Boniva’s Side Effects: What to Know

Medically Reviewed By Tanya Kertsman, PharmD

Boniva: Introduction

Boniva is a brand-name prescription drug. It’s a type of medication called a bisphosphonate, and it contains the active drug ibandronate. It comes as an oral tablet and is taken by mouth.

Boniva is approved by the Food and Drug Administration (FDA) to prevent and treat osteoporosis that happens after menopause.

Similar to other drugs, Boniva may cause side effects. Read below for information about possible side effects, including common, mild, and serious ones.

For a general overview of Boniva, including details about its uses, see this article.

If you’d like to take Boniva, search here to find a healthcare professional who might prescribe it.

Boniva: More common side effects

Some of Boniva’s side effects may be more common than others. These side effects may last only a few days to weeks. However, some side effects may last longer or become severe or bothersome. Tell your doctor or pharmacist if you have concerns about any side effects with Boniva.

In Boniva’s clinical studies, these were some side effects that occurred more often:

  • back pain
  • upset stomach or heartburn
  • pain in the arms or legs
  • diarrhea
  • headache
  • muscle aches

Boniva: Mild side effects

Boniva can cause mild side effects, which are listed below. However, this list doesn’t include all possible mild side effects. To learn more about Boniva’s side effects, view the drug’s prescribing information.

Boniva’s mild side effects include:

  • back pain
  • upset stomach or heartburn
  • diarrhea
  • headache
  • upper respiratory infection, such as the common cold
  • flu-like symptoms, such as a stuffy or runny nose and a cough
  • abdominal pain

The side effects listed above may last only a few days to weeks. However, some side effects may last longer or become severe or bothersome. Tell your doctor or pharmacist if you have concerns about side effects with Boniva.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Boniva and want to tell the FDA about it, visit MedWatch.

Boniva: Serious side effects

It’s possible to have serious side effects with Boniva. Serious side effects are listed below, but this list may not include all possibilities. To learn more about Boniva’s side effects, view the drug’s prescribing information.

Call your doctor right away if you have serious side effects with Boniva. However, if you think you’re having a medical emergency or life threatening side effects, call 911 or your local emergency number.

Serious side effects of Boniva and their possible symptoms include:

  • Low calcium level (hypocalcemia), which can be seen on the results of a blood test your doctor may order. This condition often doesn’t cause symptoms, but in rare cases, symptoms may include:
    • numbness or tingling in your fingers or toes or an area near your mouth
    • muscle spasms, cramps, or twitching
  • Severe muscle, joint, or bone pain.
  • Jaw-related side effects.*
  • Teeth-related side effects.*
  • Effects on the esophagus and upper gastrointestinal (GI) tract.*
  • Bone fracture in your femur.*
  • Allergic reaction.*

* For more information about this side effect, see “Boniva: Side effects explained” below.

Boniva: Common questions about side effects

Here are some common questions about the drug’s side effects and answers to them. Talk with your doctor if you have other questions about this drug.

Does Boniva cause weight gain as a side effect?

No, Boniva isn’t known to cause weight gain. This wasn’t reported as a side effect in the drug’s clinical studies.

Boniva is used to treat osteoporosis that happens after menopause. It’s not uncommon for people going through menopause to experience weight changes, including weight gain. Also, many people find that they gain weight more easily after menopause. However, Boniva isn’t known to affect body weight.

Talk with your doctor if you’re concerned about your weight. They can recommend ways to maintain a healthy body weight, including after menopause.

Are there side effects from stopping Boniva?

No, stopping Boniva shouldn’t cause side effects. In the drug’s clinical studies, there weren’t reports of withdrawal symptoms. (These are side effects caused by stopping a medication your body has become dependent upon.)

However, stopping Boniva could result in your osteoporosis getting worse, as this is the condition Boniva treats. Stopping it could also raise your risk of a bone fracture.

So, it’s important that you don’t stop taking Boniva unless your doctor tells you to do so. If you’re interested in stopping Boniva, talk with your doctor first. They can recommend alternative treatments for osteoporosis.

Do side effects of Boniva oral tablets differ from side effects of Boniva injections?

In the United States, Boniva is no longer available as an injection form. (It used to come in an injection form that was given as an IV infusion.)

However, generic ibandronate (the active drug in Boniva) is available in this form. And it’s given as an IV infusion.

Some side effects of Boniva oral tablets and ibandronate infusions are similar, such as serious side effects that affect your jaw or teeth. However, ibandronate infusions may also cause infusion side effects, which don’t happen with Boniva oral tablets. These side effects can include redness or swelling at the injection site.

To learn more about how Boniva tablets and ibandronate infusions compare, talk with your doctor or pharmacist.

How are side effects of Boniva and Fosamax different and alike?

