Prescription onlySee our Alendronate safety rating →

Alendronate dosage

Alendronate is unusual among oral drugs: the instructions for how to take it matter as much as the number of milligrams. Absorption of an oral bisphosphonate is poor to begin with, and anything other than plain water in the stomach collapses it further. The same tablet, if it lingers in the esophagus, can cause ulceration. So the FDA label pairs each dose with a short administration ritual — first thing in the morning, plain water, stay upright 30 minutes. Below are the labeled doses for each approved indication, verbatim, plus the renal cutoff and the warnings that drive the rules. PharmaRanks rates medications and does not sell them; dosing decisions belong to your prescriber.

This is reference, not a dosing instruction. Alendronateis prescription-only and the dose is individualized and titrated by a prescriber to your condition, response, kidney/liver function and other medicines. The figures below are the FDA label’s — do not start, change or stop a dose based on this page.

By the pharmaranks editorial teamReviewed against the FDA label for Alendronate sourcesUpdated Jul 20, 2026How we research

Approved for: Treatment of osteoporosis in postmenopausal women; prevention of osteoporosis in postmenopausal women; treatment to increase bone mass in men with osteoporosis; treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids at a daily dose equivalent to 7.5 mg or greater of prednisone; and treatment of Paget's disease of bone in men and women.
Available as: FOSAMAX itself is marketed as 70 mg tablets; the label notes that the 5 mg, 10 mg, 35 mg and 40 mg strengths and the oral solution, while available as alendronate in the marketplace, are no longer marketed under the FOSAMAX brand.

Alendronate dosage by use, from the FDA label
Use	What the label says
Postmenopausal osteoporosis — treatment	The label states the recommended dosage is "one 70 mg tablet once weekly or one bottle of 70 mg oral solution once weekly or one 10 mg tablet once daily." The 70 mg once-weekly dose is also available as an oral solution (70 mg per 75 mL) and as a 70 mg effervescent tablet dissolved in 4 oz of plain water.
Postmenopausal osteoporosis — prevention	The recommended dosage is "one 35 mg tablet once weekly or one 5 mg tablet once daily." Prevention doses are exactly half the treatment doses — 35 mg weekly, not 70 mg.
Men with osteoporosis, and glucocorticoid-induced osteoporosis	To increase bone mass in men with osteoporosis: "one 70 mg tablet once weekly or one 10 mg tablet once daily" — the same as postmenopausal treatment. For glucocorticoid-induced osteoporosis in men and women taking the equivalent of 7.5 mg or more of prednisone daily: "one 5 mg tablet once daily, except for postmenopausal women not receiving estrogen, for whom the recommended dosage is one 10 mg tablet once daily." For Paget's disease of bone, the label gives "40 mg once a day for six months."

Maximum dose

The label does not set a titratable maximum. Alendronate is prescribed as fixed labeled regimens — 70 mg weekly (or 10 mg daily) for treatment, 35 mg weekly (or 5 mg daily) for prevention, 5–10 mg daily for glucocorticoid-induced osteoporosis, and 40 mg daily for six months in Paget's disease. Doubling up on a missed weekly tablet, or taking more than one dose on the same day, is outside the label and increases the risk of esophageal injury.

Dose adjustments

Renal impairment: the label says FOSAMAX "is not recommended for patients with creatinine clearance less than 35 mL/min." No dosage adjustment is needed when creatinine clearance is 35 mL/min or above, and none is needed for age or for hepatic impairment. Hypocalcemia is a contraindication and "must be corrected before initiating therapy" — along with vitamin D deficiency and other disturbances of mineral metabolism. Patients should get adequate calcium and vitamin D intake, supplemented if dietary intake falls short.

Dosing safety — read before you rely on any number

The 30-minute rule is the core of safe use. Take alendronate "at least one-half hour before the first food, beverage, or medication of the day with plain water only," swallow the tablet whole "with a full glass of water (6-8 ounces)," and do not lie down for at least 30 minutes and until after the first food of the day. The reason is mechanical: a tablet that sits in the esophagus can cause esophagitis, esophageal ulcers and esophageal erosions. Inability to stand or sit upright for at least 30 minutes is a labeled contraindication, as are esophageal abnormalities that delay emptying (stricture, achalasia) and hypocalcemia. Coffee, orange juice, milk, mineral water, and antacids all reduce absorption — plain water only. Other labeled risks: osteonecrosis of the jaw (dental exam before starting is reasonable in higher-risk patients), and atypical low-energy femoral shaft fractures — new thigh or groin pain during therapy should be evaluated. Do not carry the 30-minute figure over to other bisphosphonates: ibandronate (Boniva) requires 60 minutes before food and 60 minutes upright, not 30.

