WHAT IS THIS MEDICINE AND
WHAT IS IT USED FOR?
Bonviva contains ibandronic acid
(ibandronate), a medicine that belongs to a group called bisphosphonates. These
drugs work by slowing down the cells (osteoclasts) that break down bone,
allowing the bone-building cells (osteoblasts) to strengthen the skeleton.
Bonviva is used to treat osteoporosis in women who have gone through the
menopause — a condition where bones lose density and become fragile, increasing
the risk of fractures, especially of the spine, hip, and wrist. The
once-monthly 150 mg tablet offers a convenient alternative to daily
bisphosphonate tablets.
3. HOW TO TAKE THIS MEDICINE
Take ONE tablet ONCE A MONTH — on the
same date each month (e.g., always on the 1st). Take it first thing in the
morning before anything else. Swallow with a large glass of plain water (at
least 180 mL) — NOT juice or mineral water. Do NOT eat, drink (except plain
water), or take any other medicines for at least 60 minutes after taking
Bonviva. Stay sitting upright or standing — do NOT lie down — for at least 60
minutes after. Also take your calcium and vitamin D supplements as prescribed
by your doctor (but not at the same time as Bonviva).
|
💡
PATIENT TIP: Not recommended for patients with severe kidney disease
(creatinine clearance <30 mL/min). No dose adjustment is needed for mild
to moderate kidney impairment. No specific hepatic dose adjustment required. |
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects to Know About |
|
Common (>1 in 10) |
Heartburn, indigestion,
nausea, abdominal discomfort, difficulty swallowing (usually mild if
instructions followed correctly), flu-like symptoms (especially after the
first dose — fever, muscle aches, headache — usually resolve within 3 days),
back pain, joint and muscle pain |
|
Less Common |
Diarrhoea, constipation,
headache, ankle swelling, skin rash, raised liver enzymes |
|
Seek Medical Help |
Osteonecrosis of the jaw
(rare but serious — jawbone deterioration, usually linked to dental
procedures). Oesophageal ulceration or perforation (if tablets are not taken
correctly — instructions must be followed exactly). Atypical femur fractures
(rare thigh bone fracture with long-term use). Severe hypocalcaemia (low
calcium) if calcium levels not corrected before starting. |
5. WHO SHOULD NOT TAKE THIS
MEDICINE
Low calcium levels (hypocalcaemia — must
be treated before starting). Severe kidney disease (CrCl <30 mL/min).
Inability to sit or stand upright for 60 minutes. Known strictures or motility
problems in the oesophagus (food pipe). Previous severe reaction to a
bisphosphonate. Not for use in children or premenopausal women.
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IMPORTANT SAFETY INFORMATION: OESOPHAGEAL REACTIONS:
Failure to follow the dosing instructions precisely can cause serious damage
to the oesophagus. Stop immediately and seek medical help if you develop
difficulty swallowing, severe chest pain, or pain on swallowing after taking
Bonviva. DENTAL HEALTH: Tell your
dentist you are on Bonviva before any dental work. Jawbone problems (ONJ)
have been reported, particularly after tooth extractions.
CALCIUM AND VITAMIN D: You
must take calcium and vitamin D supplements throughout treatment —
osteoporosis treatment only works alongside adequate calcium intake. ATYPICAL FRACTURES: Report
any new thigh or groin pain — while rare, atypical femur fractures have been
associated with long-term bisphosphonate use. |
6. MEDICINES THAT INTERACT
WITH THIS TREATMENT
Calcium supplements, antacids, iron
tablets, dairy products (milk, cheese): reduce ibandronate absorption if taken
within 60 minutes. Take Bonviva at least 60 minutes before these products.
NSAIDs (ibuprofen, diclofenac): combined use may increase risk of GI
irritation. H2 blockers and proton pump inhibitors (omeprazole) have minimal
effect on the monthly tablet.
7. HOW TO STORE THIS
MEDICINE
Store below 30°C. Keep in the original
blister packaging. This pack contains a single tablet — one month's supply.
Keep out of reach of children.
8. PRESCRIPTION REQUIREMENT
|
Status |
Prescription Only Medicine
(POM) |
9. GUIDANCE FOR PATIENTS
& CAREGIVERS
Take ONE tablet on the SAME DATE every
month — consider setting a recurring phone reminder. Take first thing in the
morning before any food, drink (except water), or other medication. Drink a
full glass of plain tap water with the tablet. Stay upright for a full hour
afterwards. After 60 minutes, you can eat breakfast and take your calcium and
vitamin D supplements. Before your next dentist appointment, inform them that
you are on Bonviva. Report any new jaw pain, thigh or groin pain, or difficulty
swallowing to your doctor.
10. PHARMACIST &
PRESCRIBER NOTES
|
Clinical Dispensing Notes |
Single-tablet monthly pack
— verify correct dosing instructions are clearly communicated. Emphasise the
60-minute fasting and upright posture requirements — non-compliance causes
oesophageal injury. Ensure calcium + Vitamin D prescribed concurrently. Dental
review recommended before initiation. Bone mineral density (DEXA scan)
monitoring and periodic drug holiday consideration should be planned with
prescriber. ONJ risk counselling especially if invasive dental work
anticipated. |
11.
FREQUENTLY ASKED QUESTIONS
Q: Why do I have to stand up for an hour
after taking Bonviva?
A: Ibandronate can irritate or even
damage the oesophagus (food pipe) if it stays in contact with the lining.
Staying upright lets gravity help the tablet travel quickly into your stomach.
Lying down after taking it significantly increases the risk of oesophageal
injury.
Q: Can I drink tea or coffee instead of
water when taking Bonviva?
A: No — you must use plain water only.
Mineral water, juice, tea, coffee, and dairy drinks all reduce the amount of
ibandronate your body absorbs. Use at least a full glass (180 mL) of plain tap
or still water.
Q: I missed my monthly Bonviva dose —
what should I do?
A: If your next scheduled dose is more
than 7 days away, take the missed tablet as soon as you remember and then
return to your usual monthly schedule. If your next dose is within 7 days, skip
the missed tablet and take the next one on the usual date. Never take two
tablets to make up for a missed dose.
Q: How long will I need to take Bonviva
for?
A: Most guidelines recommend treating
for 3–5 years initially, after which your doctor will assess whether to
continue, take a break (drug holiday), or switch treatment. This decision is
based on your bone density scans and fracture risk. Do not stop Bonviva without
discussing it with your doctor.
Q: Can Bonviva be taken at the same time
as calcium supplements?
A: No — calcium supplements (and
antacids, iron tablets, and dairy products) must be taken at least 60 minutes
AFTER Bonviva, as they block its absorption. Morning is the best time for
Bonviva, then have your supplements with breakfast.