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
- bone weakness or pain caused by breast cancer that has spread to the bones.
Cancer that has spread to the bones is called secondary bone cancer. It happens when cells from the original (primary) cancer spread to form a new tumour (secondary cancer or metastasis) in the bone.
Ibandronic acid can be given with other cancer treatments.
In normal bones, two types of cell work together to keep your bones healthy. They are:
- osteoclasts, which destroy old bone
- osteoblasts, which build new bone.
Myeloma and some secondary bone cancers make chemicals that cause osteoclasts to work harder. 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 myeloma may lose calcium 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) or as a tablet.
If you are given it as an infusion, it is usually done in the outpatient department at the hospital. Ibandronic acid is given by a drip into the vein through a fine tube called a cannula. The infusion can take up to an 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.
It is best to 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 take the tablet. Do not suck, chew or crush the tablet. Swallow it whole, with a full glass of plain tap water (not bottled mineral water).
You need to sit up straight or stand up when you swallow it. 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 an hour after you have taken the tablet. If you are in bed, prop yourself up 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.
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.
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.
Some people have very few side effects while others may have more. The side effects described below do not affect everyone taking ibandronic acid. If you are taking other drugs, you may have some side effects that we do not list here.
We explain the most common side effects here, but have not included those that are rare and therefore unlikely to affect you. If you notice any effects that are not listed below, tell your cancer doctor or specialist nurse.
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.
Feeling sick (nausea)
You may feel sick or be sick (vomit) during treatment for ibandronic acid. This is usually mild. Your doctor can prescribe anti-sickness drugs 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.
Tell your doctor if you have diarrhoea or constipation. They can give you medicine to help with this. Remember to drink at least 2 litres (3½ pints) of fluids a 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.
Sometimes pain in the affected bone gets worse for a short time when you start taking ibandronic acid. 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.
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.
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. Your doctor will check how well your kidneys are working with regular blood tests.
Rarely, this treatment may cause an allergic reaction.
Signs of an allergic reaction can include:
- a faster heartbeat
- swelling in your face
- skin reactions
- pain in your back, tummy or chest
- a rash or bruising on your skin
- flu-like symptoms.
Tell your nurse straight away if you think you may be having an allergic reaction. If you develop these symptoms when you are at home, contact the hospital straight away on the number you have been given. They can give you advice.
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 jaw bone. 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. It is also higher 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 jaw bone when you are having bisphosphonates. This includes having a tooth or root removed or dental implants put in. It is fine to 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 doctor and dentist straight away if 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.
It is important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they are not mentioned above.
Going into hospital
If you are admitted to hospital for a reason not related to the cancer, it is important to tell the doctors and nurses that you are having treatment with bisphosphonates. You should tell them the name of your cancer doctor so they can ask them for advice.
It is a good idea to find out who you should contact if you have any problems or difficult side effects when you are at home. Your cancer doctor or specialist nurse can give you advice about this.
Some medicines can increase the side effects of this treatment or make it work less well. This includes medicines and supplements you can buy in a shop or chemist. Tell your cancer doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Pregnancy and breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Women are also advised not to breastfeed when taking this treatment. This is because the medicine may be passed to the baby through the breast milk.