Ibandronic acid

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. 

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. 

The treatment of Mrs CR s hypercalcaemia is urgent and requires immediate administration of bisphosphonate therapy, the first choice therapy in cases of severe hypercalcaemia. Currently four bisphosphonates are available in the UK for the treatment of malignant hypercalcaemia - sodium clodronate, disodium pamidronate, zoledronic acid and ibandronic acid. The choice of which bisphosphonate to recommend will depend on which one is on the local hospital formulary. 

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. 

Vogt, U., Bielawski, K.P., Bosse, U., and Schlotter, C.M. (2004). Breast tnmour growth inhibition in vitro through the combination of cyclophosphamide/metotrexate/5-fluoro-uracil, epirubicin/cyclophosphamide, epimbicin/pachtaxel, and epirnbicin/docetaxel with the bisphosphonates ibandronate and zoledronic acid. Oncol Rep 12 1109-1114. 

Bisphosphonates are widely used for the prevention and treatment of osteopenia and osteoporosis and for the reduction of skeletal complications in patients with malignant bone disease. Several oral bisphosphonates, including alendronate, risedronate, and ibandronate, are approved worldwide for the treatment of osteoporosis in postmenopausal women, as are intravenous (i.v.) formulations of ibandronate (3 mg quarterly) and zoledronic acid (5 mg annually). Several i.v. bisphosphonates are available for the treatment of the skeletal complications that frequently occur in malignant disease, such as hypercalcaemia of malignancy (HCM), multiple myeloma, and bone metastases associated with solid tumours. Pamidronate is approved worldwide for the treatment of HCM, multiple myeloma, and breast cancer bone metastases. Although not registered for oncology indications in the United States, i.v. ibandronate is widely available elsewhere for HCM and breast cancer bone metastases. 

Figure 2. Histopathologic findings in the kidney of rats after single or Intermittent dosing of ibandronate or zoledronic acid. PCT = Proximal convoluted tubules. (Reprinted with permission from [47], Copyright Elsevier 2003)...

Cremers S, Weiss M, MoeniusT, Fresneau M, Schmid D, Schran FI. Plasma protein binding of ibandronate and zoledronic acid. J Bone Miner Res 2006 21 (suppi) S286. Abstract SU319. 

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