Bottom line

For osteoporosis treatment in postmenopausal women and in men: 70 mg once weekly or 10 mg once daily. For prevention: 35 mg weekly or 5 mg daily. For glucocorticoid-induced osteoporosis: 5 mg daily, or 10 mg daily in postmenopausal women not on estrogen. Every one of those doses is taken first thing in the morning with 6–8 oz of plain water, on an empty stomach, followed by 30 minutes upright with nothing else by mouth. Skip that ritual and you get less benefit and more esophageal risk. Not recommended below a creatinine clearance of 35 mL/min; correct hypocalcemia first.

Frequently asked questions

Alendronate 70 mg — how often do you take it?

Once a week, on the same day each week. Seventy milligrams is the once-weekly treatment dose for osteoporosis in postmenopausal women and in men; the daily equivalent is 10 mg. The 35 mg weekly tablet is the prevention dose, not the treatment dose — the two are easy to confuse at the pharmacy counter.

How long do you have to stay upright after taking alendronate?

At least 30 minutes, and until after the first food of the day. The label instructs patients not to lie down during that window. It is not an arbitrary wait: a tablet that stalls in the esophagus can cause esophagitis, ulcers, and erosions. Sitting or standing counts — you do not have to stand. Inability to stay upright for 30 minutes is a contraindication to the drug.

Can you take alendronate with food or coffee?

No. The label is specific: take it "at least one-half hour before the first food, beverage, or medication of the day with plain water only." Coffee and orange juice substantially reduce absorption; milk, mineral water, calcium supplements, and antacids also interfere. Plain tap or bottled water, 6–8 ounces, and nothing else for 30 minutes.

What if you miss a weekly dose of alendronate?

Take one dose on the morning after you remember, then return to your original once-weekly schedule on your chosen day. Do not take two tablets on the same day. This is the instruction in the FDA-approved patient labeling and in MedlinePlus. For the daily tablet, skip the missed dose entirely and resume the next morning — do not double up.

How long do you stay on alendronate?

The label states "The optimal duration of use has not been determined," but it does give a figure: "Patients at low-risk for fracture should be considered for drug discontinuation after 3 to 5 years of use," with the need for continued therapy re-evaluated periodically, since the risk of atypical femoral fracture rises with longer bisphosphonate use. In practice, prescribers reassess after several years and may pause therapy in lower-risk patients — a decision that belongs to your clinician, not to a table. Bone density takes about three months or longer to begin to increase.

What are the side effects of alendronate?

The common ones are gastrointestinal: abdominal pain, nausea, dyspepsia, constipation, diarrhea, flatulence, plus musculoskeletal pain and headache. The serious labeled risks are esophageal injury (esophagitis, ulcers, erosions), osteonecrosis of the jaw, atypical low-energy femoral shaft fractures, hypocalcemia, and severe musculoskeletal pain. Heartburn, painful or difficult swallowing, chest pain, jaw pain, eye pain, or new thigh/groin pain warrant a call to your prescriber.

Sources

Other dosage guides: Metformin dosage · Amoxicillin dosage · Prednisone dosage · Gabapentin dosage · Ibuprofen dosage · Lisinopril dosage · Levothyroxine dosage · Omeprazole dosage · Doxycycline dosage · Ondansetron dosage · Albuterol dosage · Allopurinol dosage · Methotrexate dosage · Fluconazole dosage · Acetaminophen dosage · Diphenhydramine dosage · Naproxen dosage · Aspirin dosage · Cetirizine dosage · Dimenhydrinate dosage · Famotidine dosage.

Doses are transcribed from the FDA-approved label and are general reference information, not medical advice or a personal dose. Only a prescriber can set or change your dose. If you think you took too much, contact Poison Control (1-800-222-1222) or 911.