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Ibandronate sodium - Prescription Drug Labeling

Product NDC Code 60505-6097
Drug Name

Ibandronate sodium

Type Generic
Pharm Class Bisphosphonate [EPC],
Diphosphonates [CS]
Active Ingredients
Ibandronate sodium 3 mg/3ml
Route INTRAVENOUS
Dosage Form INJECTION
RxCUI drug identifier 904952
Application Number ANDA204222
Labeler Name Apotex Corp.
Packages
Package NDC Code Description
60505-6097-0 1 syringe, glass in 1 carton (60505-6097-0) > 3 ml in 1 syringe, glass

Overdosage of ibandronate sodium

Information about signs, symptoms, and laboratory findings of acute ovedosage and the general principles of overdose treatment.
10 OVERDOSAGE No cases of overdose were reported in premarketing studies with ibandronate sodium injection. Overdosage with intravenous bisphosphonates may result in hypocalcemia, hypophosphatemia, and hypomagnesemia. Clinically relevant reductions in serum levels of calcium, phosphorus, and magnesium should be corrected by intravenous administration of calcium gluconate, potassium or sodium phosphate, and magnesium sulfate, respectively. Dialysis would not be beneficial unless it is administered within 2 hours following the overdose.

Adverse reactions

Information about undesirable effects, reasonably associated with use of the drug, that may occur as part of the pharmacological action of the drug or may be unpredictable in its occurrence. Adverse reactions include those that occur with the drug, and if applicable, with drugs in the same pharmacologically active and chemically related class. There is considerable variation in the listing of adverse reactions. They may be categorized by organ system, by severity of reaction, by frequency, by toxicological mechanism, or by a combination of these.
6 ADVERSE REACTIONS Adverse reactions that appear in other sections of the labeling include: Hypocalcemia and Mineral Metabolism [ see Warnings and Precautions (5.1) ] Anaphylactic Reaction [ see Warnings and Precautions (5.2) ] Renal Impairment [ see Warnings and Precautions (5.3) ] Tissue Damage Related to Inappropriate Drug Administration [ see Warnings and Precautions (5.4) ] Osteonecrosis of the Jaw [ see Warnings and Precautions (5.5) ] Musculoskeletal Pain [ see Warnings and Precautions (5.6) ] Atypical Subtrochanteric and Diaphyseal Femoral Fractures [ see Warnings and Precautions (5.7) ] The most frequently reported adverse reactions (>5%) are arthralgia, back pain, and abdominal pain. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Apotex Corp. at 1-800-706-5575 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Quarterly Intravenous Injection – In a 1-year, double-blind, multicenter study comparing ibandronate sodium injection administered intravenously as 3 mg every 3 months to ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet in women with postmenopausal osteoporosis, the overall safety and tolerability profiles of the two dosing regimens were similar. The incidence of serious adverse reactions was 8.0% in the ibandronate sodium tablets 2.5 mg (ibandronate) daily group and 7.5% in the ibandronate sodium injection 3 mg once every 3 months group. The percentage of patients who withdrew from treatment due to adverse reactions was approximately 6.7% in the ibandronate sodium tablets 2.5 mg (ibandronate) daily group and 8.5% in the ibandronate sodium injection 3 mg every 3 months group. Table 1 lists the adverse reactions reported in greater than 2% of patients. Table 1 Adverse Reactions With an Incidence of at Least 2% in Patients Treated with Ibandronate sodium Injection (3 mg once every 3 months) or Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily Oral Tablet Body System/Adverse Reaction Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily (Oral) % (n=465) Ibandronate sodium 3 mg every 3 months (Intravenous) % (n=469) Infections and Infestations Influenza 8 5 Nasopharyngitis 6 3 Cystitis 3 2 Gastroenteritis 3 2 Urinary Tract Infection 3 3 Bronchitis 3 2 Upper Respiratory Tract Infection 3 1 Gastrointestinal Disorders Abdominal Pain Combination of abdominal pain and abdominal pain upper 6 5 Dyspepsia 4 4 Nausea 4 2 Constipation 4 3 Diarrhea 2 3 Gastritis 2 2 Musculoskeletal and Connective Tissue Disorders Arthralgia 9 10 Back Pain 8 7 Localized Osteoarthritis 2 2 Pain in Extremity 2 3 Myalgia 1 3 Nervous System Disorders Dizziness 3 2 Headache 3 4 Psychiatric Disorders Insomnia 3 1 Depression 2 1 General Disorders and Administration Site Conditions Influenza-like Illness Combination of influenza-like illness and acute phase reaction 1 5 Fatigue 1 3 Skin and Subcutaneous Tissue Disorders Rash Combination of rash, rash pruritic, rash macular, dermatitis, dermatitis allergic, exanthema, erythema, rash papular, rash generalized, dermatitis medicamentosa, rash erythematous 3 2 Acute Phase Reaction-like Events Symptoms consistent with acute phase reaction (APR) have been reported with intravenous bisphosphonate use. The overall incidence of patients with APR-like events was higher in the intravenous treatment group (4% in the ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet group vs. 10% in the ibandronate sodium injection 3 mg once every 3 months group). These incidence rates are based upon reporting of any of 33 potential APR-like symptoms within 