General side effects of bisphosphonates | Cancer Research UK
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General side effects of bisphosphonates

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This page has general information about the possible side effects of bisphosphonates.


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General side effects of bisphosphonates

Bisphosphonates tend not to cause many side effects and if they occur they are usually mild. You may have one or more of these side effects

  • A high temperature (fever) and flu like symptoms – more common with bisphosphonates given by drip
  • Low calcium levels
  • Bone and joint pain
  • Constipation or diarrhoea
  • Tiredness
  • Feeling sick
  • Damage to your kidneys – you will have tests to check this
  • Irritation of your food pipe (oesophagus) – tell your doctor or nurse if you have any pain or difficulty swallowing
  • Bone damage (osteonecrosis) in the jaw after taking bisphosphonates for more than a year but this is very rare

Things to remember when taking bisphosphonates

  • Follow the instructions about taking bisphosphonate tablets
  • Take the tablets or capsules on an empty stomach – don’t eat or drink milk for an hour before or for an hour after taking them
  • Drink plenty of fluids – your doctor or nurse will tell you how much
  • Check with your doctor if you want to take any other medicines as they can interfere with bisphosphonates – this includes painkillers
  • You should not become pregnant or father a child – bisphosphonates could harm a developing baby so use reliable contraception


CR PDF Icon You can view and print the quick guides for all the pages in the Bisphosphonates section



General side effects of bisphosphonates

You can find detailed information about the side effects of individual bisphosphonate drugs in the cancer drugs section.

Generally, bisphosphonates don’t cause too many side effects. If you have side effects they tend to be mild. Everyone reacts differently to drugs and you may have one or more of the side effects listed below.

  • Fever and flu like symptoms 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 can be controlled by a mild painkiller such as paracetamol
  • Changes in your bowel movements (constipation or diarrhoea) that usually only last for a few days – it is important to drink plenty of fluids (6 to 8 glasses a day)
  • Tiredness and low energy levels may occur with some types of bisphosphonates but are usually mild
  • Feeling sick is usually mild and gets better after a few days – if it continues or is severe, your doctor or nurse can give you anti sickness tablets
  • Bisphosphonates can cause damage to your kidneys – you will have regular blood tests to check how well your kidneys are working
  • Damage to the jaw bone (osteonecrosis) is a rare side effect that may happen if you take bisphosphonates for longer than a year. You should have a dental check up before you start treatment. Always tell your dentist that you are having bisphosphonate therapy or tell your doctor if you need dental treatment
  • Irritation of the food pipe (oesophagus) can be a side effect of taking bisphosphonate tablets. Tell your doctor If you already have a condition of your oesophagus or if you develop new symptoms such as pain or difficulty swallowing

Important points about bisphosphonates

  • If you are taking bisphosphonate tablets or capsules you should take them according to the instructions your doctor or pharmacist gave you
  • Take the tablets or capsules on an empty stomach. 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. Bisphosphonate tablets or capsules aren’t absorbed well if you take them with food or 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 whilst you are taking bisphosphonates. Discuss contraception with your doctor before you start your treatment if there is any possibility that you or your partner could become pregnant
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Updated: 3 June 2014