Ibandronic acid belongs to a group of drugs called bisphosphonates. It can be used to treat:
- high levels of calcium in the blood caused by cancer that has spread to the bones (secondary bone cancer)
- bone weakness or pain caused by breast cancer that has spread to the bones.
Ibandronic acid can be given with other cancer treatments.
Bones are living and constantly renew themselves. This helps bones keep their strength and shape.
Inside the bones, there are two types of bone cell:
- osteoclasts, which break down and remove old bone
- osteoblasts, which build new bone.
When we are children and young adults our bones keep getting thicker and stronger. But, as we get older, osteoclasts begin to remove more bone than osteoblasts make. This means our bones slowly become thinner (less dense). In some people, too much bone is lost and they have an in-creased risk of bone fractures.
Myeloma and some secondary bone cancers make chemicals that cause osteoclasts to destroy more bone. This means that more bone is destroyed than rebuilt. The affected bone becomes weak and painful and can break more easily.
Bones contain calcium, which gives them strength. A bone affected by secondary cancer or mye-loma may lose calcium from the bones into the blood. A raised level of calcium in the blood is called hypercalcaemia. This may cause you to have symptoms including:
- feeling sick (nausea)
Ibandronic acid reduces the activity of osteoclasts. This can help reduce pain and strengthen the bone.
Ibandronic acid also reduces the amount of calcium that is lost from the bones. This helps calcium levels in the blood return to normal.
You may be given ibandronic acid by drip (infusion) into a vein or as a tablet.
If you are given it as an infusion, it is usually done in the outpatient department at the hospital. The infusion can take up to 1 hour and is usually given once every 3 to 4 weeks.
Ibandronic acid given to lower a high calcium level is usually given in a single dose.
Taking ibandronic acid tablets
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.
Ask your cancer doctor or pharmacist if you are not sure how to take the tablets.
- Take the tablet first thing in the morning.
- Take it when you have an empty stomach. This means you should not eat or drink anything, or take any other medicines, for at least 6 hours before you have the tablet.
- Do not suck, chew or crush the tablet.
- Swallow it whole, with a full glass of plain tap water.
- 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 (the tube that goes from your mouth to your stomach).
- Stay sitting up straight or standing for 1hour after you have taken the tablet. If you are in bed, sit upright supported with pillows.
- After you have swallowed the tablet, do not eat, drink anything (other than tap water), or take any other medicines by mouth for at least 1 hour.
- If you miss a dose, call your doctor or pharmacist for advice on when you should take it.
You usually need to take ibandronic acid for at least 6 months before it has the maximum effect on your bones. After that, you can usually take it for as long as it is working well.
We explain the most common side effects of this treatment here. We also include some less common side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Sore throat, or indigestion
This may be a sign that the drug is irritating your throat or gullet (the tube that goes from the mouth to the stomach). If swallowing is painful or difficult, or if you have indigestion that is new or getting worse, tell your doctor before taking any more ibandronic acid.
- a high temperature
- pains in your muscles or joints.
Tell your doctor if these effects do not get better within 2 days or are causing problems. It may be helpful to take mild painkillers such as paracetamol. Your doctor, nurse or pharmacist can give you advice.
You may feel sick or be sick (vomit) during treatment. This is usually mild. Your doctor can prescribe anti-sickness tablets to help.
Take the drugs exactly as your nurse or pharmacist tells you to. It is easier to prevent sickness than treat it after it has started.
Abdominal (tummy) pain
Tell your doctor if you have abdominal (tummy) pain that is severe, or continues.
Diarrhoea or constipation
Tell your doctor if you have diarrhoea or constipation. They can give you medicine to help with this. Try to drink at least 2 litres (3½ pints) of fluids each day.
Headaches and dizziness
You may have headaches or feel dizzy at times when taking this treatment. Tell your doctor if you notice these symptoms.
You may feel more tired than usual. Tell your doctor if this is a problem.
Increased bone pain
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.
Numbness or tingling
You may notice numbness or tingling around the mouth, or in the fingers and toes. This may be caused by low levels of calcium in your blood. You will have regular blood tests to check your calcium levels. Contact your doctor straight away if you have these symptoms.
You may be asked to take calcium and vitamin D supplements, unless you are having this treatment to lower the levels of calcium in your blood. Your doctor will let you know if any supplements are needed.
Changes in your blood
Ibandronic acid may cause changes in the blood. For example, it can cause a low level of red blood cells (anaemia). Symptoms of anaemia include feeling very tired and breathless. Your doctor can do blood tests to check this.
Effect on the kidneys
This treatment can affect how your kidneys work. Drinking plenty of fluids will help your kidneys work well. You will have blood tests to check how well your kidneys are working. Tell your doctor if:
- you feel generally unwell
- have any swelling of your face, arms, legs or tummy
- you notice a change in how often you pass urine (pee).
This treatment can cause a rash. Tell your doctor if this happens. They can give you advice and may give you creams and medicines to help.
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless or wheezy
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.
Sometimes a reaction happens a few hours after treatment. If you develop any signs or feel unwell after you get home, contact the hospital straight away.
Pain in the thigh, hip or groin
Rarely, people having this treatment develop a break (fracture) in their thigh bone without any obvious cause. Sometimes both thigh bones are affected.
If you have any thigh, hip or groin pain, tell your doctor and mention that you are taking bisphosphonates. They can arrange tests to check the thigh bones for any signs of 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:
- loosening of the teeth
- problems with the way the gums heal.
The risk of jaw problems is higher after some types of dental treatment and in people who have gum disease or 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.
To reduce your risk of developing jaw problems your doctor will advise you to:
- have a full dental check-up before starting treatment
- look after your teeth and gums during treatment (ask your dentist for advice)
- tell your dentist you are taking a bisphosphonate before having any dental treatment.
Tell your cancer specialist and dentist straight away if you at any time you develop:
- swelling or redness in your gums
- numbness or heaviness in your jaw
- loose teeth.
Very rarely, 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.
Going into hospital
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.