Indications: Reduction of bone damage in bone metastases in breast cancer.

Hypercalcaemia of malignancy, Treatment of postmenopausal osteoporosis.

Cautions: consider dental check-up before initiating bisphosphonate (risk of osteonecrosis of the jaw; atypical femoral fractures, monitor renal function and serum calcium, phosphate and magnesium; cardiac disease (avoid fluid overload).

Contra-indications: hypocalcaemia; oral route abnormalities of the oesophagus and other factors which delay emptying (e.g. stricture or achalasia).

Renal impairment: for treatment of osteoporosis, avoid if eGFR less than 30 ml/minute/1.73 m2; for reduction of bone damage in bone metastases, if eGFR 30–50 ml/minute/1.73 m2 reduce intravenous dose to 4 mg and infuse over 1 hour, reduce oral dose to 50 mg on alternative days, if eGFR less than 30 ml/minute/1.73 m2 reduce intravenous dose to 2 mg and infuse over 1 hour, reduce oral dose to 50 mg once weekly.

Pregnancy: avoid

Breast-feeding: avoid—present in milk in animal studies.

Side Effects: hypocalcaemia, hypophosphataemia, influenza-like symptoms (including fever, chills, and MUSCLE PAIN), bone pain; oesophageal reactions, diarrhoea, nausea, vomiting, gastritis, abdominal pain, dyspepsia, pharyngitis; headache, asthenia, rash; rarely anaemia, atypical femoral fractures, hypersensitivity reactions (pruritus, bronchospasm and angioedema reported); urticaria; injection-site reactions; very rarely osteonecrosis of the jaw, Oesophageal reactions Severe oesophageal reactions reported with all oral bisphosphonates; patients should be advised to stop tablets and seek medical attention for symptoms of oesophageal irritation such as dysphagia, pain on swallowing, retrosternal pain, or heartburn.

Dose: Reduction of bone damage in bone metastases in breast cancer, by mouth, 50 mg daily, or by intravenous infusion, 6 mg every 3–4 weeks.

Hypercalcaemia of malignancy by intravenous infusion, according to serum calcium concentration, 2–4 mg in single infusion.

Treatment of postmenopausal osteoporosis, by mouth, 150 mg once a month or by intravenous injection over 15–30 seconds, 3 mg every 3 months.

Child not recommended.

Counselling Tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes (ibandronic acid tablets, 50 mg) or 1 hour before first food or drink (other than water) of the day, or another oral medicine; patient should stand or sit upright for at least 1 hour after taking tablet.