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Hi Bo, welcome and thanks for the question.  The biggest problem with all drugs is that each and every one of us react totally different to them.  I took Actonel and didn't have any major side effects and took it for approximately 17 months.  The only reason I changed medication was due to a fracture I had and the Dr. wanted me to start Forteo.   Where is your pain?  Actonels listed side effects include bone and joint pain, and if you have gastrointestinal problems, like GERD, it *may* make it worse.  For this reason, that's why it's very important to follow the restrictions on the med--staying upright, not eating, and only using water.   I honestly can't say if it would cause a hiatal hernia to get worse.  We know about the precuations above, but you would have to ask your Dr. this question since I don't know your medical history or if you have any other medical issues that could cause further problems or side effects.  If you feel that the pain is just too much to bare, then I would ask your Dr. for some other suggestions for osteo meds.  Boniva and Reclast come in iv doses, so they have much less gi side effects since the drug doesn't go through the intestines.  You may want to look into those and see what your Dr. says.   It's always terrible when we have such horrible symptoms with drugs, but all you can do is to decide if this is something you can't live with, and if not find something else.   Here's a link on hiatal hernias from the Mayo Clinic, but I can't find any mention of this being a problem with Actonel.  With that said, that doesn't mean that this might not cause some sort of problem if the hernia is large.   Good luck, but without more pertinent info it's impossible to say if this drug would make your problem worse, only your Dr. can tell you this--sorry--but true.   If you have any other question just post again.
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