1. Introduction
Risedronate is a bisphosphonate medication used to strengthen bones and prevent bone loss. It is commonly prescribed for osteoporosis, Paget’s disease of bone, and other conditions that result in weak or fragile bones. Risedronate works by inhibiting osteoclast-mediated bone resorption, thereby increasing bone density and reducing the risk of fractures.
2. Indications
- Osteoporosis:
- Treatment and prevention of postmenopausal osteoporosis.
- Treatment of osteoporosis in men.
- Glucocorticoid-induced osteoporosis.
- Paget’s Disease:
- Treatment of Paget’s disease of bone to normalise bone turnover.
3. Dosage
Adults:
- Postmenopausal Osteoporosis (treatment):
- 35 mg orally once weekly, or 5 mg orally once daily.
- Postmenopausal Osteoporosis (prevention):
- 35 mg orally once weekly, or 5 mg orally once daily.
- Osteoporosis in Men:
- 35 mg orally once weekly.
- Glucocorticoid-induced Osteoporosis:
- 5 mg orally once daily.
- Paget’s Disease:
- 30 mg orally once daily for 2 months.
Elderly:
- No specific dose adjustment is required.
Children:
- Safety and efficacy in children have not been established.
4. Administration
- Take at least 30 minutes before the first food, drink, or medication of the day with a full glass of water (240 mL).
- Do not lie down for at least 30 minutes after taking risedronate to minimise the risk of oesophageal irritation.
- Swallow tablets whole; do not crush, chew, or suck.
5. Forms Available
- Tablets: 5 mg, 30 mg, 35 mg, 75 mg, 150 mg
6. Side Effects
6.1 Common Side Effects:
- Abdominal pain
- Indigestion (dyspepsia)
- Nausea
- Diarrhoea or constipation
- Headache
6.2 Less Common Side Effects:
- Oesophageal irritation or ulceration
- Muscle or joint pain
- Rash
6.3 Rare but Serious Side Effects:
- Osteonecrosis of the jaw (ONJ)
- Atypical femoral fractures
- Severe allergic reactions (e.g., angioedema)
- Severe hypocalcaemia
7. Warnings
- Oesophageal Irritation: Use cautiously in patients with a history of oesophageal disorders (e.g., Barrett’s oesophagus or strictures).
- Hypocalcaemia: Correct hypocalcaemia and vitamin D deficiency before initiating treatment.
- Osteonecrosis of the Jaw (ONJ): Rare cases have been reported, particularly in patients undergoing invasive dental procedures.
- Atypical Femoral Fractures: Prolonged use may be associated with an increased risk of atypical fractures.
8. Precautions
- Avoid in patients with severe renal impairment (creatinine clearance <30 mL/min).
- Advise patients to maintain good oral hygiene and inform their dentist about risedronate use before dental procedures.
- Avoid use in patients who cannot remain upright for at least 30 minutes after administration.
9. Interactions
- Calcium, Magnesium, or Aluminium-Containing Products (e.g., antacids): Decreased absorption of risedronate. Take risedronate at least 30 minutes before these products.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Increased risk of gastrointestinal side effects.
- Aspirin: May enhance the risk of gastrointestinal irritation or ulceration.
10. Monitoring Parameters
- Bone mineral density (BMD) at baseline and periodically to assess effectiveness.
- Serum calcium, phosphorus, and vitamin D levels before and during therapy.
- Monitor for symptoms of oesophageal irritation or ulceration.
- Assess for signs of atypical femoral fractures or osteonecrosis of the jaw.
11. Use in Children
- Risedronate is not approved for use in children due to a lack of safety and efficacy data.
12. Use in Pregnancy
- Category C: Use only if the potential benefit justifies the risk to the foetus. Avoid unless absolutely necessary, as bisphosphonates may affect bone development.
13. Use in Elderly
- Safe and effective in elderly patients without the need for dose adjustment. Monitor for renal function and gastrointestinal side effects.
14. Use in Kidney Disease
- Avoid in patients with severe renal impairment (creatinine clearance <30 mL/min).
- Use cautiously in patients with moderate renal impairment.
15. Use in Liver Disease
- No dose adjustment is required for mild to moderate hepatic impairment.
16. Patient Counselling Points
- Take risedronate first thing in the morning with a full glass of water, at least 30 minutes before food, beverages, or other medications.
- Stay upright for at least 30 minutes after taking risedronate to avoid oesophageal irritation.
- Do not take risedronate with calcium, antacids, or other mineral supplements, as they may interfere with absorption.
- Inform your doctor immediately if you experience thigh pain, groin pain, or jaw pain.
- Maintain a diet rich in calcium and vitamin D, and discuss supplementation with your doctor if needed.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Actonel | Sanofi | 35 mg Tablet | $100 (4 tablets) |
Atelvia | Allergan | 35 mg Delayed-Release Tablet | $120 (4 tablets) |
Generic Risedronate | Various | 35 mg Tablet | $30 (4 tablets) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Risedronate used for?
Risedronate is used to treat and prevent osteoporosis and manage Paget’s disease of bone.
2. How does Risedronate work?
It inhibits osteoclast activity, reducing bone breakdown and increasing bone density.
3. Can Risedronate be taken with food?
No, it should be taken on an empty stomach at least 30 minutes before food or drink.
4. How long should I take Risedronate?
The duration depends on your condition and response to treatment. Your doctor may review the need for continued use periodically.
5. Can I lie down after taking Risedronate?
No, remain upright for at least 30 minutes to reduce the risk of oesophageal irritation.
6. Can Risedronate cause jaw problems?
Yes, osteonecrosis of the jaw (ONJ) is a rare side effect, particularly in patients undergoing invasive dental procedures.
7. Is Risedronate safe for elderly patients?
Yes, it is commonly prescribed for osteoporosis in elderly patients.
8. Can Risedronate cause stomach problems?
Yes, it may cause abdominal pain, indigestion, or oesophageal irritation.
9. Can Risedronate be used in children?
No, it is not approved for use in children.
10. Does Risedronate interact with calcium supplements?
Yes, calcium supplements can reduce its absorption. Take them at a different time of the day.
11. Can Risedronate prevent fractures?
Yes, it has been shown to reduce the risk of fractures in patients with osteoporosis.
12. Can Risedronate be used during pregnancy?
It is not recommended due to potential risks to the foetus.
13. What should I do if I miss a dose of Risedronate?
If you miss a dose, take it the next morning. Do not take two doses on the same day.
14. How should Risedronate be stored?
Store at room temperature, away from moisture and heat.
15. Can Risedronate cause bone pain?
Yes, bone, joint, or muscle pain is a possible side effect. Inform your doctor if it becomes severe.