Ibandronate

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

  1. bone metastases
  2. hypercalcemia
  3. osteoporosis
  4. osteoporosis prophylaxis
  5. Paget’s disease

For the treatment of osteoporosis

once monthly oral regimen for postmenopausal osteoporosis

Side Effects

  1. abdominal pain
  2. anaphylactic shock
  3. angioedema
  4. arthralgia
  5. asthenia
  6. atrial fibrillation
  7. back pain
  8. bone fractures
  9. bone pain
  10. bronchospasm
  11. conjunctivitis
  12. constipation
  13. cystitis
  14. depression
  15. diaphoresis
  16. diarrhea
  17. dizziness
  18. dysgeusia
  19. dyspepsia
  20. dysphagia
  21. elevated hepatic enzymes
  22. erythema
  23. erythema multiforme
  24. esophageal stricture
  25. esophageal ulceration
  26. esophagitis
  27. fever
  28. gastritis
  29. gastroesophageal reflux
  30. GI bleeding
  31. GI perforation
  32. headache
  33. hot flashes
  34. hypercalciuria
  35. hypercholesterolemia
  36. hypertension
  37. hypocalcemia
  38. hypomagnesemia
  39. hypophosphatemia
  40. infection
  41. injection site reaction
  42. insomnia
  43. maculopapular rash
  44. melena
  45. muscle cramps
  46. musculoskeletal pain
  47. myalgia
  48. nausea
  49. ocular inflammation
  50. ocular pain
  51. oral ulceration
  52. osteonecrosis
  53. peptic ulcer
  54. pharyngitis
  55. pruritus
  56. pyrosis (heartburn)
  57. rash
  58. renal failure (unspecified)
  59. Stevens-Johnson syndrome
  60. thrombocytopenia
  61. uveitis
  62. vertigo
  63. visual impairment
  64. 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