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When and how to take bisphosphonates?

There are several different bisphosphonates, and how they can be taken varies. The three ways in which they can be taken (administered) are:

  • by mouth (orally)
  • through a drip into a vein (intravenous infusion)
  • by an injection into a vein (intravenous injection).

Oral treatment

Oral bisphosphonates tend to be poorly absorbed by the body and can cause irritation of the gullet (heartburn), so it's very important that you carefully follow the instructions for taking your medication:

  • Take it on an empty stomach with a glass or two of plain tap water. Other drinks may prevent the drug being properly absorbed by the body.
  • You shouldn't eat anything or drink anything other than tap water, or take any other medication or supplements for at least 30 minutes afterwards (45 minutes for Bonviva). This is to help ensure the medication is effectively absorbed.
  • You'll need to stay upright (sitting, standing or walking) for up to an hour afterwards to prevent the medication flowing back from your stomach and causing heartburn.
  • You shouldn't lie down after taking bisphosphonates until after you've eaten.

Intravenous treatment

If you can't tolerate bisphosphonates by mouth it's possible to have them through a drip into a vein (intravenous infusion) or as an injection:

  • Pamidronate is given as an infusion – this takes about an hour and can be repeated every three months.
  • Zoledronate is also given as an infusion – this takes 20 minutes or more but is only given once a year.
  • Ibandronate can be given by mouth (monthly) or by intravenous injection (every three months). The injection takes seconds.


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