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Bisphosphonate

Ibandronic acid

Brand names: Bonviva, Bondronat

Ibandronic acid is a nitrogen-containing bisphosphonate used to treat osteoporosis and to manage bone metastases and hypercalcaemia of malignancy.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 150 mg — one 150 mg film-coated tablet once a month
Route: Oral
Frequency: Once a month, preferably on the same date each month; taken after an overnight fast of at least 6 hours and 1 hour before the first food or drink (other than water) of the day
SCOPE — this covers only the page's primary regimen: ORAL once-monthly ibandronic acid for osteoporosis (§4.2 refers to 'the optimal duration of bisphosphonate treatment for osteoporosis'; §4.6 states the product 'is only for use in postmenopausal women and must not be taken by women of childbearing potential'). The fetched bundle is the 150 mg oral tablet SPC ONLY: it contains NO intravenous regimen and NO oncology posology, so the page's IV route and its bone-metastases / tumour-induced-hypercalcaemia indications remain UNSOURCED here and must not be inferred from these figures. Verbatim §4.2: 'The recommended dose is one 150 mg film-coated tablet once a month. The tablet should preferably be taken on the same date each month. Ibandronic acid should be taken after an overnight fast (at least 6 hours) and 1 hour before the first food or drink (other than water) of the day (see section 4.5) or any other oral medicinal products or supplementation (including calcium).' Administration, verbatim: 'Tablets should be swallowed whole with a glass of water (180 to 240 ml) while the patient is sitting or standing in an upright position. Water with a high concentration of calcium should not be used... Patients should not lie down for 1 hour after taking Ibandronic acid. Water is the only drink that should be taken with Ibandronic acid. Patients should not chew or suck the tablet, because of a potential for oropharyngeal ulceration.' Missed dose, verbatim: 'patients should be instructed to take one Ibandronic acid 150 mg tablet the morning after the tablet is remembered, unless the time to the next scheduled dose is within 7 days... Patients should not take two tablets within the same week.' Supplementation, verbatim: 'Patients should receive supplemental calcium and / or vitamin D if dietary intake is inadequate.' Duration, verbatim: 'The optimal duration of bisphosphonate treatment for osteoporosis has not been established. The need for continued treatment should be re-evaluated periodically based on the benefits and potential risks of ibandronic acid on an individual patient basis, particularly after 5 or more years of use.' Elderly (>65 years), verbatim: 'No dose adjustment is required.' maxDose is left EMPTY on purpose: the SPC states no maximum dose for this regimen — the only ceiling-like statement is the missed-dose rule 'Patients should not take two tablets within the same week', which is a frequency rule, not a maximum dose. PAEDIATRIC, verbatim §4.2: 'There is no relevant use of Ibandronic acid in children below 18 years, ibandronic sodium was not studied in this population (see section 5.1 and section 5.2).' — hence paedDose is null.

Dose adjustments

Renal

Verbatim §4.2: 'Ibandronic acid is not recommended for patients with a creatinine clearance below 30 ml/min due to limited clinical experience (see section 4.4 and section 5.2). No dose adjustment is necessary for patients with mild or moderate renal impairment where creatinine clearance is equal or greater than 30 ml/min.'

Hepatic

Verbatim §4.2: 'Hepatic impairment No dose adjustment is required (see section 5.2).'

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to ibandronic acid or to any of the excipients (§4.3)
  • Hypocalcaemia (§4.3)
  • Abnormalities of the oesophagus which delay oesophageal emptying, such as stricture or achalasia (§4.3)
  • Inability to stand or sit upright for at least 60 minutes (§4.3)

