Bondronat
How does it work?
Bondronat tablets and injection contain the active ingredient ibandronic acid, which is a type of medicine called a bisphosphonate. Bisphosphonates are medicines that reduce the turnover of bone in the body.
Bone is not a static structure. It is continually shaped, reformed and rebuilt by cells called osteoblasts and osteoclasts. These cells continously deposit and remove calcium and phophorous, stored in a protein network that makes up the structure of the bone. Old bone is broken down by the osteoclasts and new bone is formed by the osteoblasts.
Biphosphonates work by binding very tightly to the bone tissue and preventing the calcium being removed by the osteoclasts. This stops the osteoclasts from breaking down the bone.
Breast cancer that has spread to the bone can cause excessive bone breakdown. This causes areas of bone weakness that can lead to pain and fractures. Ibandronic can be used in this situation to bind to the bone and prevent it being broken down. Bondronat tablets are taken by mouth every day for this purpose. Alternatively, Bondronat injection may be given as a drip into a vein (intravenous infusion) once every three to four weeks.
When the osteoclasts remove calcium from the bones, the calcium then seeps into the blood. The excessive breakdown of bone that occurs when cancer spreads to the bones can therefore lead to high levels of calcium in the blood. This can cause symptoms such as nausea, tiredness and confusion. As ibandronic acid prevents the calcium being removed from the bone, it can be used to treat high levels of calcium in the blood that are a result of cancer. Bondronat injection is usually given as a single dose via a drip into a vein (intravenous infusion) to return the calcium levels back to normal.
As this medicine slows bone turnover and so prevents calcium being rebsorbed from the bones into the blood, it can cause the amount of calcium in your blood to fall too low. For this reason, your doctor will ask you to take calcium and vitamin D supplements if your dietary intake of calcium and vitamin D is low.
What is it used for?
- Preventing bone damage (such as fractures, or bone complications requiring radiotherapy or surgery) in people with breast cancer that has spread to the bone (Bondronat tablets or injection)
- Reducing high levels of calcium in the blood (hypercalcaemia) caused by tumours (Bondronat injection only).
Warning!
- It is very important that the instructions for taking Bondronat tablets are followed completely. This is because when the ibandronic acid is taken by mouth it can cause irritation and ulceration of the foodpipe (oesophagus). Following the instructions below minimises this risk. If you are unclear about anything ask your pharmacist for advice.
- Bondronat tablets should be taken in the morning after an overnight fast (at least six hours). The tablet should be swallowed whole with a glass of plain water (180 to 240ml, not mineral water) while you are sitting or standing in an upright position. Do not chew or suck the tablet. You should not lie down for one hour after taking your Bondronat tablet. You should not eat or drink anything other than plain water for at least 30 minutes after taking the tablet. This is because food and some drinks (including mineral water) can interfere with the absorption of the medicine from the gut and hence make it less effective.
- You should not take any other medicine by mouth in the six hours before you take your Bondronat tablet, at the same time as your Bondronat tablet, or in the hour after you have taken the tablet. See the end of this factsheet for more details.
- If you experience any signs of irritation to your foodpipe during treatment with this medicine, for example new or worsening problems with swallowing, pain on swallowing, pain behind your breastbone, or heartburn, you should stop taking these tablets and inform your doctor.
- Your doctor will want you to have regular blood tests to monitor your kidney function and the level of calcium, phosphate and magnesium in your blood while you are having treatment with this medicine.
- The class of medicines that ibandronic acid belongs to (bisphosphonates) has been associated with a rare condition called osteonecrosis of the jaw. The majority of cases of this condition have been in cancer patients treated with bisphosphonates by injection into a vein and many of these patients were also having treatment with chemotherapy or corticosteroids. However, the condition has also been seen in people taking bisphosphonates by mouth. The risk may be increased by poor oral hygiene, dental problems, teeth extractions and oral surgery. For this reason, your doctor may want you to have a dental examination and, if necessary, appropriate preventive dentistry, before you start treatment with this medicine. Discuss this with your doctor. It is important to look after your mouth and teeth as much as possible while you are receiving this medicine. Invasive dental procedures such as tooth extraction or surgery should be avoided if possible. If you need to see a dentist during treatment, make sure they know you are receiving this medicine.
. Use with caution in
- Allergy to other bisphosphonate medicines
- Decreased kidney function
- Disorders of the parathyroid gland (gland that produces hormones responsible for regulating calcium metabolism)
- Vitamin D deficiency.
- Bondronat tablets should be used with caution in people with conditions that cause difficulty swallowing or delayed passage of food through the foodpipe (oesophagus), eg narrowing of the foodpipe.
Not to be used in
- Low levels of calcium in the blood (hypocalcaemia)
- Children
- Pregnancy.
- Bondronat tablets contain lactose and should not be taken people with rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and Breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine has not been studied in pregnant women, hence its safety has not been established. It should not be used during pregnancy. Seek medical advice from your doctor.
- It is not known if this medicine passes into breast milk. It should be used with caution in breastfeeding mothers and only if the potential benefit outweighs any risk to the nursing infant. Seek medical advice from your doctor.
Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Low blood calcium level (hypocalcaemia)
- Indigestion
- Nausea
- Abdominal pain
- Flu-like symptoms
- Bone pain
- Pain in the muscles or joints
- Feeling of weakness
- Inflammation of the foodpipe (oesophagitis) (Bondronat tablets only)
- Difficulty swallowing (Bondronat tablets only)
- Inflammation of the stomach (gastritis) (Bondronat tablets only)
- Taste disturbance
- Headache
- Dizziness
- Pins and needles sensations
- Anaemia
- Itching
- Diarrhoea
- Vomiting
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
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