1in 3 female and 1 in 5 male suffers an osteoporotic fracture Osteoporosis & its Treatment.
Treatment Strategy:
Weekly: Alendronic Acid, Risedronic Acid
Monthly: Ibandronic Acid
Yearly: Zoledronic Acid
Ostel D 70/2800 Dosage & Administration:
★ Must be taken at least 30 minutes before the first food, beverage or medication of the day with plain water only.
★ Do not lie down for at least 30 minutes after taking Alendronate until after breakfast
Brand Name: Maxbon
Generic: Ibandronic Acid
Dosage form: Tablet
Strength: 150 mg
Pack Size: 1’s
Therapeutic Class: Anti-Osteoporotic
Dosage & administration:
Maxbon contains 150 mg Ibandronic acid which is to be taken once monthly, i.e. same date of each month is recommended.
Administration (applicable for all bisphosphonate):
1. To maximize the absorption and clinical benefits it is to be taken at the morning, at least one hour before the first meal
2. Tablets should be swallowed whole with a glass of plain water while the patient is sitting or standing in an upright position.
3. DO NOT take the medicine with any kind of juice/ Tea/ Coffee or saline.
4. Patients should not lie down for 1 hour after taking ibandronic acid.
5. Patient should not eat, drink anything other than plain water for at least one hour after the medication.
6. DO NOT take any other medicine with this medication at a time or within one hour of taking medication.
In special population:
★ Pregnant women:
Ibandronic acid should not be used during pregnancy.
★ Lactating mother:
Ibandronic acid should not be used during lactation.
Pregnancy Category: C
Dose adjustment:
Patients with renal impairment..1. No dose adjustment is necessary for patients with mild or moderate renal impairment (Creatinine clearance >/ 30 ml/min).
2. Ibandronic acid is not recommended in patients with severe renal impairment
Patients with hepatic impairment
Dose adjustment is not necessary in patients with hepatic impairment.
Side effects:
Common side effects are:
1. Diarrhoea
2. Indigestion
3. Stomach ache
4. Headache
5. Muscle pain and muscle cramps
6. Flu-like symptoms
Less Common but serious side effects are:
1. Inflammation of the oesophagus (oesophagitis)
2. Heartburn due to acid reflux
3. Stiff and painful joints
4. Feeling bloated (flatulence)
Contraindications:
• Hypersensitivity to Ibandronic acid or to any of the excipients
• Hypocalcaemia
• Abnormalities of the oesophagus which delay oesophageal emptying
• Inability to stand or sit upright for at least 60 minutes
National osteoporosis foundation recommended Calcium supplement as co-medication with Bisphosphonate for the treatment of OSTEOPOROSIS.
BISPHOSPHONATES & CALCIUM are widely used for OSTEOPOROSIS treatment. But success in this mission depends on how the treatment options are organized.
Brand Name: Maxbon Kit
Generic: Ibandronic Acid + Calcium Orotate
Dosage form: Tablet
Strength:150 mg + 400 mg
Pack Size: 61’s (01 Tablet of Ibandronic Acid + 60 Tablets of Calcium Orotate)
Therapeutic Class: Anti-Osteoporotic
Dosage & Administration:
01 tablet of Ibandronic Acid (pink colored Tablet) once in a month (same date of each month is recommended).
&
02 tablets of Calcium Orotate (white colored tablet) per day in divided dosage.
How to take Ibandronic Acid (Pink Colored Tablet)
Same as Maxbon tablet
How to take Calcium Orotate (White Colored Tablet)
Start taking 02 Calcium Orotate tablet from the next day of Ibandronic Acid (From Day-2 and onwards).
Benefits of Calcium Orotate:
1. Only independent Calcium which is absorbed without Vitamin-D
2. The absorption rate of Calcium Orotate is highest among all Calcium (95%)
3. Site specific Calcium delivery (Mostly absorbed in Bone Cell)
4. Conventional Calcium form non-absorbable complex with iron & other ion when taken concomitantly but Calcium Orotate has no such problem
Limitations of oral bisphosphonates:
★ GI intolerability
★ Complexity of administration
★ Frequency of dosing
★ Burden of multiple medication
For long lasting Osteoprotection with best compliance Bonizol (Zoledronic Acid)
Brand Name: Bonizol
Generic: Zoledronic Acid
Dosage form:
Solution for Infusion
Strength:
5 mg/ 100 ml
Pack Size:
1’s
Therapeutic Class:
Anti-Osteoporotic
Pregnancy & Lactation:
Should not be used
Dose adjustment required:
★ Patients with renal Creatinine clearance > 35 ml/min does not require any dose adjustment
★ Elderly patients do not require any dose adjustment unless suffering from severe renal failure
★ No dose adjustment is required in patients with hepatic failure.
Side effects:
★ Fever
★ Myalgia and arthralgia
★ Headache and flu like symptoms
Bonizol:
★ Ensures better tolerability and compliance than other conventional bisphosphonates★ Free from GI side effects like nausea, vomiting, GERD etc.
★ Less drug-drug interaction
★ No dose adjustment is required in patients with hepatic failure.