Ibandronic acid (Bondronat)

Ibandronic acid is a type of bisphosphonate. It is also called Bondronat. Doctors use it to treat cancers that affect the bones, most commonly secondary breast cancer

You may also have ibandronic acid to treat high levels of calcium in the blood (hypercalcaemia) caused by secondary bone cancer.

You may have ibandronic acid

• As a tablet
• Into your vein by drip

As a tablet

You should take the tablet with plenty of water – never milk. You need to take it on an empty stomach. So take it at least 30 minutes before you have a meal or drink, or an hour afterwards. The best time is first thing in the morning before breakfast. You should stay sitting or standing afterwards for an hour. You shouldn't suck, crush or chew the tablet.

It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

Into your vein by drip

Ibandronic acid can go into your vein as a drip (infusion). You have the drip through a fine tube (cannula) in your arm, a central line, a portacath or a PICC line.

You have the drip over 1 to 2 hours. It may be given either

• As a one off treatment to lower the calcium levels in your blood, or
• Every 3 to 4 weeks as a treatment to prevent or reduce bone damage

We have listed the possible side effects below. There is general information about bisphosphonates in the cancer treatment section. For information about coping with side effects you can click on the underlined links or go to the cancer drugs side effects section.

More than 10 in every 100 people have one or more of these.

• A high temperature (fever)
• Low levels of calcium in your blood (hypocalcaemia) – you will have blood tests to check the levels of calcium and other minerals such as potassium, phosphate and magnesium. Usually, the blood test picks up any imbalance before you have any symptoms. A low calcium level can cause changes in sensation so you may have tingling or burning in your lips and tongue
• Bone pain when you first start treatment – you may need stronger painkillers until the pain improves
• Feeling or being sick is usually mild, and you can take anti sickness drugs to control it
• It is not advisable to breastfeed while taking ibandronic acid as the drug may come through in the breast milk
• Low levels of white blood cells may make you more prone to infections than normal
• Headaches or dizziness
• Taste changes
• Changes in parathyroid hormone levels
• Cataract (clouding of the lens of the eye) – let your doctor or nurse know if you have any eyesight changes or can't see in bright light
• Heart changes, which usually go back to normal when the drug is stopped
• Skin changes – you may have a rash
• Tummy pain (abdominal pain)
• Indigestion
• Diarrhoea
• We don't yet know enough about whether ibandronic acid can harm a developing baby – you should not become pregnant while taking this drug. Discuss contraception with your doctor or nurse before you start your treatment if you think that you or your partner could become pregnant

Between 1 and 10 in every 100 people have one or more of these.

• Flu like symptoms, including chills, headaches and aching muscles – this doesn’t usually last for more than a couple of days
• Redness and pain at the injection site
• Inflammation of the bladder or vagina – let your doctor or nurse know if you have any soreness, pain or difficulty when passing urine
• Non cancerous lumps in the skin
• Low levels of red blood cells (anaemia) leading to breathlessness and tiredness
• Difficulty sleeping (insomnia)
• Mood changes
• Problems remembering things
• Migraine or nerve pain in the face
• Smell changes, such as smelling odours that are not present
• Muscle tension
• Increased or lowered sensitivity of the skin
• Sensation of your heart beating fast (palpitations)
• Noisy breathing due to fluid on the lungs
• Mouth ulcers
• Difficulty swallowing
• Hearing loss
• Gallstones
• Hair thinning

Fewer than 1 in 100 people have these.

• Kidney changes – you will have regular blood tests to check how well your kidneys are working
• Osteonecrosis of the jaw can be a side effect of taking bisphosphonates for longer than a year – have a dental check up before you start treatment and tell your dentist that you are having ibandronic acid. Ask your doctor or specialist nurse to advise you about how to keep your mouth clean
• Irritation of the food pipe (oesophagus) can be a side effect of taking bisphosphonate tablets – tell your doctor if you already have a condition of your oesophagus or if you develop pain or difficulty when swallowing
• Fractures at the top of the thigh bone (femur) – let your doctor or nurse know if you have any pain in the top of the leg, your groin, or your hip
• Inflammation of the eye – tell your doctor or nurse if you have sore or red eyes
• Thrush in the mouth

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

For ibandronic acid to work well you need to have good levels of vitamin D and calcium in your body. If you are not able to take in enough vitamin D and calcium in your diet, your doctor will prescribe vitamin D and calcium supplements for you.