Drug Guide
Ibandronate Sodium
Classification
Therapeutic: Bisphosphonate for osteoporosis
Pharmacological: Pyrophosphate analog that inhibits osteoclast-mediated bone resorption
FDA Approved Indications
- Treatment and prevention of osteoporosis in postmenopausal women
Mechanism of Action
Ibandronate binds to hydroxyapatite in bone, inhibiting osteoclast-mediated bone resorption, leading to increased bone mass and strength.
Dosage and Administration
Adult: 150 mg orally once monthly. IV formulation: 3 mg IV every 3 months.
Pediatric: Not approved for pediatric use.
Geriatric: No dosage adjustment necessary based on age alone.
Renal Impairment: Use with caution; contraindicated in severe renal impairment (creatinine clearance <30 mL/min).
Hepatic Impairment: No specific adjustment necessary.
Pharmacokinetics
Absorption: Poor oral bioavailability (~0.6%), absorption decreased by food.
Distribution: Initially binds to bone mineral; minimal distribution to other tissues.
Metabolism: Not metabolized.
Excretion: Primarily excreted unchanged via the kidneys.
Half Life: Approximately 10 days in bone tissue.
Contraindications
- Hypocalcemia
- Hypersensitivity to ibandronate or other bisphosphonates.
- Inability to sit or stand upright for at least 60 minutes (oral).
Precautions
- Renal impairment
- Gastrointestinal disorders causing esophageal abnormalities
- Risk of osteonecrosis of the jaw
- Atypical femoral fractures
Adverse Reactions - Common
- Back pain (Common)
- Musculoskeletal pain (Common)
- Indigestion, pain upon swallowing (Common)
Adverse Reactions - Serious
- Osteonecrosis of the jaw (Rare)
- Atypical femur fracture (Rare)
- Esophageal ulcer, erosion, or perforation (Rare)
Drug-Drug Interactions
- Alendronate, risedronate (risk of additive effects on bone resorption)
Drug-Food Interactions
- Food, calcium, magnesium, and other minerals/antacids decrease absorption—recommend taking on an empty stomach, at least 60 minutes before food or beverages.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor calcium and vitamin D levels, renal function, and dental health.
Diagnoses:
- Imbalanced nutrition: less than body requirements due to gastrointestinal effects.
- Risk for osteonecrosis of the jaw.
Implementation: Administer oral doses first thing in the morning with plain water; patient remains upright for at least 60 minutes. For IV, administer over 15-30 seconds every 3 months.
Evaluation: Assess for improvement in bone mineral density, monitor for adverse effects.
Patient/Family Teaching
- Take with a full glass of plain water on an empty stomach.
- Remain upright for at least 60 minutes after taking.
- Report new or worsening jaw pain, unusual thigh or groin pain, or gastrointestinal symptoms.
- Maintain adequate intake of calcium and vitamin D.
Special Considerations
Black Box Warnings:
- Risk of osteonecrosis of the jaw, mainly after invasive dental procedures.
- Atypical femur fractures with long-term use.
Genetic Factors: No specific genetic factors identified.
Lab Test Interference: May affect calcium and bone turnover markers.
Overdose Management
Signs/Symptoms: Hypocalcemia, esophageal irritation, hypophosphatemia.
Treatment: Discontinue drug; provide calcium and vitamin D; supportive care.
Storage and Handling
Storage: Store at room temperature away from moisture and light.
Stability: Stable when stored properly.