Ibandronic acid (Bondronat)
Ibandronic acid is a type of
It is a treatment to help prevent breaks in the bones (fractures) in people with cancer affecting the bone. You might have it to treat breast cancer that has spread to the bone (secondary breast cancer).
You might also have ibandronic acid to treat high levels of calcium in the blood (hypercalcaemia) caused by secondary bone cancer.
How ibandronic acid works
Ibandronic acid strengthens the bone and stops the bone from breaking down.
How you have it
You can have ibandronic acid into your bloodstream (intravenously) or as a tablet.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
If you don't have a central line
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
Taking your tablets
If taking ibandronic acid as tablets, you take them with a full glass of water in the morning at least 6 hours after you have had anything to eat or drink (with the exception of water).
Wait 30 minutes before you have your first food and drink and before you take any other medicines.
You take the tablets sitting or standing. After taking the tablets you should not lie down for 1 hour.
Do not take ibandronic acid with high calcium drinks or in a hard water area. Use bottled water instead.
You must take tablets according to the instructions your doctor or pharmacist gives you.
Speak to your pharmacist if you have problems swallowing the tablets.
Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more or less.
Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.
When you have it
You might have ibandronic acid as a:
- drip into your bloodstream for 1 to 2 hours if you're having it as a treatment to lower the calcium levels in your blood
- drip into your bloodstream over at least 5 minutes, every 3 to 4 weeks if you're having it as a treatment to prevent or reduce bone damage
- tablet you take once a day
You may also have to take calcium and vitamin D supplements if your levels are low. You will have regular blood tests to check your levels.
How often you have this drug depends on your individual situation. Speak to your healthcare team to find out more about this.
You have blood tests before starting and during your treatment. They check your levels of blood cells and other substances in the blood such as calcium and vitamin D. You might also need to do urine samples for testing and have tests to check how well your heart and kidneys are working.
Your doctor may ask you to see a dentist before and regularly while you're having ibandronic acid.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
Common side effects
Common side effects happen in more than 10 in 100 people (more than 10%). At the time of this review, there have been no reports of common side effects for this treatment.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
It may include high temperature, shivering or shaking, headaches, aching muscles, joints or bone aches. Let your team know straight away if you have a temperature or generally feel unwell.
These symptoms might go away in a few hours or days and may not need treatment.
Increased risk of infection
Increased risk of getting an infection. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Changes to your calcium levels
Ibandronic acid can affect the
Symptoms of too much calcium include:
- feeling tired and weak
- tummy, bone or joint pain
- feeling like you want to pass urine often
Symptoms of too little calcium include:
- tingling or burning in your fingertips and toes
- aching muscles
- muscle cramps
- tiredness and weakness
- dry skin
You have regular blood tests to monitor your calcium levels. Contact the advice line or tell your doctor or nurse if you have any of these symptoms
Headaches and dizziness
Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.
Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.
Clouding of the lens of the eye (cataract)
A cataract is clouding of the lens of the eye which leads to slow loss of vision. You might experience:
- cloudy or blurry vision
- trouble seeing in the dark– night driving may be difficult
- colours may appear faded or dull
- lights appear to be too bright, or there may be a halo around lights
- double vision, which gradually gets worse
Let your doctor or nurse know if you have any of these changes.
Heart problems include changes in how your heart works. These changes might cause you to feel faint and dizzy.
Much less common, it might also cause feelings of your heart to beat faster (palpitations), heart attack or high blood pressure.
Tell your doctor or nurse immediately if any of these happen to you, or you have chest pain.
Your throat might get sore. It may be painful to swallow drinks or food. You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.
Tell your doctor or nurse if your throat is sore.
Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.
Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.
Much less common this drug can cause inflammation of the bowel from infection.
Feeling sick (nausea)
Feeling sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Indigestion or heartburn
Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.
Problems with your teeth
You might get tooth problems while having this drug. Make sure you’re brushing your teeth at least twice a day. Have regular check ups with your dentist. Report any problems with your teeth to your doctor or nurse.
Tummy (abdominal) pain
Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help.
Skin problems that might happen include a skin rash, dryness, itching. You might also get skin colour changes that are flat and look blue or purple in colour like a bruise. It is because blood has leaked from very small blood vessels. It usually gets better after a few weeks.
Much less common you might develop a non cancerous skin growth and rash with this drug.
Pain and stiffness in your joint, bone or muscle
You might feel some aches, pains and stiffness in your joints, bones and muscles. This can make it difficult to get around. Speak to your doctor or nurse about what painkillers you can take to help with this.
Swelling of the legs and feet
Swelling of legs and feet is due to fluid build up. This is called oedema. Let your doctor or nurse know if you have any swelling.
Lack of energy and strength
This is usually mild. You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard and eat a well balanced diet.
Talk to your doctor or nurse if this effect is stopping you from doing your usual daily activities.
Feeling very thirsty
Let your doctor or nurse know if you feel very thirsty or have dry skin. This might be due to dehydration.
Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.
You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.
You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.
Rare side effects
This side effects happens in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:
- inflammation of the bladder (cystitis) symptoms include pain and burning feeling when pass urine, passing small amounts of urine more often, being unable to pass urine or you might have an urgency to go
- inflammation of the vagina (vaginitis) that can cause pain when passing urine or during sex, soreness and itching, discharge and light bleeding
- fluid on the lungs. Let your team know if you have symptoms such as getting short of breath or chest pain.
- low levels of red blood cells in your blood (anaemia)
- low levels of platelets in your blood making it easier to bleed or bruise
- low levels of and enzyme called alkaline phosphate (ALP) in your blood
- problems sleeping
- mood changes and feeling anxious
- problems with bleeding in the brain or a stroke
- nerve problems such as numbness, tingling, weakness, sudden sharp pain
- memory loss
- migraine – symptoms can include a severe throbbing pain, feeling or being sick, dizzy and faint and sensitive to light and noise
- changes to touch, taste and smell
- mouth problems such as ulcers, infection, swollen lips
- loss of hearing or being sensitive to noise - this may be permanent or temporary
- changes to breathing including wheezing
- inflammation of the stomach due to infection – symptoms might include feeling or being sick, stomach pain that burns, indigestion, bloated tummy or loss of appetite
- difficulty swallowing
- hair thinning or loss – this is usually temporary and will grow back when treatment has finished
- fluid filled sac (cyst) on your kidney
- a low body temperature (hypothermia)
- weight loss
- inflammation and injury of the drip site
Damage to the bones (for example in the jaw or thigh) is a rare but serious side effect. Contact your medical team if you have any of the following:
- jaw pain
- discharge from your ear
- an ear infection
- pain in the mouth, teeth or jaw
- loosening of a tooth
- pain or weakness in your hip, thigh or groin
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods and drinks
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
This drug contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.
Pregnancy and contraception
It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment. Let your team know straight away if you or your partner falls pregnant while having treatment.
Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.
Loss of fertility
It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment. For example, if you need treatment for anything else, including teeth problems.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.