Side effects

  • §4.8 summary — most serious: 'anaphylactic reaction/shock, atypical fractures of the femur, osteonecrosis of the jaw, gastrointestinal irritation, ocular inflammation'; most frequent: 'arthralgia and influenza-like symptoms', 'typically in association with the first dose, generally of short duration, mild or moderate in intensity, and usually resolve during continuing treatment'
  • Musculoskeletal — common: arthralgia, myalgia, musculoskeletal pain, muscle cramp, musculoskeletal stiffness; uncommon: back pain; rare/very rare: atypical subtrochanteric and diaphyseal femoral fractures
  • Gastrointestinal — common: oesophagitis, gastritis, gastro-oesophageal reflux disease, dyspepsia, diarrhoea, abdominal pain, nausea; uncommon: oesophagitis including oesophageal ulcerations or strictures and dysphagia, vomiting, flatulence; rare: duodenitis
  • Nervous system — common: headache; uncommon: dizziness
  • Immune — uncommon: asthma exacerbation; rare: hypersensitivity reaction; very rare/not known: anaphylactic reaction/shock
  • Metabolism — hypocalcaemia
  • Eye — ocular inflammation
  • Skin — common: rash; uncommon: angioedema, face oedema, urticaria; very rare: Stevens-Johnson syndrome, erythema multiforme, bullous dermatitis
  • Osteonecrosis of the jaw — §4.4: 'reported very rarely in the post marketing setting in patients receiving ibandronic acid for osteoporosis'
  • Osteonecrosis of the external auditory canal — §4.4: 'reported with bisphosphonates, mainly in association with long-term therapy'; consider it 'in patients receiving bisphosphonates who present with ear symptoms including chronic ear infections'

Monitoring

  • Correct hypocalcaemia BEFORE starting — §4.4, verbatim: 'Existing hypocalcaemia must be corrected before starting Ibandronic acid therapy. Other disturbances of bone and mineral metabolism should also be effectively treated. Adequate intake of calcium and vitamin D is important in all patients.'
  • Upper GI / oesophageal symptoms — §4.4, verbatim: 'Physicians should be alert to any signs or symptoms signalling a possible oesophageal reaction and patients should be instructed to discontinue Ibandronic acid and seek medical attention if they develop dysphagia, odynophagia, retrosternal pain or new or worsening heartburn.'
  • Dental assessment before starting or restarting — §4.4: 'The start of treatment or of a new course of treatment should be delayed in patients with unhealed open soft tissue lesions in the mouth. A dental examination with preventive dentistry and an individual benefit-risk [assessment]' (sentence truncated in the fetched text).
  • Ear symptoms — §4.4: consider osteonecrosis of the external auditory canal in patients presenting with ear symptoms including chronic ear infections.
  • Periodic re-evaluation of the need to continue — §4.2: 'particularly after 5 or more years of use'.
  • Adherence to the dosing instructions — §4.4: 'The risk of severe oesophageal adverse experiences appears to be greater in patients who do not comply with the dosing instruction and/or who continue to take oral bisphosphonates after developing symptoms suggestive of oesophageal irritation.'

Clinical monograph

How it works

It binds avidly to bone mineral and inhibits osteoclast-mediated bone resorption, reducing bone turnover and fracture risk.

Prescribing in practice

  • Oral doses must be taken on an empty stomach with plain water while sitting or standing upright and remaining so afterwards, to reduce the risk of oesophageal irritation and ulceration.
  • Correct hypocalcaemia and ensure adequate calcium and vitamin D before starting, and assess dental health given the risk of osteonecrosis of the jaw.
  • Use is restricted in significant renal impairment; review against current prescribing references.

Monitoring

Monitor renal function and serum calcium, and reinforce dental review for osteonecrosis-of-the-jaw risk during treatment.

Counselling the patient

  • Follow the dosing instructions exactly: take with water on an empty stomach and stay upright, not lying down, afterwards.
  • Maintain good oral hygiene and report any dental pain, jaw swelling or new thigh or groin pain.
  • Report difficulty or pain on swallowing or new heartburn promptly.

Evidence & guidelines

Bisphosphonates reduce fracture risk in osteoporosis and are recommended within NICE and MHRA-informed prescribing guidance, including warnings on jaw osteonecrosis and atypical femoral fractures.

Reference: NICE TA464; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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