weekly: take one dose the morning after you remember, then go back to your usual day; never take two doses on the same day. Daily: skip it rather than taking it later in the day, and take the next dose the following morning as usual.

Storage

In the container it came in, tightly closed, at room temperature, away from excess heat and moisture, out of reach of children. Do not freeze the oral solution.

Interactions to know about

Calcium, antacids and medicines containing magnesium, aluminum or iron block its absorption, so take any other medicine, vitamin or antacid at least 30 minutes after alendronate. Aspirin products raised the rate of stomach and esophagus side effects with daily doses above 10 mg, and NSAIDs are used with caution.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Alendronate differs from pharmacy to pharmacy

The weekly 70 mg generic tablet comes from several makers, so quotes for the same prescription differ by each pharmacy’s fee and markup and by whether alendronate is on its flat-price generic list. The 5 and 40 mg tablets and the oral solution have fewer makers, and the pharmacist fills the tablet or solution written. Fosamax and Fosamax Plus D, which has no generic, are quoted as brands.

Ways to pay less for Alendronate without insurance

• Ask whether alendronate is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Ask the prescriber about a ninety-day supply of the weekly tablet.
• If you take Fosamax Plus D, ask the prescriber whether generic alendronate with a separate vitamin D supplement would suit you; the pharmacist cannot make that change.
• If the prescription names Fosamax, ask whether it allows a generic to be dispensed.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Alendronate

1. 1.Exactly how should I take my dose, and how long must I stay upright?
2. 2.What should I do if I miss my weekly dose?
3. 3.When can I take my calcium, vitamins or antacids?
4. 4.Should I see my dentist first, and which jaw, thigh or groin pain should I report?

Related medications