Boniva and Fosamax belong to the bisphosphonate drug class. And they’re both prescribed to prevent and treat osteoporosis.

So, it’s not surprising that these medications can cause many similar side effects, including:

However, they also cause some different side effects as well. To learn more about how Boniva and Fosamax compare, view this article. You can also talk with your doctor or pharmacist.

Boniva: Side effects explained

Here’s detailed information about some of Boniva’s side effects.

Jaw-related side effects

Bisphosphonate medications such as Boniva can cause jaw-related side effects. It doesn’t appear that these side effects happened in Boniva’s clinical studies. However, they have been reported since the drug was approved for use.

Specifically, bisphosphonates may cause a condition called jaw necrosis (bone loss in your jaw). While jaw necrosis can happen at any time during Boniva treatment, it’s thought that the risk increases the longer you take Boniva.

Symptoms of jaw necrosis can include:

  • pain or redness around your jaw
  • loose teeth
  • numbness in your jaw
  • exposed jawbone inside your mouth, in extreme cases

Certain factors can increase your risk of jaw necrosis with Boniva, including:

  • certain dental procedures, such as tooth extraction, while taking Boniva
  • other therapies you may be receiving, such as chemotherapy or corticosteroids
  • certain health conditions, including:
    • coagulopathy (a blood-clotting disorder)
    • preexisting dental problems
    • cancer
    • anemia (low red blood cell level)
    • infection

What to do

Your doctor will likely examine your mouth before you start taking Boniva. Based on this exam, they may refer you to a dentist for a teeth cleaning or other dental work before prescribing Boniva.

Practicing healthy oral hygiene is very important while you’re taking Boniva. Regularly brushing and flossing your teeth can help prevent jaw necrosis.

If you develop jaw necrosis from Boniva, you’ll likely need to receive care from an oral surgeon. Additionally, your doctor may recommend that you permanently stop treatment with Boniva.

Teeth-related side effects

Jaw necrosis, a serious side effect of Boniva described above, can cause dental (teeth-related) side effects.

Dental side effects caused by jaw necrosis include loose teeth as well as other symptoms listed in “Jaw-related side effects” directly above.

Also, some people had a tooth disorder due to Boniva in the drug’s clinical studies. However, researchers didn’t specify exactly what happened in these few cases.

What to do

Your doctor will likely examine your mouth before you start taking Boniva. Based on this exam, they may refer you to a dentist for a teeth cleaning or other dental work before prescribing Boniva.

Remember to practice healthy oral hygiene every day while you’re taking Boniva. This includes regularly brushing and flossing your teeth.

If you develop teeth-related side effects from Boniva, you may need care from an oral surgeon. Also, your doctor may recommend that you permanently stop receiving Boniva.

Effects on the esophagus and upper GI tract

Boniva can have effects on your esophagus (the tube that connects your stomach to your mouth). The drug can also affect your upper gastrointestinal (GI) tract. This is a known side effect of all bisphosphonate medications, including Boniva.

Effects of Boniva on the esophagus may include:

  • esophagitis (inflammation in your esophagus)
  • esophageal ulcer, which may or may not bleed
  • erosion of your esophagus
  • holes in your esophagus or a narrowing of your esophagus, in rare cases

While not always the case, it’s possible for Boniva to cause severe effects on the esophagus. These may require treatment in a hospital.

Rarely, Boniva can also cause problems in other parts of your GI tract. These include ulcers and inflammation in locations such as your duodenum (a part of your small intestine).

Symptoms of these side effects can include:

  • difficulty swallowing or pain with swallowing
  • heartburn or upset stomach
  • hoarse voice
  • chest pain

What to do

Due to these risks, doctors usually won’t prescribe Boniva or other bisphosphonates if you have a condition that affects how well your esophagus empties. This could include having a narrow esophagus, for example. The presence of certain other conditions, such as Barrett’s esophagus, may also stop doctors from prescribing Boniva.

Taking certain precautions can help prevent Boniva from causing side effects in your esophagus or upper GI tract. So, it’s important to take Boniva exactly as your doctor instructs.

Following these steps for each Boniva dose can help lower your risk of esophageal side effects:

  • Take your dose of Boniva as soon as you wake up. You should take your dose at least 60 minutes before you eat, drink, or take other medications. Do not eat or drink anything except plain water or take other medications for at least 60 minutes after you take a Boniva dose.
  • Swallow Boniva tablets whole with a full glass (6 to 8 ounces) of plain water. Do not take any other liquids with your Boniva dose, including tea, coffee, soda, or juice.
  • Take your Boniva dose while standing or sitting. And do not lie down for at least 60 minutes after taking the dose.
  • Do not suck on or chew Boniva tablets.

