Side effects of boniva

For women experiencing postmenopausal osteoporosis or wishing to prevent osteoporosis; for those who are experiencing corticosteroid-induced osteoporosis; for those with Paget’s disease and for those with malignant/metastatic disorders, healthcare providers can prescribe Boniva (Ibandronate sodium). This class of medication is called a third-generation biophosphonate. Boniva can be given by mouth or by intravenous injection. Boniva is the brand name for Ibandronate sodium, manufactured by Genentech, a pharmaceutical business that belongs to Roche, a Swiss multinational healthcare company.

What Is Boniva?

​Biophosphonates impede the function of osteoclasts---cells that break down bone, and enhance the function of osteoblasts---cells that build bone. Boniva slows down bone loss while increasing bone mass to hopefully prevent bone fractures.

How Does Osteoporosis Weaken Bone?

​There are two kinds of bone tissue: dense cortical bone and lattice-like spongy trabecular bone. Cortical bone forms the hard outside layer of all bones in the body, especially the skull and ribs. Spongy trabecular bone is mainly found inside the vertebrae and inside the ends of long bones like the thigh bone (see image). Osteoporosis reduces the structure and bone density of the spongy tissue and thins out the cortical bone.

When the cortical bone becomes thinner and spongy bone becomes less dense with bigger spaces between the latticework, the risk of fracture increases. The three most common sites for a fracture due to osteoporosis are the thigh bone near the hip, the vertebrae of the spine and the wrist. Fractures can occur with a minor fall or a light bump. Spinal fractures can occur because of compression and can happen by moving the body or lifting an object.

Indications


Boniva is used to prevent bone loss. Its primary use is for adult postmenopausal females who have osteoporosis, and for osteoporosis prophylaxis. It is also prescribed “off-label” for corticosteroid-induced osteoporosis in men and women. Paget’s disease, malignant and metastatic disorders are also off-label disorders which may benefit from Boniva therapy.

Osteoporosis

​Osteoporosis means “porous bone”; it is a disease that weakens bone and increases the risk of unexpected fractures. There is a direct relationship between the lack of estrogen in the development of osteoporosis. Estrogen promotes the activity of osteoblasts---cells that produce bone. As estrogen falls during menopause, the bone reducing osteoclasts overpower the bone building osteoblasts and bones begin to weaken.

​Corticosteroid-Induced Osteoporosis In Men And Women

​Steroid medications are used for certain inflammatory conditions such as rheumatoid arthritis, lupus and asthma. Corticosteroids include the medications prednisone and cortisone. Corticosteroids have considerable effect on the metabolism of calcium, vitamin D and bone. In high doses, osteoporosis and the resulting fractures can occur rapidly.

Paget’s Disease

​This disorder interferes with the body’s normal cycle of bone building and bone recycling. The result is softened, misshapen and fractured bones. The cause of Paget’s disease is unknown, but environmental and genetic factors contribute to the disorder. There is a controversial theory that the disease is related to a viral infection.

​Hypercalcemia Of Malignancy

​This disorder is commonly found in patients with advanced stage cancers. Hypercalcemia is an increase in serum calcium levels, and calcium in the blood is not calcium in the bones. Several mechanisms are responsible for the development of hypercalcemia of malignancy:
•    Parathyroid hormone
•    Osteolytic (dissolution of bone) metastases-related hypercalcemia
•    Vitamin D mediated hypercalcemia
•    Parathyroid carcinoma

Adverse Skeletal Events Due ​To Bone Metastases


Bone is one of the most common sites where cancer cells metastasize, especially breast cancer. Although prostate and lung cancers commonly metastasize to bone, patients with bone involvement account for up to 80% of those with metastatic breast cancer. As a result of metastasis, patients are at risk for fractures and spinal cord compression.

​Common Administration Considerations

​Oral Boniva should be taken by mouth, monthly on the same date; supplemental calcium and vitamin D may also be required. Boniva causes gastric upset; patients will need to set up for at least an hour after administration. Boniva binds and otherwise interacts with a plethora of other substances; it must be administered on an empty stomach at least an hour before the consumption of a meal or any other medication. Boniva is to be administered intravenously every three months, and by a healthcare professional; it is not to be parenterally administered by any other route.

Boniva has to be administered with caution to anyone with a pre-existing gastrointestinal disorder, or who cannot sit upright for an hour after administration. Boniva is not recommended for patients with severe renal impairment, due to renal toxicity. This precaution includes patients who have any concomitant diseases that have the potential to adversely affect the kidney, such as diabetes and hypertension. As well, the concomitant use of any drugs that have the potential to cause renal toxicity must be taken into consideration before the administration of Boniva.

