10 Ibandronate (Boniva) Side Effects You Should Know About

After you’ve gone through menopause, you have a higher risk of osteoporosis — weakened bones with a greater chance of breaking. In this case, your healthcare provider may recommend ibandronate (Boniva) to help treat or prevent this condition.

Ibandronate is known as a bisphosphonate. It helps slow bone breakdown to improve your bone strength. You can take it as a once-monthly tablet, or as an infusion through the vein that’s given every 3 months. 

But ibandronate can be hard on your digestive tract, causing side effects like indigestion and nausea. This may be more common with the tablet than the IV infusion. Headaches and joint pain are possible, too.

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Some ibandronate side effects are mild and typically manageable at home. Others can be more serious and require medical attention. Here, we’ll discuss 10 important ones you should know and how to manage them.

1. Indigestion

Indigestion is a common side effect you might experience while taking ibandronate. This can feel like discomfort near your upper stomach area, fullness too soon while eating, or bloating. Heartburn can also occur.

Over-the-counter (OTC) medications can help temporarily relieve indigestion. Examples include calcium carbonate (Tums) and bismuth subsalicylate (Pepto-Bismol). Talk to your healthcare provider to see if you need medications to manage this side effect.

Make sure you take ibandronate tablets first thing in the morning. You should also wait at least an hour before eating or lying down after your dose. And to prevent indigestion from getting worse, avoid spicy, fatty, or greasy foods and carbonated drinks. It’s also a good idea to wait a couple of hours before you lie down after a meal.

Contact your healthcare provider if you also have other symptoms, like trouble swallowing, bloody vomit, or chest pain. This could be a sign of something more serious. 

2. Nausea

Along with indigestion, some people experience nausea after taking ibandronate. Sometimes, taking medications with food can help with nausea. But in this case, oral ibandronate should be taken on an empty stomach. This also means avoiding food and other medications for at least an hour after taking the medication.

If you become nauseated after your dose, eating bland foods like crackers or noodles can help. But make sure to wait until the recommended time after taking the medication to do so. 

Avoid strong-smelling foods that could worsen your nausea. You can also try sitting quietly or cracking open a window for some fresh air. If you end up vomiting, make sure to drink fluids to help prevent dehydration. 

Contact a healthcare provider if you can’t keep any foods or liquids down. Also let them know if you have nausea for more than a few days or vomit several times in one day. They can determine the best next steps.

3. Diarrhea

Some people experience diarrhea during ibandronate treatment. If this happens, remember to keep hydrated to help restore any lost fluids.

OTC medications like loperamide (Imodium A-D) can help lessen diarrhea. Check with a healthcare provider or pharmacist first to make sure it’s appropriate for you.

To prevent diarrhea from getting worse, avoid greasy and spicy foods and dairy products (milk, cheese). It’s also a good idea to avoid or minimize caffeinated or alcoholic beverages.

Contact your healthcare provider if your diarrhea is persistent or gets worse. Let them know if you notice bloody or black, tarry stools or dehydration symptoms, like dark urine.

4. Headache

Headaches may pop up unexpectedly while you’re taking ibandronate. If you experience one during treatment, there are some things you can do to help.

To prevent or lessen the severity of headaches, make sure to drink enough water every day. Breathing exercises and other relaxation techniques may help, too. 

Your healthcare provider may also recommend an OTC pain reliever, like acetaminophen (Tylenol). Let them know if your headaches become more frequent or feel severe.

5. Abdominal pain

Ibandronate can irritate your stomach. So you might experience abdominal pain while taking it. If your pain is causing you discomfort, contact your healthcare provider. Get immediate medical attention if it’s severe or accompanied by other symptoms, like bloody or black, tarry stools.

There are many reasons why your stomach can hurt, and some problems can be serious. Your healthcare provider can diagnose it so you can get the right treatment.

6. Constipation

Sometimes, taking ibandronate can cause constipation. This can include having trouble passing stools, dry or hard stools, or fewer bowel movements per week than usual.

