ibandronate

Absorption: 0.6% absorbed following oral administration (significantly ↓ by food).

Distribution: Rapidly binds to bone.

Protein Binding: 90.9–99.5%.

Metabolism/Excretion: 50–60% excreted in urine; unabsorbed drug is eliminated in feces.

Half-Life: PO: 10–60 hr; IV: 4.6–25.5 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	unknown	0.5–2 hr	up to 1 mo
IV	unknown	3 hr	up to 3 mo

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Abnormalities of the esophagus that delay esophageal emptying (e.g., strictures, achalasia);
Uncorrected hypocalcemia;
Inability to stand/sit upright for ≥60 min;
Severe renal impairment;
OB: Pregnancy.

Use Cautiously in:

History of upper GI disorders;
Invasive dental procedures, cancer, receiving chemotherapy, corticosteroids, or angiogenesis inhibitors, poor oral hygiene, periodontal disease, dental disease, anemia, coagulopathy, infection, or poorly fitting dentures (may ↑ risk of jaw osteonecrosis);
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: Consider age-related ↓ in body mass, renal and hepatic function, concurrent disease states, and drug therapy in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME

GI: diarrhea, dyspepsia, dysphagia, ESOPHAGEAL CANCER, esophageal/gastric ulcer, esophagitis

Local: injection site reactions

MS: musculoskeletal pain, pain in arms/legs, femur fractures, osteonecrosis (primarily of jaw)

Resp: asthma exacerbation

Misc: ANAPHYLAXIS

Interactions ⬆ ⬇

Drug-drug:

Calcium-, aluminum-, magnesium-, and iron-containing products, including antacids, ↓ absorption; give ibandronate 60 min before these medications.
NSAIDs, including aspirin, may ↑ risk of gastric irritation.

Drug-Food:

Food may ↓ absorption.

Route/Dosage ⬆ ⬇

PO (Adults ): 150 mg once monthly.
IV (Adults ): 3 mg every 3 mo.

Availability ⬆ ⬇

(Generic available)

Tablets: 150 mg
Injection (prefilled syringes): 1 mg/mL

Assessment ⬆ ⬇

Osteoporosis: Monitor bone mass before and periodically during therapy and re-evaluate need for ibandronate. If low risk for fracture, consider discontinuation after 3–5 yr of therapy.
IV: Monitor for signs and symptoms of anaphylaxis (swelling of face, lips, mouth, or tongue; dyspnea; wheezing; rash; syncope; tachycardia; diaphoresis) during therapy. If symptoms occur, immediately discontinue ibandronate and begin supportive treatment.
Perform routine oral exam prior to initiation and periodically during therapy. If osteonecrosis of the jaw occurs, consult oral surgeon and consider discontinuing ibandronate.

Lab Test Considerations:

Assess serum calcium before and periodically during therapy. Treat hypocalcemia and vitamin D deficiency before initiating ibandronate therapy.
- Obtain serum creatinine prior to each IV injection and as clinically indicated.
- May ↓ alkaline phosphatase.
- May cause hypercholesterolemia.

Implementation ⬆ ⬇

PO: Administer ≥60 min before the 1st food, drink, or other medications of the day with 6–8 ounces of plain water. Take while standing or sitting upright; avoid lying down for ≥60 min after swallowing tablet. DNC: Tablet should be swallowed whole; do not break, crush, or chew.

IV Administration:

IV: Administer using prefilled syringe. Do not administer if solution is discolored or contains particulates.
Rate: Administer as a 15–30 sec bolus.
Y-Site Incompatibility: Do not administer with calcium-containing solutions or other IV drugs.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient to take tablet on the same day each month. If dose missed >7 days before next scheduled dose, take the morning after remembered; if ≤7 days before next scheduled dose, omit missed dose. In both cases return to scheduled dosing.
Advise patient that IV doses should not be administered sooner than every 3 mo. If a dose is missed, have health care provider administer as soon as possible; next injection should be scheduled 3 mo from last injection.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Advise patient to eat a balanced diet and consult health care provider for supplemental calcium and vitamin D need.
- Encourage patient to participate in regular exercise and to modify behaviors (smoking, alcohol consumption) that ↑ risk of osteoporosis.
- Inform patient that severe musculoskeletal pain may occur within days, months, or years after starting ibandronate. Symptoms may or may not resolve completely after discontinuation. Notify health care provider if severe pain occurs.
- Advise patient to have routine dental exams and notify health care provider if rash or other signs and symptoms of osteonecrosis of the jaw (pain, numbness, swelling of, or drainage from the jaw, mouth, or teeth) occur.
- Instruct patient to notify health care provider if chest pain, new or worsening heartburn, or trouble or pain when swallowing occurs.
- Advise patient to inform health care provider of ibandronate therapy prior to dental surgery.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