ibandronate

Boniva

Indications

Action

Pharmacokinetics

Time/action profile

Contraindications/Precautions

Adverse Reactions/Side Effects

Gastrointestinal

• diarrhea (most frequent)
• dyspepsia (most frequent)
• dysphagia
• esophageal cancer
• esophagitis
• esophageal/gastric ulcer

Musculoskeletal

• musculoskeletal pain (most frequent)
• pain in arms/legs (most frequent)
• femur fractures
• osteonecrosis (primarily of jaw)

Respiratory

• asthma exacerbation

Miscellaneous

• anaphylaxis (life-threatening)
• injection site reactions

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Osteoporosis: Assess patients for low bone mass before and periodically during therapy.
• Intravenous: Monitor for signs and symptoms of anaphylactic reactions (swelling of face, lips, mouth or tongue; trouble breathing; wheezing; severe itching; skin rash, redness or swelling; dizziness or fainting; fast heartbeat or pounding in chest; sweating) during therapy. Discontinue injection immediately and begin supportive treatment if symptoms occur.
• Lab Test Considerations: Assess serum calcium before and periodically during therapy. Hypocalcemia and vitamin D deficiency should be treated before initiating ibandronate therapy.
  • May cause ↓ total alkaline phosphatase levels.
  • May cause hypercholesterolemia.

Potential Nursing Diagnoses

Implementation

• Oral: Administer first thing in the morning with 6–8 oz plain water 30 min before other medications, beverages, or food. Tablet should be swallowed whole; do not break, crush, or chew.
  • Once-monthly tablet should be administered on the same date each month.

• Intravenous Administration

• Intravenous: Administer using prefilled syringe. Do not administer solution that is discolored or contains particulate matter. Administer IV only; other routes may cause tissue damage.
• Rate: Administer as a 15–30 second bolus.
• Y-Site Incompatibility: Do not administer with calcium-containing solutions or other IV drugs.

Patient/Family Teaching

• Advise patient to eat a balanced diet and consult health care professional about the need for supplemental calcium and vitamin D. Wait at least 60 min after administration before taking supplemental calcium and vitamin D.
  • Encourage patient to participate in regular exercise and to modify behaviors that increase the risk of osteoporosis (stop smoking, reduce alcohol consumption).
  • Inform patient that severe musculoskeletal pain may occur within days, months, or yr after starting ibandronate. Symptoms my resolve completely after discontinuation or slow or incomplete resolution may occur. Notify health care professional if severe pain occurs.
  • Instruct patient to notify health care professional if swallowing difficulties, chest pain, new or worsening heartburn, or trouble or pain when swallowing occurs; may be signs of problems of the esophagus.
  • Advise patient to inform health care professional of ibandronate therapy prior to dental surgery.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.
• Oral: Instruct patient on the importance of taking as directed, first thing in the morning, 60 min before other medications, beverages, or food. Ibandronate should be taken with 6–8 oz plain water (mineral water, orange juice, coffee, and other beverages decrease absorption). Do not chew or suck on tablet. If a dose is missed, skip dose and resume the next morning; do not double doses or take later in the day. If a once-monthly dose is missed and the next scheduled dose is >7 days away, take in the morning following the date it is remembered. Resume original schedule the following month. If the next dose is <7 days away, omit dose and take next scheduled dose. Do not discontinue without consulting health care professional.
  • Caution patient to remain upright for 60 min following dose to facilitate passage to stomach and minimize risk of esophageal irritation. Advise patient to stop taking ibandronate and contact health care professional if symptoms of esophageal irritation (new or worsening dysphagia, pain on swallowing, retrosternal pain, or heartburn) occur.
• Intravenous: Advise patient that IV doses should not be administered sooner that every 3 mo. If a dose is missed, have health care professional administer as soon as possible; next injection should be scheduled 3 mo from last injection.

Evaluation/Desired Outcomes

• Prevention of or decrease in the progression of osteoporosis in postmenopausal women. Discontinuation after 3–5 years should be considered for women with low risk for fractures.