Drug reference

Ibandronic acid

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 789, 790, 791

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Reduction of bone damage in bone metastases in breast cancer ▶INITIALLY BY MOUTH ▶Adult: 50 mg daily, alternatively (by intravenous infusion) 6 mg every 3–4 weeks Hypercalcaemia of malignancy ▶BY INTRAVENOUS INFUSION ▶Adult: 2–4 mg as a single infusion, dose to be adjusted according to serum calcium concentration Treatment of postmenopausal osteoporosis ▶INITIALLY BY MOUTH ▶Adult (female): 150 mg once a month, alternatively (by intravenous injection) 3 mg every 3 months, to be administered over 15–30 seconds.

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Contra Indications

GENERAL CONTRA-INDICATIONS Hypocalcaemia SPECIFIC CONTRA-INDICATIONS ▶With oral use Abnormalities of the oesophagus. other factors which delay emptying (e.g. stricture or achalasia)

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Cautions

GENERAL CAUTIONS Atypical femoral fractures SPECIFIC CAUTIONS ▶With intravenous use Cardiac disease (avoid ﬂuid overload) ▶With oral use Upper gastro-intestinal disorders

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National Funding Access Decisions

NICE decisions ▶Bisphosphonates for treating osteoporosis (updated July 2019) NICE TA464 This technology appraisal guidance should be applied clinically in conjunction with: . NICE guideline on osteoporosis (CG146), which deﬁnes who is eligible for osteoporotic fracture risk assessment. . NICE quality standard on osteoporosis (QS149), which deﬁnes the clinical intervention thresholds for the 10-year fracture probability of a major osteoporotic fracture, in those patients who have undergone fracture risk assessment. Ibandronic acid is recommended as an option for treating osteoporosis in patients: . who are eligible for risk assessment as deﬁned in the full NICE guideline and quality standard on osteoporosis, and . who have been assessed as being at higher risk of osteoporotic fragility fracture using the methods recommended in the full NICE guideline and quality standard on osteoporosis, and . when bisphosphonate treatment is appropriate, taking into account their risk of fracture, their risk of adverse effects from bisphosphonates, and their clinical circumstances and preferences. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta464

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Safety

Interactions

→Appendix 1: bisphosphonates Endocrine system

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Side Effects

GENERAL SIDE-EFFECTS ▶Common or very common Face oedema ▶Uncommon Asthma exacerbated SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With intravenous use Bundle branch block. cataract. increased risk of infection. joint disorder. oral disorders. osteoarthritis. parathyroid disorder. thirst ▶With oral use Acute phase reaction. gastrointestinal disorders. muscle cramps. musculoskeletal stiffness ▶Uncommon ▶With intravenous use Acrochordon. affective disorder. altered smell sensation. anxiety. blood disorder. cardiovascular disorder. cerebrovascular disorder. cholelithiasis. cystitis. deafness. hyperaesthesia. hypothermia. injury. memory loss. migraine. muscle tone increased. myocardial ischaemia. palpitations. pelvic pain . pulmonary oedema. radiculopathy. renal cyst. sleep disorder. stridor. urinary retention. weight decreased ▶Rare or very rare ▶With intravenous use Hypersensitivity ▶Frequency not known ▶With oral use Oesophagitis erosive (discontinue)

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Pregnancy

Avoid.

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Breast Feeding

Avoid—present in milk in animal studies.

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Renal Impairment

When used for postmenopausal osteoporosis, avoid if eGFR less than 30 mL/minute/1.73 m2. Dose adjustments ▶With intravenous use When used for bone metastases, if eGFR 30–50 mL/minute/1.73 m2 reduce dose to 4 mg and infuse over 1 hour; if eGFR less than 30 mL/minute/1.73 m2 reduce dose to 2 mg and infuse over 1 hour. ▶With oral use When used for bone metastases, if eGFR 30–50 mL/minute/1.73 m2 reduce dose to 50 mg on alternative days; if eGFR less than 30 mL/minute/1.73 m2 reduce dose to 50 mg once weekly.

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Monitoring Requirements

Monitor renal function and serum calcium, phosphate and magnesium.

