General side effects of bisphosphonates

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

You can find more 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
Change in your bowel movements (constipation or diarrhoea) 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 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
Osteonecrosis of the jaw is a rare side effect which may happen if you take bisphosphonates for longer than a year - you should have a dental check up before you start treatment and always tell your dentist 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. If you already have a condition of your oesophagus or you develop new symptoms such as pain or difficulty swallowing tell your doctor.

Things to remember

If you are taking bisphosphonate tablets you should take them according to the instructions your doctor or pharmacist gave you
You should take bisphosphonate tablets 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 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. You should 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.