Ibandronic acid is a bisphosphonate. This treatment works by slowing down the rate of bone change. There are 2 types of bone cells; osteoclasts which break down old bone (resorption) and osteoblasts which build up new bone. Ibandronic acid stops osteoclast bone resorption and reduces bone mineral loss. This treatment helps to ensure the balance of these cells is correct and bone stays healthy.
Your treatment
Ibandronic acid tablets are taken once each day continuously.
How to take your medication
Take your tablet in the morning, after an overnight fast (at least 6 hours) and before the first food or drink of the day.
Take the tablet with a full glass of plain water only. Do not take your ibandronic acid with any drink other than plain water.
Do not chew, suck or allow the tablet to dissolve in your mouth.
Remain in an upright position (sitting or standing) while taking the tablet and remain upright for 30 minutes after taking the tablet. This will allow time for it to reach your stomach.
After taking your tablet, wait at least 30 minutes before you drink, eat or take any other medication of the day.
It is important to keep taking ibandronic acid for as long as your clinical team prescribes the treatment. (If you cannot take it there is an alternative 6 monthly intravenous treatment. Please let us know if you would prefer this treatment).
Possible side effects
This treatment can cause many different side effects. Some are more likely to occur than others. Everyone is different and not everyone gets all the side effects. Most side effects are usually temporary, but in some rare cases they can be life-threatening. It is important to tell your clinical team about any side effects so they can be monitored and, where possible, treated.
Common side effects (more than 1 in 10)
Indigestion and altered taste
Some people may have mild symptoms of indigestion, such as acid reflux or heartburn. You may also have a strange taste and/or dry mouth. It is important to tell your clinical team if you have these symptoms, so they can give you the appropriate counselling.
Low calcium levels in the blood
Please tell your GP immediately if you have spasms, twitches or cramps in your muscles, and/or numbness or tingling in your fingers, toes or around your mouth. These are possible symptoms caused by low levels of calcium in your blood. Your doctor will monitor this and can offer you treatment if this happens.
However, you may be given calcium and vitamin D combination supplements as a preventative measure (after your baseline bloods have been checked) to make sure your calcium remains in the normal range. These will continue for the entire time you are on ibandronic acid.
Uncommon side effects (less than 1 in 10)
Flu-like symptoms
Ibandronic acid may cause flu-like symptoms such as fever, fatigue, weakness, drowsiness, headache, chills and aches in your muscles, joints and bones. In most cases, you do not need any specific treatment and the symptoms should improve after a short time. However, taking paracetamol can be helpful with these symptoms.
Nausea, vomiting, diarrhoea and tummy pain
The severity of this varies from person to person and for most people the side effects are not severe. If you do have these symptoms, please contact your GP or cancer team.
Skin reactions
A skin reaction is not very common. Some people may develop a rash and itching. If this happens, please tell your clinical team.
Very rarely, this treatment can cause serious skin reactions that need to be treated immediately. If you have a skin rash that is spreading, blistering or peeling skin, flu-like symptoms such as a high temperature and joint pain, sore on your lips or in your mouth, stop taking the ibandronate and contact the treatment hotline immediately.
Changes in kidney function
You will have a blood test before commencing ibandronic acid and 6 to 12 monthly thereafter. This test is to ensure your corrected calcium and kidney function are within the normal range.
Rare side effects (less than 1 in 100)
Osteonecrosis of the jaw
Very occasionally, a rare side effect can occur with ibandronic acid, when there is necrosis (a loss of bone). This most commonly affects the jawbone. It is called osteonecrosis of the jaw (ONJ) and can be a serious condition. Some of the symptoms are:
pain, swelling or infection of the gums
loosening of the teeth
poor healing of the gums
numbness or feeling of heaviness in the jaw
Very rarely, the small bones in the outer ear may be affected by this treatment. Always tells your cancer team if you have any ear pain, discharge from your ear, ear infections or any changes in your ears or hearing.
Dental guidance
Before you start this treatment, it is essential you have a dental examination with your dentist, and if needed, any dental work. Please refer to the 'Dental letter' for correspondence with a dentist.
How to access an NHS dentist
If you do not have a regular dental practice or are new to where you live, you can search for an NHS dentist near to you or a place of work on the NHS website. Some dentist practices offer both NHS and private appointments, ask for an NHS appointment.
If you need any dental treatment while taking ibandronic acid
While you are having treatment with ibandronic acid, you should try to avoid invasive dental procedures for example having teeth removed. For non-invasive procedures such as tooth fillings, please speak to your dentist or Christie contact.
If you do have to have teeth removed while you are having treatment with ibandronic acid or soon after finishing treatment with ibandronic acid, it is important to discuss this with your clinical team first. They may be able to offer advice on the most appropriate way to proceed.
Dental health and check ups
Try to keep your mouth clean and healthy at all times. You can continue to see your dentist for your normal, regular check-ups and cleaning (but not treatment). You can also see your dental hygienist. Show them this leaflet and the dental letter, as it is important that the dentist and dental hygienist know that you are receiving ibandronic acid.
If you have any of the symptoms listed above or any other dental problems, tell your Christie contact immediately.
Very rare side effects (less than 1 in 10,000)
Atypical fractures
Unusual fractures of the hip bone have been reported in patients receiving bisphosphonates. This usually occurs after very long term treatment with a bisphosphonate for osteoporosis. Such fractures are not usually the result of trauma.
Please report any unusual hip, groin or thigh pain developed while on treatment.
Muscle or joint pain or increased bone pain
You may get pain in your muscles or joints for a few days after treatment. Sometimes pain in the bones affected by cancer can get worse for a short time when you start taking this treatment.
Sore throat or indigestion
Ibandronic acid tablets can irritate the throat and oespahgus (food pipe). If you have new or worsening indigestion tell your GP or cancer team.
Fatigue
Fatigue is a common side effect of most cancer treatments.
Anaemia
This treatment can cause anaemia. Tell your GP or cancer team if you develop symptoms of anaemia which can include low energy, breathlessness, feeling dizzy and light headed.
Eye problems
Rarely this treatment can cause eye problems. If you have any issues with your eyes or changes to your vision you may need to have a check up with an ophthalmologist.
Late side effects
After extended use of bisphosphonates some side effects may occur only after a number of years. In reaching any decision with you about treatment, the potential benefit you receive from treatment will be weighed against the risks of serious long-term side effects. If any of these problems specifically applies to you, your clinical team will discuss these with you and note this on your consent form.
Flu vaccinations
We advise that all patients receive a flu vaccination when this is offered. However, if you are thinking of having any other vaccines, check with your clinical team first, because some vaccines should be avoided.
COVID-19 vaccination
We advise that all patients receive a COVID-19 vaccination when this is offered.
Contacts
If you have any general questions or concerns about your treatment, please contact your consultant's secretary or your breast cancer nurse.
For urgent advice, ring The Christie Hotline on 0161 446 3658 (24 hours a day, 7 days a week).