Boniva (ibandronate) Side Effects, Warnings, and Drug Interactions

Boniva (ibandronate) is an oral and intravenous bisphosphonate drug used to treat osteoporosis in women after menopause. 

Bone is in a constant state of remodeling. New bone is laid down by cells called osteoblasts while old bone is removed by cells called osteoclasts. Bisphosphonates strengthen bone by inhibiting bone removal (resorption) by osteoclasts. After menopause, there is an increased rate of bone loss leading to osteoporosis, and Boniva has been shown to increase bone density and decrease fractures of bones.

Common side effects of Boniva include:

• headache,
• back pain,
• pain in the legs or arms,
• abdominal pain,
• nausea,
• stomach upset,
• diarrhea,
• tooth problems,
• abnormal weakness,
• indigestion,
• dizziness,
• bone pain,
• joint pain, and
• muscle pain.

Serious side effects of Boniva include:

• respiratory tract infections,
• pneumonia,
• bronchitis,
• urinary tract infections (UTIs),
• low-trauma femoral fractures, and
• high blood pressure.

Drug interactions of Boniva include calcium supplements, antacids, and other products that contain aluminum, magnesium, or iron, which may reduce absorption of Boniva. Irritation in the stomach and intestines may increase if aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are combined with Boniva. 

Bisphosphonates like Boniva have been shown to cause fetal harm in animals, but there are no data on risk to the fetus in humans. Boniva should be used during pregnancy only if the physician feels that its potential benefit justifies the potential risk to the fetus. Boniva is secreted into the breast milk of animals. It is unknown if Boniva is secreted into human breast milk. It is generally recommended that caution be exercised while breastfeeding.

Common side effects of Boniva include:

• headache,
• back pain,
• pain in the legs or arms,
• abdominal pain,
• nausea,
• stomach upset,
• diarrhea,
• tooth problems,
• abnormal weakness,
• indigestion,
• dizziness,
• bone pain,
• joint pain, and
• muscle pain.

Serious side effects of Boniva include:

• respiratory tract infections,
• pneumonia,
• bronchitis,
• urinary tract infections (UTIs),
• low-trauma femoral fractures, and
• high blood pressure.

Some of the more common side effects of ibandronate include:

• Headache
• Back pain
• Pain in the legs or arms
• Abdominal pain
• Nausea
• Stomach upset
• Diarrhea
• Tooth disorder
• Abnormal weakness
• Indigestion
• Dizziness

Other side effects include:

• Bone pain
• Joint pain
• Muscle pain

Possible serious side effects include:

• Respiratory tract infections
• Pneumonia
• Bronchitis
• Urinary tract infections (UTIs)
• Low-trauma femoral fractures
• High blood pressure

Low calcium levels may occur if calcium and vitamin D intake is not adequate.

Severe irritation of the esophagus (for example, esophagitis, esophageal ulcers, esophageal erosions) can occur. This occurs more often when patients do not drink enough water with ibandronate, wait less than 60 minutes before lying down after taking ibandronate, or continue to take ibandronate after developing symptoms of esophageal irritation. Ibandronate should not be used by individuals with abnormalities of the esophagus.

Patients may experience jaw problems (osteonecrosis of the jaw) associated with delayed healing and infection after tooth extraction.

Bisphosphonates have been shown to cause fetal harm in animals, but there are no data on risk to the fetus in humans. Ibandronate should be used during pregnancy only if the physician feels that its potential benefit justifies the potential risk to the fetus.

Ibandronate is secreted into the breast milk of animals. It is not known whether it is secreted into human breast milk. Since most medications do appear in human breast milk, it is generally recommended that caution be exercised when ibandronate is given to women who are nursing.

• Calcium supplements,
• antacids, and
• other products that contain:
  • aluminum,
  • magnesium, or
  • iron may reduce absorption of ibandronate.

Ibandronate should be administered at least 60 minutes before administration of any oral medication, including medications containing iron, aluminum, magnesium, or calcium.

The occurrence of irritation in the stomach and intestines may increase if aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen (Motrin), Advil, naproxen (Aleve) are combined with ibandronate.