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Dose and formulations

Directions For Administration

Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes (for most ibandronic acid tablets, 50 mg) or 1 hour (for Bonviva ® tablets, 150 mg) before ﬁrst food or drink (other than water) of the day, or another oral medicine; patient should stand or sit upright for at least 1 hour after taking tablet. For intravenous infusion (Bondronat ®), give intermittently in Glucose 5% or Sodium chloride 0.9%; dilute requisite dose in 500 mL infusion ﬂuid and give over 1–2 hours.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Ibandronic acid (Non-proprietary) Ibandronic acid (as Ibandronic sodium monohydrate) 1 mg per 1 ml Ibandronic acid 3mg/3ml solution for injection pre-filled syringes | 1 pre-filled disposable injection P £65.40 DT = £37.80 (Hospital only) | 1 pre-filled disposable injection P £10.30–£65.20 DT = £37.80 ▶Bonviva (Atnahs Pharma UK Ltd) Ibandronic acid (as Ibandronic sodium monohydrate) 1 mg per 1 ml Bonviva 3mg/3ml solution for injection pre-filled syringes | 1 pre-filled disposable injection P £68.64 DT = £37.80 Solution for infusion ▶Ibandronic acid (Non-proprietary) Ibandronic acid (as Ibandronic sodium monohydrate) 1 mg per 1 ml Ibandronic acid 6mg/6ml concentrate for solution for infusion vials | 1 vial P £130.42 (Hospital only) Ibandronic acid 2mg/2ml concentrate for solution for infusion vials | 1 vial P £43.60 (Hospital only) ▶Bondronat (Atnahs Pharma UK Ltd) Ibandronic acid (as Ibandronic sodium monohydrate) 1 mg per 1 ml Bondronat 2mg/2ml concentrate for solution for infusion vials | 1 vial P £89.36 (Hospital only) Bondronat 6mg/6ml concentrate for solution for infusion vials | 1 vial P £183.69 Tablet ▶Ibandronic acid (Non-proprietary) Ibandronic acid (as Ibandronic sodium monohydrate) 50 mg Ibandronic acid 50mg tablets | 28 tablet P £186.69 DT = £60.89 Ibandronic acid (as Ibandronic sodium monohydrate) 150 mg Ibandronic acid 150mg tablets | 1 tablet P £18.40 DT = £6.25 | 3 tablet P £3.09–£55.21 ▶Bondronat (Atnahs Pharma UK Ltd) Ibandronic acid (as Ibandronic sodium monohydrate) 50 mg Bondronat 50mg tablets | 28 tablet P £183.69 DT = £60.89 ▶Bonviva (Atnahs Pharma UK Ltd) Ibandronic acid (as Ibandronic sodium monohydrate) 150 mg Bonviva 150mg tablets | 1 tablet P £18.40 DT = £6.25 ▶Iasibon (Aspire Pharma Ltd) Ibandronic acid (as Ibandronic sodium monohydrate) 50 mg Iasibon 50mg tablets | 28 tablet P £174.50 DT = £60.89 ▶Quodixor (Aspire Pharma Ltd) Ibandronic acid (as Ibandronic sodium monohydrate) 150 mg Quodixor 150mg tablets | 1 tablet P £18.40 DT = £6.25 eiiii F 765

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Clinical care

Patient And Carer Advice

Patients or carers should be given advice on how to administer ibandronic acid tablets. Oesophageal reactions Patients and carers should be advised to stop tablets and seek medical attention for symptoms of oesophageal irritation such as dysphagia, pain on swallowing, retrosternal pain, or heartburn. Patient reminder card A patient reminder card should be provided to patients receiving intravenous ibandronic acid (risk of osteonecrosis of the jaw).

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Dose text by age group

Adult

50 mg daily, alternatively (by intravenous

First-line fragment. Read the complete Indications and Dose section above.

PDF page 789

Adult

2–4 mg as a single infusion, dose to be adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 789

Adult (female)

150 mg once a month, alternatively (by

First-line fragment. Read the complete Indications and Dose section above.

PDF page 789

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Ibandronic acid

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 789, 790, 791

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 789

Contra Indications

GENERAL CONTRA-INDICATIONS Hypocalcaemia SPECIFIC CONTRA-INDICATIONS ▶With oral use Abnormalities of the oesophagus. other factors which delay emptying (e.g. stricture or achalasia)

PDF pages 789, 790

Cautions

GENERAL CAUTIONS Atypical femoral fractures SPECIFIC CAUTIONS ▶With intravenous use Cardiac disease (avoid ﬂuid overload) ▶With oral use Upper gastro-intestinal disorders

PDF page 790

National Funding Access Decisions

PDF page 790

Safety

Interactions

→Appendix 1: bisphosphonates Endocrine system

PDF page 790

Side Effects

PDF page 790

Pregnancy

Avoid.

PDF page 790

Breast Feeding

Avoid—present in milk in animal studies.

PDF page 790

Renal Impairment

PDF page 790

Monitoring Requirements

Monitor renal function and serum calcium, phosphate and magnesium.

PDF page 790

Dose and formulations

Directions For Administration

PDF page 790

Medicinal Forms

PDF pages 790, 791

Clinical care

Patient And Carer Advice

PDF page 790

Dose text by age group

Adult

50 mg daily, alternatively (by intravenous

First-line fragment. Read the complete Indications and Dose section above.

PDF page 789

Adult

2–4 mg as a single infusion, dose to be adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 789

Adult (female)

150 mg once a month, alternatively (by

First-line fragment. Read the complete Indications and Dose section above.

PDF page 789

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.