Which point is most appropriate to advise a patient starting alendronic acid 70 mg weekly?

• A. Take it in the morning with a full glass of water and remain upright (sitting or standing) for 30 minutes
• B. Take it at night with tea
• C. Take it with a meal to reduce stomach upset
• D. Take it lying down after exercise

Answer: (A)

Alendronic acid must be taken in a way that protects the esophagus and maximizes absorption. It is poorly absorbed if taken with meals or other drinks besides water, and it can irritate the esophagus if it stays in contact with the lining. Taking it first thing in the morning with a full glass of water and staying upright for about 30 minutes before eating or drinking anything else keeps the tablet in the stomach long enough for absorption and prevents reflux that could irritate the esophagus. The other options fail because they either interfere with absorption (taking with a meal or a non-water beverage) or don’t protect the esophagus by keeping you upright, which is essential for this medication.