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This document outlines crucial safety information and warnings regarding the use of ibandronate (Boniva). Please review these details and consult your healthcare provider if you have any questions or concerns.

• Stomach and Esophagus Irritation and Ulcers: Ibandronate (Boniva) can cause irritation or ulcers in the stomach and esophagus, potentially leading to heartburn, chest pain, or difficulty swallowing. To minimize these effects, it is vital to take the medication with a full glass of water while upright and remain standing or sitting for at least one hour afterward. Discontinue use and contact your healthcare provider if you experience swallowing difficulties, chest pain, or heartburn. Risks include a history of ulcers or digestive issues, concurrent use with aspirin or NSAIDs, inadequate water intake, and lying down soon after taking the medication.

• Jawbone Breakdown (Osteonecrosis): Although rare, ibandronate (Boniva) may contribute to jawbone deterioration, particularly if dental procedures are performed or infections occur in the mouth. Maintaining good oral hygiene and informing your dentist about your medication can help mitigate this risk. If you experience jaw pain or swelling, seek medical or dental advice promptly. Risks are higher for those with dental disease, undergoing surgery, or receiving cancer treatments.

• Severe Pain in Bones, Joints, or Muscles: Some individuals may experience severe pain in these areas shortly after beginning treatment with ibandronate (Boniva). Typically, the pain subsides after discontinuing the medication. If you encounter such pain, consult your healthcare provider about the possibility of stopping the drug.

• Leg Bone Fractures: In rare cases, unexplained fractures in the leg bones may occur. If you notice persistent pain in your hips or thighs, contact your healthcare provider immediately. This risk is heightened by simultaneous use of corticosteroid medications.

• Low Calcium Levels in the Blood: Ibandronate (Boniva) can lead to reduced calcium levels, necessitating treatment for any pre-existing low calcium before starting the medication. Supplements of calcium and vitamin D may be required to maintain adequate levels. Symptoms of low calcium include muscle spasms, twitching, or numbness around the mouth or in the extremities.

Contraindications: This medication should not be used if you have conditions affecting the esophagus, are unable to remain upright for an hour post-dosing, or have low blood calcium levels. Consult your healthcare provider if any of these conditions apply to you.

Common side effects:

• stomach upset
• heartburn
• joint or back pain
• nausea
• diarrhea
• headache
• mild muscle pain
• flu-like symptoms
• tiredness
• muscle ache

Less common but important to monitor:

• constipation
• symptoms resembling the common cold
• urinary tract infections
• dizziness
• trouble sleeping

Serious side effects:

• severe or new bone, joint, or muscle pain
• jaw pain
• vision changes
• irritation or ulcers in the stomach or esophagus
• severe heartburn
• chest pain
• difficulty swallowing
• severe abdominal pain
• black or tarry stools
• vomit resembling coffee grounds
• very serious allergic reaction
• rash
• swelling (especially of the face, tongue, or throat)
• severe dizziness
• trouble breathing