Short answer: Both are bisphosphonate tablets for osteoporosis, swallowed with plain water on an empty stomach.12 Actonel (risedronate) comes as 5 mg daily, 35 mg weekly, 75 mg on two days a month or 150 mg monthly, with a 30-minute wait. Ibandronate, the drug in Boniva, is 150 mg once a month with a 60-minute wait. Neither has a boxed warning or reports a trial against the other.
| Actonel (risedronate) | Boniva (ibandronate) | |
|---|---|---|
| Approved for | Treat and prevent postmenopausal osteoporosis; men; steroid-induced osteoporosis; Paget's disease1 | Treat and prevent postmenopausal osteoporosis2 |
| Schedules | 5 mg daily, 35 mg weekly, 75 mg on two days in a row each month, or 150 mg monthly1 | 150 mg once a month on the same date2 |
| Wait before food, drink or other medicine | At least 30 minutes; no lying down for 30 minutes1 | At least 60 minutes; upright for 60 minutes2 |
| Flu-like reaction after a monthly dose | 5.2% on 150 mg monthly vs 1.1% on 5 mg daily1 | 9% on 150 mg monthly vs 3% on 2.5 mg daily, over two years2 |
| Side effects in label trials | Back pain 28.0% vs 26.1% on placebo; abdominal pain 12.2% vs 9.9% (5 mg daily)1 | Abdominal pain 7.8%; indigestion and joint pain 5.6% each (150 mg monthly, no placebo)2 |
| Kidney limit | Not recommended with creatinine clearance under 30 mL/min1 | Not recommended with creatinine clearance under 30 mL/min2 |
| Missed monthly dose | If the next dose is more than 7 days away, take it the next morning; otherwise wait1 | If the next dose is more than 7 days away, take it the next morning; otherwise wait2 |
| Boxed warning | None1 | None2 |
Both tablets are swallowed whole with 6 to 8 ounces of plain water, before any food, drink or other medicine of the day, and calcium, antacids and similar supplements are taken at another time.12 Actonel gives a choice of schedules and a 30-minute wait. Ibandronate is one tablet on the same date each month with a 60-minute wait, and its Medication Guide says not to take it later in the day if a dose is missed.2
The warnings are the same set: esophagus irritation, low calcium, severe bone, joint or muscle pain, jaw bone death and unusual thigh fractures. The Actonel label adds that Atelvia has the same active ingredient, so the two are not taken together.12 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Actonel side effects, ibandronate side effects, the Actonel and ibandronate dosing schedules, the Actonel and ibandronate missed-dose pages, the risedronate and ibandronate guides, and Ibandronate vs Fosamax: how do the monthly and weekly tablets differ?.