Ibandronic acid

Bones are living and constantly renew themselves. This helps bones keep their strength and shape.

Inside the bones, there are 2 types of bone cell:

• osteoclasts, which break down and remove old bone
• osteoblasts, which build new bone.

When we are children and young adults our bones keep getting thicker and stronger. But, as we get older, osteoclasts begin to remove more bone than osteoblasts make. This means our bones slowly become thinner (less dense). In some people, too much bone is lost and they have an in-creased risk of bone fractures.

Myeloma and some secondary bone cancers make chemicals that cause osteoclasts to destroy more bone. 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 mye-loma may lose calcium from the bones 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)
• vomiting
• tiredness
• irritability
• confusion.

You may be given ibandronic acid by drip (infusion) into a vein or as a tablet.

If you are given it as an infusion, it is usually done in the outpatient department at the hospital. The infusion can take up to 1 hour. It is usually given every 3 to 4 weeks.

If you are having ibandronic acid to lower a high calcium level, you usually only have one dose of treatment.

If you are having ibandronic acid as tablets, your cancer doctor, nurse or pharmacist will give you the tablets to take at home. 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, nurse or pharmacist if you are not sure how to take the tablets.

• 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 have the tablet.  
• Do not suck, chew or crush the tablet.
• Swallow it whole, with a full glass of plain tap water.  If you cannot swallow or have difficulty swallowing, you must tell your doctor or pharmacist. 
• You need to sit up straight or stand up when you swallow the tablets. 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 1 hour after you take the tablet. If you are in bed, sit upright supported with pillows. 
• After you take the tablet, do not eat, drink anything (other than tap water), or take any other medicines by mouth for at least 30 minutes to 1 hour. The exact length of time you need to wait will depend on your dose of ibandronic acid. Your doctor or pharmacist will give you more information about this. 
• If you miss a dose, contact your cancer doctor, nurse or pharmacist for advice on when you should take it.

Ibandronic acid can be given with other cancer treatments.

Rarely, this treatment can affect the jawbone. You can read more about this in the “Less common side effects” section below.

Having a healthy mouth and teeth reduces your risk of jaw problems. You usually need a dental check-up to check for any problems before you start treatment.

If you need urgent treatment to lower high calcium levels in your blood, you do not usually need a dental check-up first.

Some people have flu-like symptoms, such as:

• a high temperature
• chills
• 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.

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.

You may feel sick or be sick (vomit) during treatment. This is usually mild. Your doctor can prescribe anti-sickness tablets 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.

Tell your doctor if you have abdominal (tummy) pain that is severe, or continues.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

You may have headaches or feel dizzy at times when taking this treatment. Tell your doctor if you notice these symptoms.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

Sometimes pain in the affected bone gets worse for a short time when you start taking this treatment. If this happens, your doctor can prescribe painkillers to help.

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. Your doctor will let you know if you need any supplements.

You may get a bitter or strange taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Your doctor or nurse can give you more advice.

This treatment can cause a rash. Tell your doctor if this happens. They can give you advice and may give you creams and medicines to help.

This treatment can cause eye problems. If you have any of these symptoms during treatment or after it finishes, contact your doctor straight away:

• double vision
• redness or inflammation
• eye pain
• eyes that are sensitive to light
• changes to your eyesight - things appear blurry or faded.

You may need to have an eye check with a specialist eye doctor (ophthalmologist).

Ibandronic acid tablets contain lactose. If you have an intolerance to some sugars, talk to your doctor before taking this treatment

Ibandronic acid is not usually given to people who are pregnant as it may harm a developing baby. If you are pregnant or if you think you might be pregnant or are planning to have a baby, you must tell your doctor as early as possible.

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.