Can I take Alendronic Acid later in the day? - PMRGCAuk


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Can I take Alendronic Acid later in the day?

Trenny profile image

I stopped Alendronic Acid six months ago, mainly because I *hate* having to wait an hour after taking it before I can have breakfast. As I take leflunomide also, it means a full hour and a half to wait.

I am waiting for the result of of a dexascan. Two years ago I was Osteopaenic in one hip (-1.5). I was dx with GCA in Jan 2013 and have got down to 9.5mg Pred.

Has anyone found a way around taking AA on waking? Couldn't I take it mid-afternoon?

I take thyroxine 150mcg daily and sinemet 2 three times daily (for Parkinson's) also.

23 Replies

Hi - I don't know whether this is helpful to you or not -(it may just be foolish of me) but I take both Alendronic Acid and leflunomide immediately after my (late) breakfast, and have done for some time. I'm not aware of any side effects, but then I'm not aware of any benefits either! I too take levothyroxine and a whole raft of other meds to deal with RA and GCA.

Good luck.

PMRpro profile image
PMRproAmbassador in reply to venezia1

AA being taken at the same time as another medication interferes with the AA being absorbed and taking it with food not only does that but increases the risk of reflux - that is why the instructions are what they are. As I have just replied to Trenny, ArthritisUK says leflunomide can be taken at any time, with or without food.

Even if you have no reflux problems, you can't SEE the downside: that the AA isn't being absorbed so isn't available to be taken into the bones to improve your bone density. So - in effect - you might as well not bother taking it.

Telfordian profile image
Telfordian in reply to PMRpro

Just checked instructions with my Alendronic acid tablets and its says "wait at least 30 minutes before taking your first food, drink or other medicine". I've been doing that for almost two years with no reflux or other obvious problems. Thirty minutes saved is thirty minutes saved and by the time I've got dressed, sorted myself out and made the tea 30 minutes have usually gone by!

venezia1 profile image
venezia1 in reply to PMRpro

Ok, PMRpro - I'll have another go at remembering to take AA 30 mins before breakfast - my problem is that I forgot so many times that I just gave up!

PMRpro profile image
PMRproAmbassador in reply to venezia1

Choose a memorable day - and set yourself a weekly alarm on your phone! I know what a pain it is to remember something you don't do every day.

Trenny profile image
Trenny in reply to venezia1

CORRECTION! I mean Lansoprazole, not Leflunomide!

Hi. My Rheumatologist stressed the importance of taking it first thing in the morning on an EMPTY stomach and with a full glass of water to make sure it goes right down so as not to irritate the oesophagus. You shouldnt take anything else at the same time. Apparently it is not absorbed by the body very well, and taking it with anything else makes it pretty useless. You have to stay upright afterwards so the tablet doesnt come back to burn the throat. I hate having to do this too and Tuesday is not a good day because of it. I try to get up a bit earlier and spend the hour tidying up or taking a shower etc before having breakfast. I find the AA also upsets my stomach, but i want to protect my bones. Angela

Hi trendy. I've just been prescribed AA but I'm reluctant to take it as I've not heard anything positive about it, but my GP says that you take it on an empty stomach with glass of water and wait 30 mins before sitting down or eating /drinking. I've yet to hear anything positive about it and am considering getting some osteoking Chinese herbal pills which are supposed to be very good for bones. I will check that with GP first, but if any of you have tried this, please let me know.

PMRpro profile image
PMRproAmbassador in reply to JJackdaw

They will not work in the same way AA does, it will be similar to taking extra calcium probably. I will repeat my warning (though you are going to ask your doctor) - don't take any supplement without checking with your doctor or pharmacist.

Have you had a dexascan? Have you been shown to have osteoporosis or advanced osteopenia? If you haven't - I personally wouldn't take it. I have no problem with it being used when needed providing you do not have any contraindication such as a history of gastric problems/reflux - but until you have had a dexascan noone can know. I have taken pred at well above 10mg for much of the 3+ years between dexascans, my bone density was essentially unchanged. Not everyone develops osteoporosis.

I don't find it a problem. The instructions say half an hour not an hour. I get up at my normal time and take the tablet with a full glass of water, and by the time I have had my shower, dressed and emptied the dishwasher it is time for breakfast. Having seen my aunt, who had RA and was on steroids, break her ankle stepping out of a car, I am very conscious of the risk of osteoporosis. I'd rather take the AA and avoid it, the inconvenience is very slight compared with the risk of losing bone density in my view.

Ibandronic acid - once a month. and same wait. I was exactly the same as you with the Alendronic Acid and found that waiting for the alendronic and then the sinemet whilst my lower half ached with the PMR wastoo much even just once a week. Not to mention avoiding taking thyroxine (and other meds.) clashing with calcium supplement which is advised with both alendronic and ibandronic The other advantage of once a month, it is not so important if you go either side of the date judging by the fact that they give you the option of the same date each month (12 times a year) or once very four weeks (13 a year). I I also take "calcichew" which is a bit of a misnomer as it practically melts if you only suck it. I cant stand fizzy calcium supplements and the bog standard calcium tablets made me nauseous. By the way I was told it was better to take thyroxine at night rather than in the morning. Anyone else been told this?

