Drug Interaction Report

Risedronate and Esomeprazole Injection: Interaction Details

A pharmacist-reviewed analysis of the Risedronate and Esomeprazole Injection interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Risedronate

Actonel Actonel® Atelvia
+

Esomeprazole Injection

Nexium Nexium I.V.®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 8 documented Risedronate interactions, 8 are rated moderate — including this one.
Onset
unspecified
Evidence
established
Severity
Moderate

What happens

Increased risedronate bioavailability

Interaction Deep Dive

Concomitant administration of enteric-coated risedronate sodium (Atelvia(TM)) delayed-release tablets and a proton pump inhibitor, such as esomeprazole1, may increase the bioavailability of risedronate. In drug interaction studies between risedronate delayed-release tablets and esomeprazole, the Cmax and AUC of risedronate increased 60% and 22%, respectively. Due the possible increase in risedronate bioavailability, the concomitant use of esomeprazole and enteric-coated risedronate sodium (Atelvia(TM)) delayed-release tablets is not recommended 2.

Why it happens (mechanism)

Increased stomach pH resulting in faster release of enteric-coated products

Literature reports

1 report — tap to read

a) During a phase 1, 2-period, crossover study of 60 healthy postmenopausal women coadministration of esomeprazole and delayed-release risedronate tablet resulted in increased risedronate AUC and Cmax. The women were administered a single dose of delayed-release risedronate 35 mg after breakfast following 6 days of treatment with delayed-release esomeprazole 40 mg. On day 6, esomeprazole 40 mg was administered one hour prior to breakfast with 240 mL of water. Risedronate 35 mg was administered within 10 minutes of breakfast with an additional 240 mL of water. Laboratory tests revealed an increase of 60% and 22% in risedronate AUC and Cmax, respectively, in the presence of esomeprazole 2.

Common questions

Can I take Risedronate and Esomeprazole Injection together?

Increased risedronate bioavailability Always confirm with your pharmacist or prescriber before making any change.

How serious is the Risedronate and Esomeprazole Injection interaction?

It is rated moderate. Can be significant — usually manageable with monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

How strong is the evidence for this interaction?

The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.

Questions for your pharmacist

  • Does my dose of Risedronate or Esomeprazole Injection need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there anything you'd monitor while I'm on both?

References (2)

  1. Product Information: NEXIUM(R) I.V. intravenous injection, esomeprazole sodium intravenous injection. AstraZeneca LP (per FDA), Wilmington, DE, 2012.
  2. Product Information: Atelvia(R) oral delayed release tablets, risedronate sodium oral delayed release tablets. Warner Chilcott (US), LLC (per FDA), Rockaway, NJ, 2012. DailyMed
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Risedronate

Keep reading about Risedronate

All Risedronate interactions (8) Risedronate drug information
Esomeprazole Injection

Keep reading about Esomeprazole Injection

All Esomeprazole Injection interactions (95) Esomeprazole Injection drug information
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Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Risedronate + Activated Charcoal Calcium Coffee Charcoal Dolomite European Mandrake Glucomannan Guar Gum Gum Arabic + 15 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.