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The following safety information outlines critical warnings and precautions for the use of ibandronate (Boniva). Please read carefully and consult your healthcare provider with any concerns.

• Stomach and Esophagus Irritation and Ulcers: Ibandronate (Boniva) can cause irritation and ulcers in the stomach and esophagus, leading to symptoms like heartburn and pain. To minimize these risks, take the medication with a full glass of plain water while standing or sitting upright, and avoid lying down for at least one hour afterward. Contact your healthcare provider immediately if you experience trouble swallowing, chest pain, or worsening heartburn. Increased risk factors include a history of ulcers, concurrent use of aspirin or NSAIDs, insufficient water intake, and lying down soon after taking the medication.

• Jawbone Breakdown (Osteonecrosis): Ibandronate (Boniva) may lead to jawbone deterioration, especially if undergoing dental procedures or facing unresolved oral infections. Maintaining good oral hygiene and informing your dentist about your medication can reduce this risk. Seek medical advice if you experience jaw pain or swelling. Risk factors include dental disease, anemia, bleeding disorders, cancer, concurrent cancer medications, poor oral care, ill-fitting dentures, and prolonged ibandronate use.

• Severe Bone, Joint, or Muscle Pain: Some individuals may experience intense pain in bones, joints, or muscles, which can occur shortly after starting ibandronate (Boniva) or after several months. If severe pain arises, consult your healthcare provider to determine if discontinuation is necessary.

• Leg Bone Fractures: Rarely, spontaneous leg bone fractures may occur. Report any new dull or aching pain in the hips or thighs to your healthcare provider immediately. Concurrent use of corticosteroids increases this risk.

• Low Blood Calcium Levels: Ibandronate (Boniva) can decrease blood calcium levels. Ensure low calcium levels are treated prior to starting the medication. Calcium and vitamin D supplements may be recommended to maintain adequate calcium levels. Symptoms of low calcium include muscle spasms, twitching, or numbness and tingling in extremities or around the mouth. Consult your healthcare provider if these occur. Individuals with a history of low blood calcium levels are at increased risk.

Contraindications: Ibandronate (Boniva) should not be used in situations where it may pose serious health risks:

• Conditions affecting the esophagus.
• Inability to remain upright for at least one hour after taking the medication.
• Existing low levels of calcium in the blood.

Ensure to discuss any of these conditions with your healthcare provider before using ibandronate (Boniva).

When taking this medication, some individuals may experience mild side effects such as stomach upset, diarrhea, or mild flu-like symptoms, including tiredness and muscle aches. Joint pain, back pain, nausea, and headaches are also common but generally manageable. If any of these persist or worsen, it is advisable to consult a healthcare provider to ensure proper management.

There are other side effects that may occur, such as constipation, flu-like symptoms, common cold, urinary tract infections, dizziness, and trouble sleeping. While these are generally not serious, monitoring their progression is important.

Serious side effects, though rare, require immediate medical attention. These include severe bone, joint, or muscle pain, new or unusual pain in the hip, thigh, or groin area, jaw pain, and vision changes. This medication can also cause irritation and ulcers in the stomach or esophagus, leading to severe heartburn, chest pain, or difficulty swallowing. Signs of gastrointestinal bleeding, such as black or tarry stools and vomit resembling coffee grounds, are critical and necessitate urgent care.

A very serious allergic reaction is rare but needs immediate medical intervention if symptoms such as rash, itching, swelling of the face, tongue, or throat, severe dizziness, and trouble breathing occur. Always stay vigilant for any additional side effects not listed here and seek medical advice if they arise.