• Ibandronate strengthens bones and may be used for the treatment or prevention of osteoporosis.
• Ibandronate has a high affinity for hydroxyapatite, which is part of the mineral matrix of bone. It works by inhibiting osteoclasts which are responsible for breaking down and reabsorbing bone (by a process known as bone resorption). In postmenopausal women, ibandronate reduces high rates of bone turnover leading to increases in bone mass.
• Ibandronate belongs to a group of medicines known as bisphosphonates.

• Ibandronate is used in the treatment of osteoporosis in postmenopausal women.
• An ibandronate injection only requires administration by a healthcare provider once every three months.
• Ibandronate tablets are taken once a month and can be taken at home.
• Both oral and IV ibandronate are available as generics.

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Heartburn, stomach pain, or diarrhea; back, muscle, or joint pain; a headache, and flu-like symptoms are the most common side effects. Injection-site reactions (such as redness or swelling around the injection site) are common with ibandronate injection.
• The optimal duration of use of ibandronate has not been determined. Clinical studies of ibandronate have only been of one year's duration. Periodically re-evaluate the need for therapy. Discontinuation of therapy should be considered by doctors after 3 to 5 years in patients at low risk of fracture. Patients who discontinue therapy should have their risk for fracture re-evaluated periodically.
• Ibandronate sodium injection must be administered by a healthcare provider. Before administration, a blood test to check serum creatinine levels needs to be done as well as a routine oral examination to rule out osteonecrosis of the jaw (ONJ).
• Oral ibandronate, like other bisphosphonates, may irritate the esophagus and stomach. Some cases have been severe enough to warrant hospitalization. The risk is greater in people who lie down soon after taking oral ibandronate or who don't take it with a full glass of water. Take exactly as directed. Oral ibandronate should be taken on the same day each month, with a full glass of water, and the person taking oral ibandronate should not eat or drink anything else and remain upright for 60 minutes after taking it.
• May not be suitable for some people including those with kidney disease, pre-existing esophageal or gastrointestinal conditions, low blood calcium levels (hypocalcemia), a dental problem, who have difficulty swallowing (applies to oral ibandronate), or who are unable to stand or sit upright for at least 60 minutes after taking oral ibandronate. The dosage of ibandronate may need to be reduced in people with kidney disease.
• There are concerns about the long-term safety of bisphosphonates (such as ibandronate) as long-term use has been associated with atypical femur fractures, osteonecrosis of the jaw, and esophageal cancer. The risk of osteonecrosis of the jaw is greater in those who have received chemotherapy, radiation, or steroids.
• Rarely may cause other side effects including uveitis (eye inflammation) and other adverse effects.
• Ibandronate may interact with aspirin; NSAIDs such as ibuprofen, naproxen, or diclofenac; or supplements containing calcium or magnesium.
• Avoid in pregnancy. Bisphosphonates, such as ibandronate, can cause fetal harm in animals, such as renal pelvis ureter syndrome and interference with natural delivery. Animal data suggest that the uptake of bisphosphonates into fetal bone is greater than into maternal bone. There are no data on fetal risk and pregnancy in humans. It is unknown if ibandronate is excreted into human milk and use should be avoided.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

• Take oral ibandronate first thing in the morning, on the same day each month. Take at least 60 minutes before eating or drinking any food or beverages (other than water), or taking any other medication, including calcium, antacids, or vitamins.
• Take oral ibandronate with a full glass of water and remain upright for at least 60 minutes. Do not lie down. Do not substitute water with mineral water, coffee, soda, juice, or tea. Never take ibandronate at bedtime. Take ibandronate exactly as directed by your doctor. Do not increase or decrease the dosage without your doctor's advice.
• Avoid eating, drinking (other than water), or taking other medications for 60 minutes after taking oral ibandronate.
• You may need to take supplementary calcium or vitamin D if your dietary intake is inadequate. Your doctor will advise you about this. If you are taking supplemental calcium, iron, magnesium, or antacids, take them at a different time of day to oral ibandronate (for example at lunchtime), as they may interfere with the absorption of oral ibandronate. Note that mineral water may contain a higher concentration of calcium than tap or bottled water, and you should only drink it if your doctor has confirmed it is compatible with oral ibandronate.
• Talk to both your dentist and doctor if you require dental surgery or tooth extraction and you have been on ibandronate long-term. They may advise discontinuation of ibandronate.
• Tell your doctor if you experience any thigh or groin pain, muscle cramps or twitches, severe or debilitating muscle pain, eye inflammation, or any other adverse effects of concern while you are taking ibandronate (oral or IV).
• Ibandronate is only FDA-approved for use in postmenopausal women. But if you inadvertently find yourself pregnant, tell your doctor immediately.

• Ibandronate rapidly binds to bone or is excreted unchanged in the urine following administration.
• Administration of ibandronate injection for a year increased lumbar spine bone mineral density (BMD) by 1.1% and hip density by 2.1% after one year.
• Administration of ibandronate tablets for one year increased hip BMD by 1.5% after one year.
• Ibandronate injection appears to be more effective at increasing BMD than ibandronate oral tablets.

Medicines that interact with ibandronate may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with ibandronate. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with ibandronate include:

• aluminum salts
• amikacin
• angiogenesis inhibitors, such as bevacizumab or everolimus
• aspirin
• chemotherapy agents for cancer
• diuretics, such as bumetanide and furosemide
• iron salts
• lithium
• magnesium salts
• NSAIDs, such as ibuprofen, diclofenac, and naproxen
• olsalazine
• oral steroids, such as dexamethasone, prednisone, and methylprednisone
• sirolimus and tacrolimus
• zinc salts.

Note that this list is not all-inclusive and includes only common medications that may interact with ibandronate. You should refer to the prescribing information for ibandronate for a complete list of interactions.