Ibandronate Brand Name– Boniva
What is Ibandronate
Ibandronate is a potent oral and parenteral third-generation bisphosphonate. Oral daily and monthly regimens, and every 3 month intravenous regimens have been used, but how the drug is administered varies widely with the indication for use.
Treatment with ibandronate is associated with significant increases in bone mineral density (BMD) and reduces the risk for radiographic vertebral fractures in patients with osteoporosis.
Bisphosphonates are generally considered to be first-line therapy for the treatment of postmenopausal osteoporosis.
However, ibandronate is not considered the first line bisphosphonate choice per osteoporosis treatment guidelines since evidence is insufficient to determine the effect of ibandronate on nonvertebral fractures (e.g., hip fractures); experts state ibandronate may be considered initially for patients requiring spine-specific osteoporosis therapy.
For osteoporosis prevention, the second and third-generation bisphosphonates appear to offer similar benefits across the class to increase bone mineral density; the balance of costs, benefits, and harms of treating osteopenic patients with bisphosphonates is most favorable when the estimated risk for fracture is high.
Ibandronate is under investigation for the management Paget’s disease; ibandronate has been shown to provide effective short-term control of Paget’s disease, but long-term studies are lacking; guidelines for Paget’s disease preferentially recommend other potent bisphosphonates for this indication.
Ibandronate has been investigated for the prevention and treatment of osteoporosis in patients receiving chronic corticosteroid treatment; evidence of sufficient quality is not yet available for this population.
Ibandronate, as with other bisphosphonates, has been studied in the treatment of hypercalcemia of malignancy. In patients with breast cancer and bone metastases, the drug has been approved in Europe for the prevention of adverse skeletal events, but the drug is not approved in the U.S. for this indication.
As with other bisphosphonates, the drug may also be useful in other cancer patients with osteopenia to help reduce the risk for skeletal events, but more study is needed. Ibandronate was first approved by the FDA in 2003.
Indications
- bone metastases
- hypercalcemia
- osteoporosis
- osteoporosis prophylaxis
- Paget’s disease
For the treatment of osteoporosis
once monthly oral regimen for postmenopausal osteoporosis
Side Effects
- abdominal pain
- anaphylactic shock
- angioedema
- arthralgia
- asthenia
- atrial fibrillation
- back pain
- bone fractures
- bone pain
- bronchospasm
- conjunctivitis
- constipation
- cystitis
- depression
- diaphoresis
- diarrhea
- dizziness
- dysgeusia
- dyspepsia
- dysphagia
- elevated hepatic enzymes
- erythema
- erythema multiforme
- esophageal stricture
- esophageal ulceration
- esophagitis
- fever
- gastritis
- gastroesophageal reflux
- GI bleeding
- GI perforation
- headache
- hot flashes
- hypercalciuria
- hypercholesterolemia
- hypertension
- hypocalcemia
- hypomagnesemia
- hypophosphatemia
- infection
- injection site reaction
- insomnia
- maculopapular rash
- melena
- muscle cramps
- musculoskeletal pain
- myalgia
- nausea
- ocular inflammation
- ocular pain
- oral ulceration
- osteonecrosis
- peptic ulcer
- pharyngitis
- pruritus
- pyrosis (heartburn)
- rash
- renal failure (unspecified)
- Stevens-Johnson syndrome
- thrombocytopenia
- uveitis
- vertigo
- visual impairment
- vomiting
Monitoring Parameters
- serum 25(OH)hydroxyvitamin D concentrations
- serum alkaline phosphatase
- serum calcium
- serum creatinine/BUN
- serum electrolytes
- serum magnesium
- serum phosphate
Contraindications
- achalasia
- anemia
- breast-feeding
- chemotherapy
- children
- coagulopathy
- corticosteroid therapy
- dental disease
- dental work
- diabetes mellitus
- dysphagia
- esophageal stricture
- esophagitis
- extravasation
- gastritis
- gastroesophageal reflux disease (GERD)
- geriatric
- GI disease
- GI perforation
- hiatal hernia
- history of angioedema
- hypertension
- hypocalcemia
- hypoparathyroidism
- inability to stand or sit upright
- infants
- infection
- intraarterial administration
- laboratory test interference
- multiple myeloma
- neonates
- phosphonate hypersensitivity
- pregnancy
- renal failure
- renal impairment
- requires a specialized care setting
- vitamin D deficiency
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Amikacin
- Aminoglycosides
- Amlodipine; Celecoxib
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Bumetanide
- Calcium
- Calcium Acetate
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Calcium Chloride
- Calcium Gluconate
- Calcium; Vitamin D
- Celecoxib
- Chromium
- Cyclosporine
- Deferasirox
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Esomeprazole; Naproxen
- Ethacrynic Acid
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Etodolac
- Famotidine; Ibuprofen
- Fenoprofen
- Flurbiprofen
- food
- Furosemide
- Gentamicin
- Hetastarch; Dextrose; Electrolytes
- Hydrocodone; Ibuprofen
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Iron
- Iron Salts
- Kanamycin
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Lanthanum Carbonate
- Loop diuretics
- Magnesium
- Magnesium Citrate
- Magnesium Salts
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Non-Ionic Contrast Media
- Nonsteroidal antiinflammatory drugs
- Omeprazole; Sodium Bicarbonate
- Oxaprozin
- Paromomycin
- Piroxicam
- Plazomicin
- Polycarbophil
- Polysaccharide-Iron Complex
- Rofecoxib
- Sodium Bicarbonate
- Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
- Streptomycin
- Sulindac
- Tacrolimus
- Tobramycin
- Tolmetin
- Torsemide
- Valdecoxib
- Vancomycin
