The Oral Bisphosphonates are Fosamax, Actonel, Boniva, and generic Alendronate. While generic Alendronate is the cheapest, it is also the most likely to cause heartburn or Reflux Disease in some individuals.
Oral Bisphosphonates are pills taken weekly or monthly. They are poorly absorbed when taken orally, so they require special care. All Oral Bisphosphonates must be taken on an empty stomach. You cannot eat anything nor drink anything but plain water for at least 30 minutes after taking the pill. Boniva requires at least an hour of nothing but plain water.
Oral Bisphosphonates are very irritating to the esophagus. You must flush them down to the stomach with at least 8 ounces of plain water. You must remain upright for the entire time to keep the medicine from coming back up into your esophagus. If the medicine gets back up into the esophagus it can cause pain or even an ulcer just above the stomach.
Jay Ginther, MD
2008 / Revised March 2011