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General side effects of bisphosphonates

Find out about the general side effects of bisphosphonates. 

Bisphosphonates don’t usually cause too many side effects. If you do have side effects, they tend to be mild. Everyone reacts differently to drugs and you may have one or more side effects.

Possible side effects

Fever and flu symptoms

These are more common when you have the bisphosphonate as a drip (infusion) – they usually last for a few hours and taking paracetamol can help.

Low levels of calcium in your blood (hypocalcaemia)

You will have blood tests to check the levels of calcium and other minerals such as potassium and magnesium.

Bone and joint pain

You can control this with a mild painkiller such as paracetamol.

Changes in bowel movements

Constipation or diarrhoea usually lasts only for a few days – it is important to drink plenty of fluids (6 to 8 glasses a day).

Tiredness and low energy levels

These may occur with some types of bisphosphonates but are usually mild.

Feeling sick

This is usually mild and gets better after a few days, but your doctor or nurse can give you anti sickness tablets if it continues or is severe.

Changes to the kidneys

You'll have regular blood tests to check how well your kidneys are working.

Irritation of the food pipe (oesophagus)

This can be a side effect of taking bisphosphonate tablets. Tell your doctor if you already have problems with your food pipe (oesophagus) or if you develop new symptoms such as pain or difficulty swallowing.

Changes to the jaw bone (osteonecrosis)

This is a rare side effect that might happen if you take bisphosphonates for over a year. You should have a dental check up before you start treatment. Always tell your dentist that you’re having bisphosphonate therapy or tell your doctor if you need dental treatment.

Important points about bisphosphonates

  • When you're taking bisphosphonate tablets or capsules, you should follow the instructions your doctor or pharmacist gives you.
  • Take the tablets or capsules on an empty stomach, or they won't be absorbed well. Some people find it easiest to take them first thing in the morning and wait at least an hour before eating anything or having any milk.
  • Drink plenty of fluids when you are taking bisphosphonates, as this helps to protect your kidneys. Ask your doctor or nurse how much fluid they recommend you to drink each day.
  • Bisphosphonates can interact with other drugs you are taking. This includes some painkillers such as non steroidal anti inflammatory drugs (NSAIDs) and antibiotics. Check with your doctor or pharmacist before taking any new medicines.
  • Bisphosphonates could harm a developing baby. You should not become pregnant or father a child while taking bisphosphonates. Discuss contraception with your doctor before starting treatment if you or your partner could become pregnant.
Last reviewed: 
03 Jun 2014
  • Electronic Medicines Compendium
    Accessed June 2014

  • Emerging role of bisphosphonates in the clinic--antitumor activity and prevention of metastasis to bone

    A Lipton (2008) 

    Cancer Treatment Reviews 34 Suppl 1:S25-30

  • Prescription of bisphosphonates in prostate cancer

    M Colombel (2008) 

    Progres en Urologie Feb;18(1 Suppl FMC):F5-7

  • Zoledronic acid in the management of metastatic bone disease

    Polascik TJ1, Mouraviev V (2008) 

    Therapeutics and Clinical Risk Management Feb;4(1):261-8

  • Role of bisphosphonates for the management of skeletal complications and bone pain from skeletal metastases

    L Costa and others (2006)

    Supportive Cancer Therapy  Apr 1;3(3):143-53

  • Normalization of bone markers is associated with improved survival in patients with bone metastases from solid tumors and elevated bone resorption receiving zoledronic acid

    A Lipton and others (2008) 

    Cancer Jul 1;113(1):193-201

  • Protection of bone in premenopausal women with breast cancer: focus on zoledronic acid

    R Aft (2012) 

    International Journal of Women's Health 4:569-76

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