Class: Bisphosphonate
Dosage Forms. Tablet: 5 mg, 30 mg, 35 mg, 150 mg; Tablet, Delayed Release: 35 mg
Common FDA Label Indication, Dosing, and Titration.
1. Postmenopausal osteoporosis: Delayed-release tablet, 35 mg po once weekly immediately following breakfast; Immediate-release tablet, 5 mg po daily or 35 mg po once weekly, or 150-mg tablet po once a month; all with supplemental calcium and vitamin D
2. Paget disease: Immediate-release tablet, 30 mg po daily for 2 mo
Off-Label Uses. None
MOA. Risedronate binds to bone hydroxyapatite, and at the cellular level, inhibits osteoclast activity, thereby modulating bone metabolism.
Drug Characteristics: Risedronate
Medication Safety Issues: Risedronate
Drug Interactions: Risedronate
Adverse Reactions: Risedronate
Efficacy Monitoring Parameters. Increased BMD, decreased incidence of bone fractures.
Toxicity Monitoring Parameters. Baseline SCr, calcium. Severe skin rash, chest pain, difficulty in swallowing, swelling, tooth problems, pain with urination, severe pain.
Key Patient Counseling Points. Take as soon as you get out of bed in the morning, before you eat or have anything to drink. Swallow tablet whole with 8 ounces of plain water only (not mineral water, coffee, juice, or any other liquid). Do not chew tablet. Do not take the medicine while you are still in bed, and do not take it at bedtime. Wait at least 30 min after you swallow the tablet before you eat or drink anything or take any other medicines. Do not lie down for at least 30 min after taking this medicine, and do not lie down until after you have eaten some food.
Clinical Pearls. Concurrent chemotherapy and poor oral hygiene increase the risk for osteonecrosis of the jaw. Atypical fractures of the thigh (subtrochanteric and diaphyseal femur fractures) have been reported in patients taking bisphosphonates for osteoporosis; discontinue therapy in patients who develop evidence of a femoral shaft fracture. Atelvia is the brand name of the extended-release product. Medication guide required at dispensing.