Ibandronate
Inhibitors of Bone Resorption
VA Chemical Name: [1-Hydroxy-3-(methylpentylamino)propylidene] Class: HS900 sodium diphosphonate trihydrogen monohydrate
C9H22NNaO7 is the molecular formula.
138926-19-9 is the CAS number.
Boniva is a brand.
Introduction
Bone resorption inhibitor; synthetic bisphosphonate
Ibandronate Osteoporosis Uses
Osteoporosis prevention in postmenopausal women. Early menopause, advanced age, low bone mineral density (BMD), low body mass index (BMI), previous fracture or family history of fracture/osteoporosis, excessive alcohol intake, smoking, inadequate physical activity, low calcium and vitamin D intake, certain drugs (e.g., glucocorticoids), and medical conditions or diseases are all risk factors for postmenopausal osteoporosis and related fractures (e.g., rheumatoid arthritis, diabetes mellitus, Cushing syndrome, hyperparathyroidism). Osteoporosis treatment in postmenopausal women. In addition to adequate calcium/vitamin D intake and other lifestyle changes (e.g., exercise, avoidance of excessive alcohol and tobacco use), experts recommend that pharmacologic therapy for osteoporosis be considered in postmenopausal women with previous hip or vertebral fractures or low BMD; pharmacologic therapy may also be considered in postmenopausal women with low bone mass, though there is less evidence supporting overall fracture risk reduction in suckers. It is suggested to use a medicine with established effectiveness in lowering fracture risk; bisphosphonates (e.g., alendronate, risedronate, zoledronic acid, ibandronate) are one of many first-line treatments indicated. Individualize treatment selection based on possible benefits (reduced fracture risk) and adverse effects of therapy, patient preferences, comorbidities, and risk factors.
Osteoporosis Caused by Glucocorticoids.
It has also been used to treat glucocorticoid-induced osteoporosis. The American College of Rheumatology (ACR) recommends optimising calcium and vitamin D intake as well as lifestyle modifications (e.g., diet, smoking cessation, weight-bearing or resistance-training exercise) in all patients receiving long-term glucocorticoid therapy. Pharmacologic therapy with an oral bisphosphonate is also recommended in patients who are considered to be at moderate-to-high risk of fracture. Oral bisphosphonates are commonly recommended because to their proven antifracture advantages, safety, and inexpensive cost.
Dosage and Administration of Ibandronate
- General Prior to starting treatment, correct hypocalcemia and other problems in bone and mineral metabolism.
- If food intake is insufficient, supplement with calcium and vitamin D.
Administration.
Administration orally.
Administer orally 60 minutes before the first meal, beverage (other than plain water), or other orally given medicine or supplement (including vitamins, antacids, and calcium) of the day, with a full glass (180–240 mL) of plain water. (See Food in the Pharmacokinetics section.) Avoid laying down for at least 60 minutes after administration. Tablets should not be sucked or chewed; there is a risk of oropharyngeal ulcers.(See Cautions for Upper GI Effects.) If a daily oral dosage is missed in the morning, do not take it later that day.The next day, return to your usual routine. When taking pills on a monthly basis, take them in the morning on the same day each month. If a monthly dosage is missed and the next planned dose is more than 7 days away, take the missing dose the following morning after remembering it and continue the usual schedule. Maintain the normal schedule if the next planned dosage is 1–7 days away; do not take more than one 150-mg tablet in the same week.
Administration of IV fluids.
A health-care practitioner should administer the medication by IV injection once every three months. Injections must only be delivered intravenously; the safety and effectiveness of IV injections provided through other routes have not been verified. Because there is a potential of anaphylaxis or other serious hypersensitivity responses during IV administration, proper medical assistance should be promptly accessible. (See Hypersensitivity in the Cautions section.) If a dosage is missed, reschedule it as soon as possible with a health-care practitioner. Schedule further injections at 3-month intervals; injections should not be given more than once every 3 months.
Administration Dangers.
Take care to avoid intra-arterial or paravenous injections, since they might cause tissue injury.
Rate of Administration.
Administer IV during a 15–30 second interval.
Dosage
Ibandronate sodium (monosodium monohydrate) is available; dose is indicated in terms of ibandronate.
Adults
Postmenopausal Women Osteoporosis Prevention Oral 150 mg once monthly.
Oral Osteoporosis Treatment for Postmenopausal Women.
150 mg once a month
The optimal period of therapy has not been determined. Safety and effectiveness are based on data collected over a three-year period. In all patients taking bisphosphonates, the requirement for continuing treatment should be reassessed on a regular basis. In individuals with low risk of fracture, consider discontinuing bisphosphonate medication after 3–5 years. In patients who have stopped taking their medication, the risk of fracture should be assessed on a regular basis.
Every three months, an IV of three milligrammes is administered.
The optimal period of therapy has not been determined. Based on evidence confirming fracture reduction after a year of therapy, the safety and effectiveness of IV ibandronate were determined. In all patients taking bisphosphonates, the requirement for continuing treatment should be reassessed on a regular basis. In individuals with low risk of fracture, consider discontinuing bisphosphonate medication after 3–5 years. In patients who have stopped taking their medication, the risk of fracture should be assessed on a regular basis.
People with Disabilities
Impaired Renal Function
In individuals with mild to moderate renal impairment (Clcr 30 mL/minute), no dosage modifications are required; usage is not indicated in patients with severe renal impairment (Clcr 30 mL/minute).
Cautionary Notes Regarding Ibandronate Contraindications.
- Oral: Esophageal anomalies that cause esophageal emptying to be delayed (e.g., stricture, achalasia).
- Uncorrected hypocalcemia, both oral and intravenous.
- Oral and IV: Known hypersensitivity to ibandronate or any of the formulation’s ingredients.
- Oral: Inability to stand or sit straight for more than 60 minutes.
Warnings/Precautions.
Upper Gastrointestinal Effects
Severe esophageal side effects are possible (e.g., esophagitis, esophageal ulcers, erosions, strictures, perforation). (See Dosage and Administration, Oral Administration.) Monitor for signs of dysphagia, odynophagia, new or worsening heartburn, or retrosternal discomfort and cease if they develop. In individuals with active upper GI illness (e.g., Barrett’s oesophagus, dysphagia, various esophageal disorders, gastritis, duodenitis, ulcers), use with care. During the postmarketing period, there were reports of gastric and duodenal ulcers (some serious and with problems).
Administration Pathway.
A health-care professional must deliver the injection IV; do not use non-IV (e.g., intra-arterial) means. (See Dosage and Administration, Administration Risks.)
Effects on Metabolic Rate.
Before beginning medication, correct hypocalcemia, hypovitaminosis D, and other bone and mineral metabolism problems. If your regular intake is insufficient, supplement with calcium and vitamin D.
Jaw Osteonecrosis.
Patients using bisphosphonates have been known to have osteonecrosis and osteomyelitis of the jaw. The majority of instances are related to tooth extraction and/or local infection with delayed healing. Cancer, concurrent treatments (e.g., chemotherapy, corticosteroids, angiogenesis inhibitors), poor oral hygiene, and comorbid diseases (e.g., periodontal and/or other underlying dental disease, anaemia, coagulopathy, infection, ill-fitting dentures) are all known risk factors. The risk may also rise with the length of bisphosphonate usage. If you develop jaw osteonecrosis, see an oral surgeon for treatment. Dental surgery may aggravate the problem. In individuals who need dental operations, discontinuing medication before to the surgery may lower the incidence of jaw osteonecrosis. Individual risk and benefit assessments should be used to manage individuals who need dental care.
