Ibandronate Sodium

Last Reviewed: Oct 28, 2024

Warnings

Ibandronate (Boniva) Risks, Warnings, and Complications

Ibandronate may cause or worsen health problems in some postmenopausal women. Talk to your doctor or pharmacist about other treatment options for osteoporosis if you are at an increased risk of adverse events from this drug. Some of the risks of taking ibandronate include:

UPPER GASTROINTESTINAL IRRITATION: Ibandronate and other oral bisphosphonates can cause local irritation of the mucosa (lining) of the upper gastrointestinal tract. There are reports of severe esophageal complications, including esophagitis (inflammation) and esophageal ulcers, erosions, bleeding, stricture, and perforation after treatment with oral bisphosphonates.
This medicine should therefore be used with caution in people with underlying conditions such as dysphagia (difficulty swallowing), Barrett's esophagus, other esophageal conditions, gastritis, duodenitis, and gastric or duodenal ulcers.
The risk of esophageal complications is higher if you lie down after taking a dose of ibandronate or if you do not take ibandronate tablets with a full glass of plain water. If you are unable to comply with these dosing instructions for oral ibandronate, talk to your doctor about taking an ibandronate sodium injection instead.
Stop taking ibandronate and seek immediate medical attention if you develop difficulty swallowing, pain with swallowing, upper chest pain, or new or worsening heartburn.
HYPOCALCEMIA: Your healthcare provider will treat hypocalcemia (low blood calcium levels) and other bone and mineral disturbances before starting treatment with ibandronate. You will need to have adequate calcium and vitamin D intake while on this drug to prevent hypocalcemia.
BONE, JOINT, AND MUSCLE PAIN: There are reports of severe pain in the bones, joints, and muscles in people taking ibandronate and other bisphosphonates. This severe bone, joint, and muscle pain can occur anytime from one day to several months or even years after starting this medicine. In most people, the pain stops after treatment is discontinued. Some people have a recurrence of pain when they retry ibandronate or another bisphosphonate. Your doctor may advise stopping ibandronate therapy if you develop severe pain.
OSTEONECROSIS OF THE JAW: Osteonecrosis of the jaw (ONJ) is the death of bone tissue in the jaw and has been reported in patients treated with bisphosphonates, including ibandronate. Most of the cases have occurred in cancer patients undergoing dental procedures, but there are reports of jaw osteonecrosis in patients with other diagnoses as well.
Known risk factors for jaw osteonecrosis include a cancer diagnosis, cancer treatments (chemotherapy, radiotherapy, corticosteroids), co-existing disorders such as infections, anemia, coagulopathy (blood clotting disorders), and dental disease. The risk is greater in people who receive intravenous bisphosphonate injections but can also occur after oral treatment.
If osteonecrosis of the jaw develops while on bisphosphonate therapy, dental surgery can worsen it. There is no data on whether discontinuing bisphosphonate treatment before dental procedures reduces the risk of osteonecrosis of the jaw.
Your doctor will carefully weigh the benefits versus risks of ibandronate therapy. They will recommend getting a dental exam and any required dental procedures before starting ibandronate treatment. It may not be safe to get procedures such as a tooth extraction or dental implants while on bisphosphonates.
Tell your doctor without delay if you experience severe pain in the jaw, numbness or heaviness in the jaw, gum pain or swelling, poor healing in the gums after dental treatments, or loose teeth while on ibandronate.
SEVERE RENAL IMPAIRMENT: Ibandronate is contraindicated in patients with kidney problems (severe renal impairment with creatinine clearance less than 30 mL/minute).

Precautions Before Starting Ibandronate (Boniva)

Tell your healthcare professional if you have ever had allergic reactions to ibandronate, any of the active or inactive ingredients in ibandronate tablets, other bisphosphonate drugs, or any other drugs. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of all your medications, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible interactions.

Give your doctor a complete medical history. Ibandronate may not be safe for people with certain medical conditions such as anemia, dysphagia (difficulty swallowing), acid reflux or heartburn, stomach ulcers, any esophagus, stomach, or intestine problems, infections, cancer, cancer treatment, problems with your mouth, gums, or teeth, blood clotting problems, or kidney disease.

You should have a dental exam and any necessary dental treatments, including cleaning, fixing of poorly fitting dentures, or tooth extraction, before you start taking ibandronate.

Tell your doctor if you are pregnant, could be pregnant, or are planning a pregnancy at any time in the future. Ibandronate can stay in your body for many years after you stop taking it. Also, tell your healthcare provider if you are nursing an infant with breast milk.

Precautions During Use of Ibandronate (Boniva)

Keep all your medical and lab appointments while taking ibandronate.

Take ibandronate on an empty stomach, first thing in the morning after you get out of bed. Make sure you take the medicine with a full glass of plain water.

Do not eat your first food, drink anything, or take any other oral medications or dietary supplements (vitamins, calcium, antacids) before and for at least 60 minutes after your dose of ibandronate. Remain standing or sitting upright for at least 60 minutes after you take this medicine. These dosing instructions are important. Failure to follow them can cause damage to your mouth and esophagus.

Practice good oral hygiene by brushing your teeth and cleaning your mouth properly while on this medicine. Tell your dentist you are on ibandronate before any dental treatments.

Ibandronate can cause severe bone, muscle, or joint pain in some people. This can happen days, months, or years after you start treatment with this drug. Tell your doctor immediately if you experience severe pain at any point during ibandronate therapy. You may need to stop taking this medicine. The pain usually goes away when treatment is discontinued.

Talk to your doctor about other ways to prevent osteoporosis or prevent it from getting worse. You should avoid smoking and heavy drinking. Your provider will also recommend getting regular weight-bearing exercise.

Ibandronate (Boniva) Drug Interactions

Taking ibandronate with certain other medications can affect how it works. Drug interactions with other medicines can also increase the risk of severe adverse events. Some of the medications that can interact with ibandronate include:

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Naprelan, Aleve)
Cancer medications (angiogenesis inhibitors) such as everolimus (Afinitor, Zortress), bevacizumab (Avastin), sorafenib (Nexavar), pazopanib (Votrient), or sunitinib (Sutent)
Cancer chemotherapy drugs
Oral corticosteroids such as dexamethasone, prednisone (Rayos), and methylprednisolone (Medrol)

The above list may not describe all the potential interactions of ibandronate. Give your doctor or pharmacist a complete list of your other medicines, including prescription medications, over-the-counter medications, dietary supplements, and herbal products. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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