Boniva is frequently administered to the elderly. Those patients with psychiatric or mental compromise, who cannot follow directions, may have to be excluded from the therapeutic regimen. Geriatric patients may be at increased risk for the development of gastrointestinal reactions, and their greater usage of medication must be taken into consideration.

Side Effects Of Boniva

​A side effect is a secondary, unwanted effect that occurs due to drug therapy. Any medicine may cause unwanted side effects and drug companies are required to list every side effect known, no matter how rare its occurrence. Many side effects go away with time, and a healthcare professional may be able to provide guidance on how to prevent or reduce some of the symptoms. The following is not a complete list of side effects. 

​Side Effects:

  • ​Bladder pain
  • ​Bloody or cloudy urine
  • ​Burning, painful urination
  • ​Frequent urge to urinate
  • ​ Chest pain
  • ​Tightness in the chest
  • ​Shortness of breath
  • ​Cough with mucus
  • ​Difficulty breathing
  • ​Pounding in the ears
  • ​​Slow or fast heartbeat
  • ​​Dizziness
  • ​​Sneezing
  • ​​Runny nose
  • ​​ Sore throat
  • ​Tender, swollen neck glands
  • ​​Difficulty swallowing
  • ​​ Dry throat
  • ​Hoarseness
  • ​Voice changes
  • ​Fever or chills
  • ​Sweating
  • ​​Lower back or side pain
  • ​Hives
  • ​​ Itching
  • ​​ Numbness
  • ​Puffiness of the eyelids, eyes, face, lips, or tongue
  • ​​Skin rash
  • ​Tingling
  • ​​ Unusual tiredness or weakness
  • ​​ Difficulty having a bowel movement
  • ​​ Difficulty with moving
  • ​​Joint pain
  • ​Lack or loss of strength
  • ​​ Muscle aches and pain
  • ​​Muscle stiffness
  • ​Pain, swelling, or redness in the joints
  • ​  Tooth disorder
  • ​​ Sensation of spinning
  • ​Loss of interest or pleasure
  • ​General malaise
  • ​Discouragement
  • ​ Feeling sad or empty
  • ​Irritability
  • ​Nervousness
  • ​   Trouble concentrating
  • ​Trouble sleeping

Serious Side Effects ​Of Boniva

​You must stop taking Boniva and call a healthcare provider immediately for signs of anaphylaxis or severe allergic reaction:

  • ​Hives
  • ​ Rash
  • ​ Itching
  • ​Chest tightness
  • ​ Swelling of the face, lips, tongue, or throat

You must also stop taking Boniva and call a healthcare provider immediately for any of the following serious side effects:

  • ​ New or worsening heartburn
  • ​ Chest pain
  • ​ New or unusual pain in the hips or thighs
  • ​Difficult or painful swallowing
  • ​Pain or burning sensation under the ribs or in the back

Boniva Overdose

​​You must get emergency help if any of the following symptoms occur due to an overdose:

​ Stomach discomfort, upset, or pain

  • ​​Acid or sour stomach
  • ​​Belching
  • ​ Any bone pain
  • ​Burning feeling in the chest or stomach
  • ​Indigestion
  • ​ Loss of appetite
  • ​Pain or burning in the throat
  • ​Sores or ulcers
  • ​ Tenderness in the stomach area
  • ​Vomiting
  • ​White spots on the lips or tongue or inside the mouth

Conclusion

​Boniva is a serious medication that treats and prevents a very serious condition---osteoporosis.

Osteoporosis can be successfully managed with Boniva if the patient can tolerate the medication. Essential to the management of Boniva therapy is a team approach between the patient and healthcare providers. This will require a proactive patient; there is no lump, bump, rash or funny feeling that is too trivial to discuss with the healthcare team.

There is more that the patient can do, however, than just call the doctor. They say that knowledge is power; knowledge is also about peace of mind. As patients read through the literature, the internet and the package inserts about Boniva, they will discover that drug companies are required to report every reaction, interaction and side effect known across the planet, no matter how frequent the occurrence nor seemingly trivial the symptom may be. There is peace of mind in knowing that not every side effect will occur and that most minor side effects will go away as the body gets used to taking Boniva.

A handy place to store information, including that given by the healthcare team, is a personal health record/journal or a patient diary.  Armed with knowledge about the medication and its side effects, and a journal to help keep track of printed information and personal signs and symptoms, the patient will be better able to decide what information is useful and what information is just a neighbor’s personal experience or opinion. Hopefully, patients can reduce the fear and anxiety associated with taking Boniva and focus on getting better