Bisphosphonate Pregnancy: Contraindicated — teratogenic potential. Use calcium and vitamin D in pregnancy.

Risedronate Sodium

Brand names: Actonel, Actonel Once a Week

Adult dose

Dose: Osteoporosis: 35mg once weekly or 5mg OD. Paget's disease of bone: 30mg OD for 2 months.

Route: Oral

Frequency: Once weekly (35mg) or once daily (5mg)

Max: 35mg once weekly; 30mg OD (Paget's)

Administration: same as alendronate — take on empty stomach, upright, 30 minutes before food/drink/drugs. Alternative to alendronate when GI intolerance occurs — slightly better GI tolerability profile. Same bone protection efficacy as alendronate (head-to-head comparisons).

Paediatric dose

Route: Oral

Frequency: Weekly or daily

Max: Individualised

Not licensed under 18 years. Seek specialist paediatric metabolic bone opinion.

Dose adjustments

Renal

eGFR <30: avoid.

Hepatic

No dose adjustment required.

Clinical pearls

Preferred over alendronate in patients with GI intolerance — has similar efficacy with marginally better oesophageal tolerability
Same ONJ and atypical fracture warnings apply — inform dentist, consider drug holiday after 5 years oral use
Correct calcium and vitamin D deficiency before initiation — hypocalcaemia risk if deficient patient given bisphosphonate
Monthly and quarterly formulations available — useful for adherence issues

Contraindications

eGFR <30
Hypocalcaemia
Oesophageal disease
Inability to remain upright 30 minutes
Hypersensitivity to risedronate

Side effects

Oesophageal irritation (less than alendronate)
GI upset
Hypocalcaemia
ONJ (rare)
Atypical femoral fractures (long-term)
Musculoskeletal pain

Interactions

Calcium, antacids — chelate risedronate; separate by ≥2 hours
NSAIDs — additive GI risk

Monitoring

DEXA scan baseline and 2-yearly
Calcium and vitamin D
eGFR
Dental review

Reference: BNFc; BNF 90; NICE CG146 (Osteoporosis). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways