What are the appropriate instructions to be given while prescribing bisphosphonates to a patient:

Ans: A. To be given empty stomach with a glass of water(Ref: Gilman 12/e p1296; Katzung 13/e p754. 12/e p776; KDT 7/e p344, 6/e p334; 19/e p2.Esophageal irritation:Minimized by taking the drug with full glass of water and remaining upright for 30 minutes or by using the intravenous forms of these compounds.GI side effects:Oral bisphosphonates (including alendronate, ibandronate & risedronate) - Cause heaburn, esophageal irritation /esophagitis.Also cause abdominal pain & diarrhea.Symptoms often abate when patients take the medication after an overnight fast, with tap or filtered water (not mineral water), and remain upright.