Alendronate is prescribed for osteoporosis. Which instruction should the nurse reinforce?

• A. Take on an empty stomach
• B. Take with a full glass of milk
• C. Take just before bedtime
• D. Take the medication with a full glass of water after rising in the morning

Answer: (D)

Taking alendronate with a full glass of water first thing in the morning, after arising, is the best instruction because this class of medication can irritate the esophagus and needs to be taken on an empty stomach with plenty of water, followed by remaining upright for at least 30 minutes to prevent reflux. Milk or calcium-containing beverages interfere with absorption, so taking it with milk is not appropriate. Taking it just before bedtime increases the risk of esophageal irritation since you’re lying down soon after taking the pill. Therefore, the morning dose with water after rising best meets safety and absorption needs.