Short answer: Both contain risedronate sodium, so they are never taken together.12 Atelvia is a 35 mg delayed-release tablet taken once a week right after breakfast. Actonel is taken at least 30 minutes before the first food or drink. The Atelvia label compared it with "risedronate sodium immediate-release 5 mg daily" and found similar spine bone density gains. Neither has a boxed warning.
| Atelvia | Actonel | |
|---|---|---|
| Ingredient | Risedronate sodium, delayed-release1 | Risedronate sodium2 |
| Dose | 35 mg once a week1 | 5 mg daily, 35 mg weekly, 75 mg two days a month or 150 mg monthly2 |
| Food | Immediately following breakfast1 | At least 30 minutes before the first food or drink2 |
| Water | At least 4 ounces, upright for 30 minutes1 | 6 to 8 ounces, upright for 30 minutes2 |
| Approved for | Treating postmenopausal osteoporosis1 | Treating and preventing postmenopausal osteoporosis, men, steroid-induced osteoporosis, Paget's disease2 |
| Spine bone density, 1 year (Atelvia label) | +3.3%1 | Risedronate immediate-release 5 mg daily: +3.1%1 |
| Diarrhea, same trial | 8.8%1 | 4.9% on risedronate 5 mg daily1 |
| Other medicines | Not with H2 blockers or PPIs; calcium, antacids and iron at another time1 | Calcium, antacids and iron at a different time of day2 |
| Missed weekly dose | Take it the morning after you remember; never 2 on one day1 | Take it the morning after you remember; never 2 on one day2 |
In a 1-year active-control trial of about 900 postmenopausal women, Atelvia 35 mg once a week after breakfast was compared with "risedronate sodium immediate-release 5 mg daily". Lumbar spine bone density rose 3.3% on Atelvia and 3.1% on the daily tablet, a difference of −0.2 (95% CI −0.8 to 0.3), and Atelvia was found non-inferior.1 The comparator is Actonel's ingredient at one of its doses; the label does not name Actonel, and it did not test Actonel 35 mg weekly.
In the same trial, diarrhea was 8.8% vs 4.9%, abdominal pain 5.2% vs 2.9% and vomiting 4.9% vs 1.6%; headache was 2.6% vs 4.9%. Taking Atelvia before breakfast while fasting gave more abdominal pain, which is why it is taken after breakfast. The fracture results in the Atelvia label come from trials of daily immediate-release risedronate 5 mg against placebo.1
Both labels say the two are not used together. Atelvia is not recommended with H2 blockers or proton pump inhibitors, which may speed release of the coated tablet. Both labels share the same warnings on the esophagus, low calcium, jaw bone problems, severe pain and unusual thigh fractures, and neither is recommended when creatinine clearance is under 30 mL/min.12
Which, if either, fits is for your prescriber. More detail: Atelvia side effects, Actonel side effects, the Atelvia and Actonel dosing schedules, the Actonel missed-dose page, how to store Actonel and Fosamax vs Actonel: how do alendronate and risedronate differ?.