Ibandronate

Bisphosphonates (BP) are today the first line treatment of benign and malignant bone diseases. As pyrophosphate analogues (Fig. 3), BP accumulate in bone and are taken up by osteoclasts. Once in the cell, the nitrogen-containing BP (N-BP) such as Alendronate, Risedronate, Ibandronate and Zoledronate effectively inhibit osteoclast resorption and induce cell... 

Bone Metabolism. Figure 3 Chemical structure of pyrophosphate (a) and the bisphosphonates etidronate (b), clodronate (c), pamidronate (d), ibandronate (e). alendronate (f), risedronate (g), zoledronate (h). 

In placebo-controlled clinical trials, alendronate, ibandronate, and risedronate increased bone mineral density by up to 5% to 8% in the lumbar spine and up to 3% to 5% in the hip.13-16 Additional data suggest that bone mineral density continues to increase with long-term therapy of 7 to 10 years.17,18... 

Large, well-designed trials have proven the benefits of bis-phosphonate therapy in preventing vertebral and nonvertebral fractures. Several studies have found decreases in vertebral fracture risk by as much as 40% to 50% with alendronate and risedronate.13,14,19-21 Data suggest a similar reduction with ibandronate on vertebral fractures.16,22 Alendronate and risedronate decrease the incidence of hip and nonvertebral fractures as well.14,19,23... 

Ibandronate 2.5-, 150-mg Treatment or prevention of Same as alendronate except administer 76 for 150-mg... 

There is considerable interest in using injectable bisphosphonates, such as pamidronate and zoledronic acid, in patients unable to tolerate or absorb oral bisphosphonates. Zoledronic acid in particular has a potential advantage of once-yearly dosing. Currently, neither drug has received FDA approval for this indication. Ibandronate has recently been approved for this indication. 

Alendronate, risedronate, and oral ibandronate are FDA approved for prevention and treatment of postmenopausal osteoporosis. IV ibandronate and zoledronic acid are indicated only for treatment of postmenopausal women. Risedronate and alendronate are also approved for male and glucocorticoid-induced osteoporosis. 

Intravenous bisphosphonates Ibandronate (Boniva) Zoledronic add0 (Reclast) 5 mg IV infusion yearly... 

Ibandronate 2-6 mg IV bolus 2 days Renal insufficiency Fever, musculoskeletal pain... 

Bonviva consists of ibandronic acid, a bisphosphonate and is available as 150 mg tablets and 1 mg/mL injection. Patients receiving the oral formulation for the treatment of postmenopausal osteoporosis are advised to take one tablet once a month. Absorption of bisphosphonates from the gastrointestinal tract may be effected by food or other administered drugs. Therefore patients are advised to take the Bonviva 150 mg tablet at least 1 hour before breakfast or another oral medicine and to continue standing or sitting upright for at least 1 hour after administration. 

Q75 Use of ibandronic acid leads to an increase in the bone mineral density at the spine. Ibandronic acid interferes with bone mineralization and results in an overall increase in bone remodelling and bone turnover. 

Ibandronic acid is classified as a bisphosphonate and is used in the management of osteoporosis. It acts selectively on the bone mass, decreasing the osteoclast activity and hence resulting in an increase in bone mass, including the spine cavity. 

Osteoporosis (alendronate, risedronate, ibandronate) (alendronate/cholecalciferol treatment only) ... 

Administration - To maximize absorption and clinical benefit, patients should take ibandronate at least 60 minutes before the first food or drink (other than water) of the day or before taking any oral medication or supplementation, including calcium, antacids, or vitamins. 

To facilitate delivery to the stomach and reduce the potential for esophageal irritation, ibandronate tablets should be swallowed whole with a full glass of plain water (180 to 240 ml 6 to 8 oz) while the patient is standing or sitting in an upright position. Patients should not lie down for 60 minutes after taking ibandronate. 

Patients should drink only plain water with ibandronate. Please note that some mineral waters may have a higher concentration of calcium and therefore should not be used. 

A patient should take the ibandronate 150 mg tablet on the same date each month (ie, the patient s ibandronate day). 

Missed monthly dose - If the once-monthly dose is missed, and the patient s next scheduled ibandronate day is more than 7 days away, instruct the patient to take 1 ibandronate 150 mg tablet in the morning following the date that it is remembered. The patient then should return to taking 1 ibandronate 150 mg tablet every month in the morning of the chosen day, according to the original schedule. 

Ibandronate - Ibandronate is not recommended for use in patients with severe renal impairment (creatinine clearance [Ccr] less than 30 mL/min). 

Ibandronate (Boniva) [Bone Resorption Inhibitor/ Bisphosphonate] Uses Rx prevent osteoporosis in postmenopausal... 

Agents include etidronic acid, pamidronic acid, clodronic acid, alendronic acid, ibandronic acid, rise-dronic acid, zoledronic acid and tiludronic acid. Formulations of clodronic acid and pamidronic acid are available for intravenous administration. The indications for the use of bisphosphonates include treatment of postmenopausal osteoporosis, hypercal-caemia of malignancy and Paget s disease. 

In post-menopausal women with osteoporosis oral biphosphonate treatment is associated with an increase of BMD and a more than 40% reduced risk of hip fracture. To increase compliance once monthly 150 mg oral ibandronate is introduced, which is equally effective as an oral dose of 2.5 mg once daily. Intravenous drips of ibandronate 2-3 mg... 

Dehnas PD, Adami S, Strugala C, Stakkestad JA, Regin-ster JY, Eelsenherg D et al. Intravenous Ibandronate injections in postmenopausal women with osteoporosis one-year results from the dosing intravenous administration study. Arthritis Rheum 2006 54 1838-46. 

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