Bisphosphonate (Osteoporosis) Pregnancy: Not indicated for use in women of reproductive potential. There are no data with ibandronate use in pregnant women to inform any drug-associated risks; reproductive toxicity (post-implantation loss, obstruction of labour, maternal and fetal periparturient mortality, kidney developmental toxicity in offspring) was seen in animal studies at multiples of human exposure.

Ibandronate

Brand names: Bonviva, Ibandronic Acid

Ibandronate is a nitrogen-containing bisphosphonate used in the treatment of osteoporosis to reduce fracture risk, and in some malignancy-related bone conditions.

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: One 150 mg tablet

Route: Oral. Swallow the tablet whole with a full glass (6 to 8 oz) of plain water only, while standing or sitting upright; do not chew or suck the tablet

Frequency: Once monthly, on the same date each month

NO UK SPC (eMC) RECORD WAS FETCHED FOR THIS DRUG (providers.emc is null) - this dose is taken from US prescribing information (ibandronate sodium 150 mg tablets, Golden State Medical Supply / Apotex, label date 2026-02-19, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4b35c1c6-29e6-40f7-e063-6294a90ada88) and MUST be verified against UK labelling before use. Administration (US label section 2.2): take at least 60 minutes before the first food or drink (other than water) of the day and before any oral medication or supplement, including calcium, antacids or vitamins, to maximise absorption; avoid mineral water because of its higher calcium concentration; avoid lying down for at least 60 minutes after the dose; do not eat, drink anything except plain water, or take other medicines for at least 60 minutes after the dose. Calcium and vitamin D (2.3): instruct patients to take supplemental calcium and vitamin D if dietary intake is inadequate, but avoid calcium supplements within 60 minutes of ibandronate. Missed once-monthly dose (2.4): if the next scheduled tablet day is more than 7 days away, take one 150 mg tablet on the morning following the date it is remembered; if the next scheduled day is only 1 to 7 days away, wait until the following month's scheduled day; then return to the original monthly schedule. NOTE ON OTHER STRENGTHS: this label's dosage section states only the 150 mg once-monthly regimen (the product is a 150 mg tablet). A 2.5 mg once-daily oral regimen is referred to in the geriatric-use and adverse-reaction sections of the same label as a comparator, but no 2.5 mg daily posology is given in the dosage section and none has been extracted here.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Abnormalities of the oesophagus which delay oesophageal emptying, such as stricture or achalasia
Inability to stand or sit upright for at least 60 minutes
Hypocalcaemia
Known hypersensitivity to ibandronate sodium or to any of its excipients (cases of anaphylaxis have been reported)

Side effects

Back pain
Dyspepsia and other upper gastrointestinal adverse reactions (oesophagitis, oesophageal ulcers and erosions)
Pain in extremity and myalgia (severe bone, joint and muscle pain may occur)
Diarrhoea
Headache
Osteonecrosis of the jaw and atypical femoral fractures have been reported

Interactions

Calcium supplements, antacids and other products containing multivalent cations (aluminium, magnesium, iron) interfere with absorption - take ibandronate at least 60 minutes before any oral medication, and wait at least 60 minutes after dosing before taking other oral medicines
Aspirin and NSAIDs: caution with concomitant use, as aspirin, NSAIDs and bisphosphonates are all associated with gastrointestinal irritation
H2 blockers: co-administration with ranitidine increased ibandronate bioavailability by 20% in healthy volunteers, not considered clinically relevant

Clinical monograph

How it works

It binds to bone mineral and inhibits osteoclast-mediated bone resorption, increasing bone mineral density over time.

Prescribing in practice

Oral doses must be taken with the patient sitting or standing and remaining upright, on an empty stomach with plain water and nothing else for the period specified in the SPC, to reduce oesophageal irritation and aid absorption.
Assess and correct hypocalcaemia and vitamin D deficiency before starting, and counsel on the rare risks of osteonecrosis of the jaw and atypical femoral fractures.
Use with caution in renal impairment and ensure dental health is reviewed before treatment where indicated.

Monitoring

Monitor renal function and calcium status, and review the need for continued therapy periodically in line with current guidance.

Counselling the patient

Take oral tablets exactly as instructed: upright, on an empty stomach with plain water, and do not lie down afterwards.
Report new thigh, hip or groin pain, or any dental problems or jaw pain.
Maintain good dental hygiene and tell your dentist you take this medicine.

Evidence & guidelines

Bisphosphonates reduce fragility fracture risk in osteoporosis, and MHRA advice highlights atypical femoral fracture and osteonecrosis of the jaw as recognised risks.

Reference: NICE TA160/TA464 (Osteoporosis); BONE trial; MHRA Drug Safety Update 2011 (ONJ and AFF); SPC Bonviva; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways