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INTRODUCTION

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ibandronate (i-ban-dro-nate)

Boniva

Classification

Therapeutic: bone resorption inhibitors

Pharmacologic: bisphosphonates

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Indications
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Treatment/prevention of postmenopausal osteoporosis.

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Action
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Inhibits resorption of bone by inhibiting osteoclast activity. Therapeutic Effects: Reversal/prevention of progression of osteoporosis with decreased fractures.

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Adverse Reactions/Side Effects
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GI: diarrhea, dyspepsia, esophagitis, esophageal/gastric ulcer. MS: musculoskeletal pain, pain in arms/legs, osteonecrosis (primarily of jaw). Misc: injection site reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess any muscle or joint pain. Report persistent or increased musculoskeletal pain to determine presence of bone or joint pathology, including fracture. Be especially aware of possible mouth and jaw pain due to osteonecrosis of the jaw.

  • Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

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Interventions
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  • Institute weight-bearing and resistance exercises as tolerated to maintain or increase bone mineral density. Start with low-impact or aquatic programs in patients with extensive demineralization, and increase exercise intensity slowly to prevent fractures.

  • Protect against falls and fractures (See Appendix E). Modify home environment (remove throw rugs, improve lighting, etc.) and provide assistive devices (cane, walker) or other protective devices as needed to improve balance and prevent falls.

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Patient/Client-Related Instruction
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  • Instruct patient on the importance of taking exactly as directed and to remain upright for 60 min following oral dose to facilitate passage to stomach and minimize risk of esophageal irritation.

  • Instruct patient to notify physician if pain or difficulty swallowing, retrosternal pain, or new/worsening heartburn occur.

  • Instruct patient to report other troublesome GI problems such as severe or prolonged diarrhea or indigestion.

  • Advise patient about the benefits of proper diet in sustaining bone mineralization. If necessary, refer patient for nutritional counseling about supplemental calcium and vitamin D.

  • Encourage patient to modify behaviors that increase the risk of osteoporosis (stop smoking, reduce alcohol consumption).

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Pharmacokinetics
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Absorption: 0.6% absorbed following oral administration (significantly decreased by food).

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Distribution: Rapidly binds to bone.

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Protein Binding: 90.9–99.5%.

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Metabolism and Excretion: 50–60% excreted in urine; unabsorbed drug is eliminated in feces.

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Half-life: PO—10–60 hr; IV—4.6–25.5 hr.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
PO unknown 0.5–2 hr up to 1 mo
IV unknown 3 hr up to 3 mo

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Uncorrected hypocalcemia; Inability to stand/sit upright for at least 60 min; CCr <30 mL/min.

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Use Cautiously in: Geri: Consider age-related ↓ in body mass, renal and hepatic function, concurrent disease states and drug therapy; Concurrent use of NSAIDs ...

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