To help with constipation, eat foods that are high in fiber. Drinking plenty of water and exercising regularly can also help. If these approaches aren’t working, ask your healthcare provider for recommendations. If needed, they can guide you to certain OTC products for constipation.

Get immediate medical attention if you also have severe stomach pain and bloating.

7. Bone, joint, and muscle pain

Some people taking ibandronate have reported very severe bone, joint, or muscle pain. This might happen anywhere between one day and several months after starting treatment.

Stopping the medication usually makes the pain go away. But you shouldn’t stop taking it without talking to your healthcare provider first. They can better evaluate what’s causing your pain and recommend methods to help. This may include compressions with a wrap, ice or heat pads, or pain relief medications.

Although rare, this pain can also be a sign of something more serious, like leg fractures. More on that later.

8. Esophagus problems

Ibandronate can also irritate the lining of your esophagus. This can increase the risk of esophagus problems like inflammation, ulcers, and bleeding. These esophagus problems tend to be more common with ibandronate tablets, compared to the intravenous (IV) infusion.

Because of this risk, it’s important to follow the steps below when you’re taking ibandronate by mouth. This helps prevent the tablet from getting stuck in your esophagus and causing damage.

• Swallow the tablets whole with a full glass of water (6 to 8 oz)

• Stand or sit up straight when you’re taking the medication

• Wait at least an hour after taking the medication to lie down

Contact your healthcare provider if you develop sudden difficulty or pain when swallowing. These symptoms, as well as chest pain and heartburn, can be signs of an esophagus problem. 

9. Jaw necrosis

Osteonecrosis of the jaw (ONJ) is possible with bisphosphonates, like ibandronate. This happens when the jaw bone gets exposed, doesn’t get enough blood flow, and starts breaking down. However, this risk is very low if you’re taking a bisphosphonate by mouth for osteoporosis.

In general, the risk of ONJ tends to go up the longer you take ibandronate. Some other risk factors include:

• Having invasive dental procedures done (like tooth extraction or dental implants)

• Poor oral hygiene

• Poor-fitting dentures

To prevent jaw bone problems, make sure to take care of your oral health. This includes brushing your teeth, flossing, and getting regular dental cleanings. 

Notify your healthcare provider of any planned dental procedures. And let your dentist or oral surgeon know that you’re taking ibandronate. They can work together to adjust your care. For example, they may recommend getting your dental procedure done before starting ibandronate.

If you notice mouth pain or unusual mouth problems while taking ibandronate, contact your dentist right away.

10. Leg bone fractures

Ibandronate can help lower the risk of fractures in postmenopausal women with osteoporosis. But leg bone fractures have been reported in some people taking it. These breaks in the bone can happen anywhere along the upper leg (between your hip and your knee).

Early signs of an abnormal leg fracture can include dull, aching thigh pain. Sometimes, you might experience pain in the groin area. Contact your healthcare provider right away if you experience this type of pain while taking ibandronate. They can evaluate any bone damage before a complete break happens.

When should you contact your healthcare provider about ibandronate side effects?

Some ibandronate side effects may be mild, while others can become more bothersome. If this is the case, contact your healthcare provider for tips on how to manage them. And make sure you’re following their directions to take ibandronate properly, too.

Your healthcare provider may also discuss with you about the possibility of trying the ibandronate IV infusion instead. The IV infusion may be less likely to cause stomach-related problems.

As discussed above, there are certain ibandronate side effects that may require medical care. These situations warrant a call to your healthcare provider. Stomach pain, mouth pain, and leg pain are a few examples. If needed, they may have you stop taking ibandronate.

It’s also important to contact your provider immediately if you break any bones during treatment. You may hear a snap before you realize you’ve broken a bone. And you may have pain, swelling, or bruising where the bone broke. Your provider can check your bones, put a cast or splint on, and recommend pain relief medications.

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Written by:

Cydnee Ng, PharmD

Cydnee Ng, PharmD, is a licensed pharmacist in California. After getting licensed in 2019, she began her pharmacy career as a community pharmacist at Walgreens.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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