Ibandronic acid

Bone cells constantly renew themselves. This helps bones keep their strength and shape.

There are 2 types of cell inside the bones. These are called: 

• osteoclasts, which break down and remove old bone
• osteoblasts, which build new bone.

As we get older, osteoclasts begin to break down more bone than osteoblasts make to replace it. This means our bones slowly become thinner (less dense). In some people, too much of the bone density is lost and this increases the risk of osteoporosis and bone fractures. 

Some secondary bone cancers make a substance that causes osteoclasts to destroy more bone than can be replaced. The affected bone becomes weak and painful and can break more easily.

Bones contain calcium, which gives them strength. A bone affected by cancer may cause calcium from the bones to be released into the blood. A raised level of calcium in the blood is called hypercalcaemia. This may cause symptoms including:

• feeling sick (nausea)
• being sick (vomiting)
• feeling thirsty
• needing to pee (pass urine) more often 
• constipation
• tiredness
• irritability
• confusion.

When you have your treatment, you will meet someone from your cancer team, such as a:

• cancer doctor
• specialist nurse
• specialist pharmacist.

This is who we mean when we mention doctor, nurse or pharmacist in this information.

During the course of your treatment, you will have regular blood tests. This is to check that it is safe for you to have treatment.

You will meet with a doctor, nurse or pharmacist before you have treatment. They will talk to you about your blood results and ask how you have been feeling.

You may have ibandronic acid by a drip (intravenous infusion) into a vein, or as a tablet. Ibandronic acid can be given with other cancer treatments.

If you are having this treatment to prevent bone problems, you usually need to take ibandronic acid for at least 6 months for it to have the full effect on your bones. Your doctor or nurse can tell you more about this. After that, you can usually take it for as long as it is working well.

If you are given it as an intravenous infusion, you usually have in the outpatient department at the hospital, every 3 to 4 weeks. The infusion can take up to 1 hour. If you are having intravenous ibandronic acid into the vein to treat high calcium levels, you usually only have one dose.

You may have the ibandronic acid infusion through 1 of the following: 

• a cannula – a short, thin tube the nurse puts into a vein in your arm or hand
• a central line – a fine tube that goes under the skin of your chest and into a vein close by
• a PICC line – a fine tube that is put into a vein in your arm and goes up into a vein in your chest
• an implantable port (portacath) – a disc that is put under the skin on your chest or arm and goes into a vein in your chest.

If you are having ibandronic acid as tablets, your cancer doctor, nurse or pharmacist will give you the tablets to take at home. Always take ibandronic acid tablets exactly the way you are told to. This is to make sure they work as well as possible for you. 

Ibandronic acid can attach itself to certain substances in food, drinks and medicines. If this happens, it may not be absorbed properly and may not work as well. This means you need to do the following:

• Take the tablet first thing in the morning. 
• Take it when you have an empty stomach this means at least 6 hours after you last had anything to eat or drink except water, or had any other medicines or supplements. 
• After you take the tablet, do not eat, drink anything (other than tap water), or take any other medicines by mouth for at least 30 minutes to 1 hour. The exact length of time you need to wait will depend on your dose of ibandronic acid. Your doctor or pharmacist will give you more information about this. 
• Do not suck, chew or crush the tablet.
• Swallow the tablet whole, with a full glass of plain tap water. If the water in your area is known to have hard water (possible high levels of calcium in the water), it is advised that you use bottled water with low mineral content. If you cannot swallow or have difficulty swallowing, you must tell your doctor or pharmacist. 
• You need to sit up straight or stand up when you swallow the tablets. This is to make sure the tablet is washed down well. This stops it from irritating your gullet (oesophagus). The gullet is the tube that goes from your mouth to your stomach.
• Stay sitting up straight or standing for 1 hour after you take the tablet. If you are in bed, sit upright supported with pillows. 
• If you miss a dose, contact your cancer doctor, nurse or pharmacist for advice on when you should take it.

Ask your cancer doctor, nurse or pharmacist if you are not sure how to take the tablets.

Ibandronic acid tablets contain lactose. If you have a lactose allergy or intolerance, talk to your doctor, nurse or pharmacist before taking this treatment. They can give you more information.

We explain the most common side effects of this treatment here. We also include some that are less common. 

You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.

Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

• drugs to help control some side effects 
• advice about managing side effects. 

It is important to take any drugs exactly as explained. This means they will be more likely to work for you.

Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Some people have flu-like symptoms, such as:

• a high temperature
• chills
• fatigue (tiredness)
• pains in your muscles or joints. 

Tell your doctor if these symptoms do not get better within 2 days or are getting worse. It may help to take mild painkillers, such as paracetamol. Contact the hospital on the number you have been given. Your doctor, nurse or pharmacist can give you advice. 

