Synopsis Ibandronate (Boniva) is ...

Synopsis

Ibandronate (Boniva) is the newest oral bisphosphonate approved for the treatment and prevention of osteoporosis in women who are postmenopausal. It is the first physic in its class that can be taken daily or monthly

Safety

Ibandronate, like other bisphosphonates administered orally, may cause esophagitis, esophageal sore or gastric ulcer. these risks may be increased in patients taking coincident nonsteroidal anti-inflammatory drugs. Ibandronate is not attract favor toed for use in patients with strict renal impairment and has not been studied in patients with hepatic impairment. (1) the U rations and Drug administration has classified ibandronate category c for use during pregnancy.

Tolerability

adverse general intents with ibandronate most commonly are gastrointestinal and include dyspepsia, gastroenteritis, and nausea. They are comparable to the adverse results of other drugs in the same class. (23) In couple clinical trials, 7 percent and 75 percent of participants in the ibandronate 25 mg daily assign places tos dropped out because of medication-related adverse imports (2,3) Adverse effects that were reported in greater than 5 percent of patients taking ibandronate included back pain, headache, bronchitis, and myalgias. The overall adverse-effect profiles of the daily and monthly preparations were similar. (4)

Effectiveness

there are many questions regarding the effectiveness of ibandronate in preventing issues of importance to patients. Daily ibandronate was compared with placebo in 2929 postmenopausal women with a prior vertebral fracture. (3) Treatment decreased the absolute risk of fresh symptomatic, radiographically confirmed vertebral fracture from 53 to 28 percent athwart three years (absolute risk reduction 23 percent; number emergencyed to treat = 43 for three years). (3) There was no difference in the likelihood of clinical nonvertebral fracture between placebo and ibandronate. The 25-mg daily and 150-mg monthly dosages of ibandronate were equivalent in boundarys of percent change in lumbar spine bone mineral density from baseline to single in kind year. The effects of ibandronate in succession rates of hip fracture, death, and symptomatic vertebral fracture have not been assessed. (4) Data forward the fracture prevention of ibandronate in patients with osteoporosis on the other hand without previous fracture are lacking. (5) No bisphosphonate has been compared with adequate doses of calcium and vitamin D (5)

Price

The outlay of ibandronate is approximately $78 by month for either dosage. Weekly alendronate (Fosamax) richnesss $77 per month and weekly risedronate (actonel) costlinesss $74 per month.

Simplicity

Ibandronate can be taken formerly daily or once monthly, similar to the daily or intermittent formulations of alendronate and risedronate. It should be taken merely with water, at a time when the patient will be able to remain upright for common hour following the dose, and should not be taken within individual hour of eating or of ingesting any other medication. fruits containing calcium, aluminum, magnesium, or iron (eg milk, many sustenances antacids) interfere with absorption of ibandronate. Thus, monthly dosing may be more convenient for more [i]or[/i] less patients.

Bottom Line

Ibandronate is a bisphosphonate that can be taken daily or monthly the daily dosage has been shown to decrease vertebral fractures in women with osteoporosis and a history of previous vertebral fractures. Neither formulation has been shown to cut down the risk of hip fracture or other nonvertebral fracture, nor to render fractures in women without prior fracture. Ibandronate has not been compared directly with other bisphosphonates or with adequate daily doses of calcium and vitamin D the convenience of monthly dosing straits to be balanced against the lack of data onward fracture prevention.

REFERENCES

(1) Ibandronate. In: DRUGDEX method Greenwood Village, Colo.: Thompson Micromedex, 2004

(2) McClung MR Wasnich RD Recker R Cauley JA, Chesnut CH III, Ensrud KE et al. Oral daily ibandronate obstructs bone loss in early postmenopausal women without osteoporosis. J Bone Miner Re 2004;19:11-8

(3) Chesnut CH III, Skag A, Christiansen C Recker R Stakkestad JA, Hoiseth A, et al. efficiencys of oral ibandronate administered daily or intermittently in succession fracture risk in postmenopausal osteoporosis. J Bone Miner Re 2004;19:1241-9

(4) Palacioz K Boniva (ibandronate) monthly or daily now available. Pharmacist's literal meaning 2005;21:210420.

(5.) Bischoff-Ferrari HA, Willett WC Wong JB Giovannucci E Dietrich T Dawson-Hughes B Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controll trials. JAMA 2005:293; 2257-64

Jonathan D Ference Pharm.D. University of Oklahoma corporation of Pharmacy and College of Medicine, Tulsa, Oklahoma

STEPHEN A. WILSON, MD University of Pittsburgh Medical Center-St Margaret, Pittsburgh, Pennsylvania

The Authors

JONATHAN D FERENCE PHARM.D., is clinical assistant professor at the University of Oklahoma community of Pharmacy, Tulsa, Okla., and adjunct assistant professor in the Department of Family Medicine at the University of Oklahoma guild of Medicine, Tulsa.