Trenny profile image
Trenny in reply to paddyfields

Re taking the thyroxine at night - the packaging leaflet says 'with water before food'. So it doesn't appear to matter when you take them if it doesn't affect your sleep. I am sure it used to be 'in the morning'. For years I have been taking mine 'some time' in mid-morning ie when I remember. I usually take the calcichew half to one hour later or when I remember. I keep them by the kettle in the kitchen. When I have taken them I move them to the back of the bench.

PMRpro profile image

AA MUST be taken on an empty stomach - that means at least 2 hours after any other item including cups of tea and normally it is said 2 hours before - so the 30-45 mins that is quoted when you take AA in the morning is not too bad! Your stomach is completely empty from overnight so it is absorbed quickly. These instructions were emphasised because the majority of cases with problems were found to be because patients weren't compliant with them.

According to ArthritisUK: "Leflunomide is taken in tablet form once a day. The tablets should be swallowed whole and not crushed or chewed. It’s best to take them at the same time every day. They can be taken with or without food."

So I don't understand why you have to wait for breakfast for an hour and a half - as long as you choose a time and take it at the same time you can take your leflunomide at any time of day with no disadvantage.

Trenny profile image
Trenny in reply to PMRpro

Oh Dear PMRpro! I stand corrected. I meant Lansoprazole, not Leflunomide. I take Leflunomide every evening about half an hour before supper.

LANSOPRAZOLE - I notice that the packaging leaflet says to take whole with a glass of water 'before breakfast'. No mention of waiting half an hour before eating, as the pharmacist's label says.

PMRpro profile image
PMRproAmbassador in reply to Trenny

I did wonder!!!!! Half these drugs sound the same don't they!!!

I suppose the "wait half an hour" may be to allow it to work on the acid production before eating. Which sort do you take? Is it the gastro-resistant capsule? It also says if you have difficulty swallowing the capsule you can open it and pour the contents onto apple sauce, pudding or similar food to make it easier to take - which suggests to me the half hour isn't too important if it is a light meal!

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer


I take AA once a week, Sunday is best for me as I'm not in a rush to do things. As stated by rjw2014, if you take it upon waking, and then have a shower and get changed etc half an hour is gone by anyway.

Fortunately I've not had any side effects from AA, so it presents no problem, BUT as I am in the group of people prone to osteoporosis, and live on my own then the last thing I need is a broken hip!

If you really are unhappy then speak to GP and see if you can get the monthly alternative, and if you really need to take it. DorsetLady

I seem to remember that polkadotcom takes Denusomab (brand name prolia) in twice yearly injections and this has produced some good results, I am considering asking My Dr for the same a I can,t tolerate AA with my hiatus hernia.

Can anyone else throw some light on this drug as an alternative

PMRpro profile image
PMRproAmbassador in reply to Classicmichael

I think you have to work through the other alternatives/have a contraindication before it can be funded. It too can have side effects of course but everyone I have come across who has been on it think it is brilliant.

Hello Trenny. I've been taking Alendronic Acid for 3 yrs now, no problem but I do sit upright for half an hour & drink a large glass of water with it. Last month I had an osteoporosis scan & apparently my bones are better that they were back in 2006! I also have CalcichewD3 tablets twice a day. I take the Alendronic on a Monday as I find that easier to remember. It seems to be worth it anyway so good luck with yours.

PMR GCA UK Summer Newsletter Issue 12 read page 6 on AA.

Trenny profile image
Trenny in reply to

Yes, this article was another reason I decided to stop taking AA last summer. My consultant is keen on me taking it - or alternative. There won't be a problem if my dexascan result is OK as I can argue that I don't need it. The result won't be out for two weeks.


I take my AA on a Friday morning. It is the first thing I do. As others have said by the time I have pulled the curtains, etc etc -- 30 minutes have gone by.

Then I take my Omeprazole -- 2.

Then a few minutes later I have my first mug of tea of that day.

With breakfast I take my thyroxine. After breakfast I take the Pred. Later in the day I take my chewable calcium. When I get up in the morning I lay out the tablets in a sequence in some small saucers. They are there to remind me if I slip up.

Last year I also had a spell of Diverticulitis after I had surgery. So I also take some Psyllium husk powder in capsule form -- 2 with each meal.

My pred dose over one year went from 40 - 1. But with the severe cough and cold I had all through December I am back up to 15. I am tapering the dose down myself. I see my Dr as and when these days.

AA stops the calcium being leached out of your bones, while calcium keeps it topped up. I think women are especially prone to osteoporosis once they are past the menopause.

Hope this helps you with your thinking.

Can you not have an infusion instead? I would definitely ask your doctor about it as you may find it beneficial.

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