Sometimes pain in the affected bone gets worse for a short time when you start taking this treatment. If this happens, your doctor can prescribe painkillers to help.

This treatment can increase the risk of getting an infection. Symptoms of an infection can include:

• feeling cold and shivery
• having a higher or lower than normal temperature
• aching muscles
• headaches
• feeling generally unwell.

Depending on where the infection is you might have other symptoms.

Contact the hospital straight away on the number you have been given if:

• your temperature goes over 37.5˚C (99.5˚F)
• your temperature goes below 36°C (96.8°F)
• you suddenly feel unwell, even with a normal temperature
• you have symptoms of an infection.

You may feel sick or be sick (vomit) while having this treatment. This is usually mild. Your doctor can prescribe anti-sickness drugs to help prevent or control sickness. 

Take the drugs exactly as your doctor, nurse or pharmacist tells you to. It is easier to prevent sickness than treat it after it has started. 

If you have pain in your tummy (abdomen) that is severe or does not go away, contact the hospital straight away on the 24-hour number you have been given.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

You may have headaches or feel dizzy at times when taking this treatment. Tell your doctor if you notice these symptoms.

You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor, nurse or pharmacist. They can give you painkillers and advice. They can also tell you if any of the painkillers you usually take are suitable. 

Tell them if the pain does not get better. Having warm baths and resting regularly may help. 

If you take the ibandronic tablets, they may irritate the throat or gullet (oesophagus). This is the tube that goes from the mouth to the stomach. If you have pain or problems with swallowing or indigestion that is new or getting worse, contact the hospital as soon as possible for advice. Tell your doctor before taking any more ibandronic acid tablets. 

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

You may notice numbness or tingling around the mouth, or in the fingers and toes. Contact your doctor or the hospital straight away if you have these symptoms. This may be caused by low levels of calcium in your blood. You will have regular blood tests to check your calcium levels. 

Your doctor may ask you to take calcium and vitamin D supplements, unless you are having this treatment to lower the levels of calcium in your blood. They will tell you if you need any supplements. This will depend on blood test results.

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

• sucking sugar-free sour or boiled sweets
• eating cold foods
• eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.

This treatment can cause a rash. Always tell your doctor, nurse or pharmacist about any skin changes. They can give you advice or prescribe creams or medicines to help. 

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

This treatment can affect how the kidneys work. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your kidneys are working. Contact the hospital on the 24-hour number if you:

• have blood in your urine (pee) 
• are passing less urine or peeing less often than usual.

Drinking fluids helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.

Rarely, this treatment can cause eye problems. If you have any of these symptoms during treatment or after it finishes, contact the hospital on the 24-hour number straight away. Contact them if:

• you notice any change in your vision, such as double vision or things appear blurry or faded 
• your eyes get red and inflamed (conjunctivitis)
• you have pain in your eyes
• your eyes are sensitive to light 

You may need to have an eye check with a specialist eye doctor (ophthalmologist).

Rarely, people having this treatment develop a break (fracture) in their thigh bone without an obvious cause. Sometimes both thigh bones are affected.

If you have any thigh, hip or groin pain, tell your doctor. Let them know that you are taking bisphosphonates. They can arrange tests to check the thigh bones for any signs of bone weakness or fracture.

Rarely, this treatment can affect the jawbone. Healthy bone in the jaw becomes damaged and dies. This is called osteonecrosis of the jaw (ONJ). It can cause:

• pain
• loosening of the teeth
• problems with the way the gums heal.

The risk of jaw problems is higher:

• after some types of dental treatment
• if you smoke
• if you have gum disease
• if you wear dentures that do not fit well. 

It is important to avoid having any dental treatment that could affect your jawbone when you are having bisphosphonates. This includes having a tooth or root removed, or dental implants put in. You can still have fillings, gum treatments or a scale and polish. Your healthcare team can tell you more.

To reduce your risk of developing jaw problems, your doctor will advise you to:

• have a full dental check-up before starting treatment 
• have good oral hygiene by looking after your teeth and gums during treatment – ask your dentist for advice
• have regular dental check-ups
• tell your dentist you are taking a bisphosphonate before having any dental treatment.

Tell your doctor and dentist straight away if you develop:

• pain
• swelling or redness in your gums
• numbness or heaviness in your jaw
• loose teeth.

Very rarely, the small bones in the outer ear may be affected by this treatment. Always tell your doctor if you have any:

• ear pain
• discharge from your ear
• ear infections.

You should also let them know if you notice any other changes in your ears or hearing.

Very rarely, this treatment can cause a serious skin reaction that needs to be treated immediately in hospital.

Do not take any more of this treatment and contact the hospital straight away on the 24-hour number if you have any of these symptoms:

• a skin rash that is spreading
• blistering or peeling skin
• flu-like symptoms, such as a high temperature and joint pain
• sores on your lips or in your mouth.