Stop taking Boniva and immediately call your doctor if you notice symptoms affecting your esophagus or GI tract. Your doctor can evaluate your symptoms and determine whether you should continue taking the drug or stop it.

Bone fracture in your femur

Treatment with Boniva increases the risk of bone fractures in your femur (thigh bone). However, it’s rare for people taking Boniva to develop a thigh fracture.

Bisphosphonates such as Boniva increase your risk of a specific type of femur fracture. This type of fracture can happen in either leg and be caused by a light amount of force.

Symptoms of a bone fracture in your femur can include:

  • unusual or new pain in your hip, groin, or thigh
  • trouble moving the affected leg
  • swelling in your hip, groin, or thigh

What to do

If you have thigh pain or other symptoms of a femur fracture while taking Boniva, call your doctor right away. They will want to order certain tests to check for a fracture.

Your doctor will likely recommend that you stop taking Boniva. They may have you start treatment again once the fracture heals. However, they may also suggest that you permanently stop treatment with Boniva. In this case, they may recommend a different treatment for your condition.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Boniva. A more severe allergic reaction is rare but possible. Allergic reactions weren’t common in Boniva’s clinical studies.

Possible symptoms of mild and serious allergic reactions are listed in the table below.

Mild allergic reaction symptoms Serious allergic reaction symptoms
• itching trouble breathing
rash • swelling in your throat or mouth
flushing • swelling under your skin, possibly in your hands, feet, lips, or eyelids

If you have an allergic reaction to Boniva, call your doctor right away. This is important to do because the reaction could become severe.

However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Boniva: Precautions

Be sure to talk with your doctor about your health history before you take Boniva. This drug may not be the right treatment option for you if you have certain medical conditions or other factors that affect your health.

The conditions and factors to consider include those described below.

Digestive problems, including trouble swallowing. Boniva can cause side effects that affect your digestive system. Some of these effects can be severe. If you have existing digestive problems, including trouble swallowing, you may be at higher risk of these side effects. Taking Boniva could worsen your condition. Your doctor can determine whether it’s safe for you to take Boniva.

Low calcium level. If you have low calcium (hypocalcemia), it should be treated before you start taking Boniva. Because Boniva can lower your calcium level, taking the drug can worsen your condition if your level is already low. Talk with your doctor about treatment options for low calcium before you begin treatment with Boniva.

Malabsorption syndrome. If you have malabsorption syndrome or another condition that affects how well you absorb nutrients, talk with your doctor. (Another example condition is lactose intolerance.) Having these conditions can raise your risk of side effects from Boniva. Your doctor can determine whether it’s safe for you to take Boniva.

Kidney problems. In general, people with mild or moderate kidney problems can take Boniva. However, using Boniva isn’t recommended for people with severe kidney problems. This is because your body uses your kidneys to get rid of Boniva after you take a dose. Your doctor can determine the severity of your kidney problems and whether it’s safe for you to take Boniva.

Planned dental surgery or tooth extraction. Severe jawbone problems may happen when you take Boniva, particularly after dental surgery. This includes invasive dental procedures such as tooth extraction (removal), dental implants, or dental surgery involving bone. Your doctor can determine whether it’s safe for you to take Boniva if you plan to have any dental procedures.

Allergic reaction. If you’ve had an allergic reaction to Boniva or any of its ingredients, your doctor will likely not prescribe Boniva. Ask your doctor what other medications may be better options for you.

Consuming alcohol during Boniva treatment

There’s no known interaction between taking Boniva and drinking alcohol.

However, it’s important to note that studies have found that drinking alcohol is a risk factor for osteoporosis. And Boniva is used to prevent and treat osteoporosis in certain people.

In addition, alcohol can cause some of the same side effects Boniva may cause, including:

  • upset stomach or heartburn
  • headache
  • diarrhea
  • abdominal pain

If you drink alcohol, talk with your doctor about how much, if any, is safe for you to consume while taking Boniva.

Pregnancy and breastfeeding during Boniva treatment

Boniva isn’t approved for use in people who can become pregnant. Boniva is only prescribed to prevent or treat osteoporosis that happens after menopause. After menopause, you aren’t able to become pregnant or breastfeed.

Boniva: What to discuss with your doctor

Talk with your doctor or pharmacist to find out more information about Boniva. If you have questions about the drug’s side effects, your pharmacist or healthcare professional can help answer them for you.

In addition to discussing Boniva with your doctor, you may find the following articles helpful in learning more.

  • Overview of Boniva. To read an overview of Boniva, see this article.
  • Drug comparison. To learn how Boniva compares with Fosamax, read this article.
  • Details about osteoporosis. To learn more about osteoporosis, which Boniva is used to treat, see this osteoporosis article.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Medical Reviewer: Tanya Kertsman, PharmD
Last Review Date: 2022 May 23
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.