Ibandronic acid (Bondronat)

Ibandronic acid is a type of bisphosphonate . You pronounce it as i-ban-dron-ik ass-id. It is also known as Bondronat.

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 does ibandronic acid work?

Ibandronic acid strengthens the bone and stops the bone from breaking down.

How do you have ibandronic acid?

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
• portacath

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

You take ibandronic acid tablets in the morning with a full glass of water. You take them at least 6 hours after you last had anything to eat, drink, or any other medicines (with the exception of water).

You will need to wait a while before you have your first food and drink and before you take any other medicines. Your pharmacist will tell you how long to wait.

You take the tablets sitting or standing. After taking the tablets you should not lie down for 1 hour.

Only take ibandronic acid with water. If you live in a hard water area use bottled water instead.

Speak to your pharmacist if you have problems swallowing the tablets. Do not crush, chew or suck them.

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 do you have ibandronic acid?

You might have ibandronic acid as a: 

• drip into your bloodstream for 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 15 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.

Tests

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 kidneys are working.

Your doctor may ask you to see a dentist before and regularly while you're having ibandronic acid.

What are the side effects of ibandronic acid?

Side effects 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:

Flu-like symptoms

It may include high temperature, shivering or shaking, headaches, aching muscles, joints or bone aches. 

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.

Low levels of calcium in the blood

Low calcium levels in the blood can cause painful muscle spasms, cramps or muscle twitching. You might also get numbness or tingling in your feet, hands or around your mouth.

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

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

Heart problems include changes in how your heart works. These changes might cause you to feel faint and dizzy.

Much less commonly, it might also cause palpitations , high blood pressure or a heart attack. 

Tell your doctor or nurse immediately if any of these happen to you, or you have chest pain.

Sore throat

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.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, 2 or more extra loose bowel movements than usual each day. If you have a stoma, you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

More rarely, ibandronic acid can cause inflammation of the bowel from infection. 

Feeling sick (nausea)

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat 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 treatment team if you have this. They can check the cause and give you medicine to help. 

Skin problems

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 more rarely you might develop a non cancerous skin growth or rash with this drug.

Some people might have a severe skin reaction called Stevens-Johnson syndrome. This is rare but can be life threatening. It may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. Contact your healthcare team straight away if you have these symptoms.

Pain and stiffness in your joints, bones or muscles

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 healthcare team about what painkillers you can take to help with this.

Fluid build up in your hands and legs

You may have swelling of your hands and legs due to a build up of fluid (oedema). 

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.

Try to drink 8-10 glasses of fluid a day. This helps to keep you hydrated.

Liver changes

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.

Kidney changes

You might have some changes in the way your kidneys work. You 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 you pee, or a frequent and urgent need 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 shortness of breath or chest pain.

• low levels of red blood cells in your blood (anaemia)

• low levels of and enzyme called alkaline phosphate (ALP) in your blood

• problems sleeping

• mood changes and feeling anxious

• 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

• gallstones

• hair 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 or injury of the drip site in people who have this drug into their bloodstream

Bone problems

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 medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

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 get someone pregnant while you are having treatment. Let your team know straight away if you or your partner become 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.

Breastfeeding

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

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Dental treatment

It is important to see your dentist before you start ibandronic acid, and regularly during your treatment. You should avoid any invasive dental treatment such as extractions while you are having treatment. You can have fillings and routine cleaning.

If you need dental treatment talk to your specialist about whether you should stop your bisphosphonates beforehand. But don't stop taking them without talking to your doctor first.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.