- Take in morning, with a FULL glass of WATER (>120 mL or ½ cup)
- Do not take any food, beverages, any other medications or calcium for at least 30 to 60 minutes
- Not be chewed, cut, or crushed
- Do NOT lie down for at least 30 minutes
- DR = Delayed Release
- Can be taken with food
- May include high fat foods, coffee, tea, milk, orange juice, etc
- Higher incidence of upper abdo pain when taken in fasted state before breakfast
- Acute phase reaction
- MSK pain, flu like symptoms, fever
- Esophageal irritation
- GI symptoms
- Abdominal pain, GERD, nausea, diarrhea, constipation
- Ocular symptoms
- Osteonecrosis of the jaw
- Atypical femoral fractures
- Renal
- Risedronate: Cr Cl < 30 mL/min
- Alendronate: Cr Cl < 35 mL/min
- Zoledronic acid: Cr Cl < 35 mL/min
- GI (Oral bisphosphonates)
- Abnormalities of esophagus which delay esophageal emptying such as stricture or achalasia
- Inability to stand or sit upright for at least 30 minutes
- Hypocalcemia
- Pregnancy / Nursing
- ONJ
- AFF