ibandronate

Contraindicated in:

Hypersensitivity;
Abnormalities of the esophagus that delay esophageal emptying (e.g., strictures, achalasia);
Uncorrected hypocalcemia;
Inability to stand/sit upright for at least 60 min;
Severe renal impairment (CCr <30 mL/min);
OB: Pregnancy.

Use Cautiously in:

History of upper GI disorders;
Concurrent use of NSAIDs or aspirin;
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 (ibandronate should be taken 60 min before).
Concurrent use of NSAIDs, including aspirin, may ↑ risk of gastric irritation.

Drug-Food:

Milk and other foods ↓ absorption.

Availability ⬆ ⬇

(Generic available)

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

Route/Dosage ⬆ ⬇

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

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Inhibits resorption of bone by inhibiting osteoclast activity.

Therapeutic effects:

Reversal/prevention of progression of osteoporosis with decreased fractures.

Classifications ⬆ ⬇

Therapeutic Classification: bone resorption inhibitors

Pharmacologic Classification: biphosphonates

Pharmacokinetics ⬆ ⬇

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

Patient/Family Teaching ⬆ ⬇

Advise patient to eat a balanced diet and consult health care professional about the need for supplemental calcium and vitamin D. Wait at least 60 min after administration before taking supplemental calcium and vitamin D.
- Encourage patient to participate in regular exercise and to modify behaviors that increase the risk of osteoporosis (stop smoking, reduce alcohol consumption).
- Inform patient that severe musculoskeletal pain may occur within days, mo, or yr after starting ibandronate. Symptoms may resolve completely after discontinuation or slow or incomplete resolution may occur. Notify health care professional if severe pain occurs.
- Advise patient to notify health care professional if rash or 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 professional if swallowing difficulties, chest pain, new or worsening heartburn, or trouble or pain when swallowing occurs; may be signs of problems of the esophagus.
- Advise patient to inform health care professional of ibandronate therapy prior to dental surgery.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
PO: Instruct patient on the importance of taking as directed, first thing in the morning, 60 min before other medications, beverages, or food. Ibandronate should be taken with 6–8 oz plain water (mineral water, orange juice, coffee, and other beverages decrease absorption). Do not chew or suck on tablet. If a dose is missed, skip dose and resume the next morning; do not double doses or take later in the day. If a once-monthly dose is missed and the next scheduled dose is >7 days away, take in the morning following the date it is remembered. Resume original schedule the following mo. If the next dose is <7 days away, omit dose and take next scheduled dose. Do not discontinue without consulting health care professional.
- Caution patient to remain upright for 60 min following dose to facilitate passage to stomach and minimize risk of esophageal irritation. Advise patient to stop taking ibandronate and contact health care professional if symptoms of esophageal irritation (new or worsening dysphagia, pain on swallowing, retrosternal pain, or heartburn) occur.
IV: Advise patient that IV doses should not be administered sooner than every 3 mo. If a dose is missed, have health care professional administer as soon as possible; next injection should be scheduled 3 mo from last injection.

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Indications ⬇

Contraind./Precautions ⬆ ⬇