IBANDRONATE SODIUM

Ibandronate Sodium
Boniva
Classifications: bisphosphonate; regulator, bone metabolism;
Therapeutic: bone metabolism regulator

Prototype: Etidronate
Pregnancy Category: C

Availability

2.5 mg and 150 mg tablets

Action

Ibandronate is a potent third-generation bisphosphonate. It inhibits activity of osteoclasts and reduces bone resorption and turnover in the matrix of the bone.

Therapeutic Effect

In postmenopausal women, it reduces the rate of bone turnover, resulting in a net gain in bone mass.

Uses

Prevention and treatment of osteoporosis in postmenopausal women.

Unlabeled Uses

Treatment of metastatic bone disease in breast cancer.

Contraindications

Hypersensitivity to ibandronate; severe renal impairment; hypocalcemia, vitamin D deficiency; inability to stand or sit up straight for 60 min; achalasia, esophageal stricture, dysphagia; concurrent administration with antacids, supplements, or vitamins; children <18 y; pregnancy (category C).

Cautious Use

Mild or moderate renal impairment; history of GI bleeding or disease, esophagitis, esophageal, or gastric ulcers; older adults; lactation.

Route & Dosage

Postmenopausal Osteoporosis
Adult: PO 2.5 mg qd or 150 mg once monthly on the same day each month

Renal Impairment
Clcr <30 mL/min: use not recommended

Administration

  • Correct hypocalcemia before administering ibandronate.
  • Give at least 60 min before food, beverage, or other medications (including vitamins).
  • Instruct to swallowed whole with a full glass of plain water (180–240 mL; 6–8 oz) while standing or sitting in an upright position.
  • Keep patient sitting up or ambulating for 60 min after taking drug.
  • Store 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

CNS: Dizziness, headache, nerve root lesion, vertigo. GI: Dyspepsia, constipation, diarrhea, esophagitis, gastritis, pharyngitis, nausea, vomiting. Respiratory: Upper respiratory infection, pharyngitis. Skin: Rash. Body as a Whole: Back pain. Other: Tooth disorder.

Diagnostic Test Interference

Interferes with the use of bone-imaging agents.

Interactions

Drug: Concurrent administration of calcium, magnesium, or iron reduces ibandronate adsorption. Food: Food reduces ibandronate absorption (ibandronate should be taken in a fasting state).

Pharmacokinetics

Absorption: Bioavailability poor (0.6%). Peak: 0.5–2 h. Distribution: 86–99% protein bound. Metabolism: None. Elimination: Renal. Half-Life: 10–60 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Monitor albumin-adjusted serum calcium, serum phosphate, serum alkaline phosphatase, fasting and 24 h urinary calcium, and serum electrolytes; baseline and periodic renal function.
  • Withhold drug and notify physician if the Clcr <30 mL/min.
  • Diagnostic test: Bone density scan every 12–18 mo.
  • Monitor for S&S of upper GI distress, especially with concurrent use of NSAIDS or aspirin.

Patient & Family Education

  • Take the monthly dose (150 mg) on the same day each month. Carefully follow directions for taking the drug (see Administration).
  • If a monthly dose is missed, and the next scheduled dose is more than 7 d away, take one 150 mg tablet the next morning then resume the original monthly schedule. Do not take two 150 mg tablets in the same week.
  • Report to physician any of the following: severe bone, joint, or muscle pain; heartburn, pain behind the sternum, difficulty or pain with swallowing.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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