3 days of an intravenous dose and lasting 7 days or less. In most cases, no specific treatment was required and the symptoms subsided within 24 to 48 hours. Injection Site Reactions Local reactions at the injection site, such as redness or swelling, were observed at a higher incidence in patients treated with ibandronate sodium injection 3 mg every 3 months (1.7%; 8/469) than in patients treated with placebo injections (0.2%; 1/465). In most cases, the reaction was of mild to moderate severity. Daily Oral Tablet - The safety of ibandronate sodium tablets 2.5 mg (ibandronate) once daily in the treatment and prevention of postmenopausal osteoporosis was assessed in 3577 patients aged 41 to 82 years. The duration of the trials was 2 to 3 years, with 1134 patients exposed to placebo and 1140 exposed to ibandronate sodium tablets 2.5 mg (ibandronate). Patients with pre-existing gastrointestinal disease and concomitant use of non-steroidal anti-inflammatory drugs, proton pump inhibitors and H2 antagonists were included in these clinical trials. All patients received 500 mg calcium plus 400 international units vitamin D supplementation daily. The incidence of all-cause mortality was 1% in the placebo group and 1.2% in the ibandronate sodium tablets 2.5 mg (ibandronate) daily group. The incidence of serious adverse reactions was 20% in the placebo group and 23% in the ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet group. The percentage of patients who withdrew from treatment due to adverse reactions was approximately 17% in both the placebo group and the ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet group. Table 2 lists adverse reactions from the Treatment and Prevention Studies reported in greater than or equal to 2% of patients and in more patients treated with ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet than patients treated with placebo. Table 2 Adverse Reactions Occurring at an Incidence greater than or equal to 2% and in More Patients Treated with Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily Oral Tablet than in Patients Treated with Placebo in the Osteoporosis Treatment and Prevention Studies Body System Placebo % (n=1134) Ibandronate sodium Tablets 2.5 mg (ibandronate) daily % (n=1140) Body as a Whole Back Pain 12 14 Pain in Extremity 6 8 Asthenia 2 4 Allergic Reaction 2 3 Digestive System Dyspepsia 10 12 Diarrhea 5 7 Tooth Disorder 2 4 Vomiting 2 3 Gastritis 2 2 Musculoskeletal System Myalgia 5 6 Joint Disorder 3 4 Arthritis 3 3 Nervous System Headache 6 7 Dizziness 3 4 Vertigo 3 3 Respiratory System Upper Respiratory Infection 33 34 Bronchitis 7 10 Pneumonia 4 6 Pharyngitis 2 3 Urogenital System Urinary Tract Infection 4 6 Gastrointestinal Adverse Reactions The incidence of selected gastrointestinal adverse reactions in the placebo and ibandronate sodium tablets 2.5 mg (ibandronate) daily groups were: dyspepsia (10% vs. 12%), diarrhea (5% vs. 7%), and abdominal pain (5% vs. 6%). Musculoskeletal Adverse Reactions The incidence of selected musculoskeletal adverse reactions in the placebo and ibandronate sodium tablets 2.5 mg (ibandronate) daily groups were: back pain (12% vs. 14%), arthralgia (14% vs. 14%) and myalgia (5% vs. 6%). 6.2 Postmarketing Experience The following adverse reactions have been identified during post-approval use of ibandronate sodium injection. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Hypersensitivity Allergic reactions including anaphylaxis with fatalities, angioedema, asthma exacerbation, bronchospasm, rash, Stevens-Johnson syndrome, erythema multiforme, and dermatitis bullous [see Contraindications (4) , Warnings and Precautions (5.2) ] . Hypocalcemia Hypocalcemia [see Warnings and Precautions (5.1) ]. Renal Toxicity Acute renal failure [see Warnings and Precautions (5.3) ]. Osteonecrosis of the Jaw Osteonecrosis of the jaw and other oro-facial sites, including the external auditory canal [see Warnings and Precautions (5.5) ] . Musculoskeletal Pain Bone, joint, or muscle pain (musculoskeletal pain), described as severe or incapacitating [see Warnings and Precautions (5.6) ] . Atypical Femoral Shaft Fracture Atypical, low-energy, or low-trauma fractures of the femoral shaft [see Warnings and Precautions (5.7) ]. Eye Inflammation Iritis and uveitis. In some cases with other bisphosphonates, these events did not resolve until the bisphosphonate was discontinued.
Table 1 Adverse Reactions With an Incidence of at Least 2% in Patients Treated with Ibandronate sodium Injection (3 mg once every 3 months) or Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily Oral Tablet
Body System/Adverse Reaction Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily (Oral) % (n=465) Ibandronate sodium 3 mg every 3 months (Intravenous) % (n=469)
Infections and Infestations
Influenza 8 5
Nasopharyngitis 6 3
Cystitis 3 2
Gastroenteritis 3 2
Urinary Tract Infection 3 3
Bronchitis 3 2
Upper Respiratory Tract Infection 3 1
Gastrointestinal Disorders
Abdominal PainCombination of abdominal pain and abdominal pain upper 6 5
Dyspepsia 4 4
Nausea 4 2
Constipation 4 3
Diarrhea 2 3
Gastritis 2 2
Musculoskeletal and Connective Tissue Disorders
Arthralgia 9 10
Back Pain 8 7
Localized Osteoarthritis 2 2
Pain in Extremity 2 3
Myalgia 1 3
Nervous System Disorders
Dizziness 3 2
Headache 3 4
Psychiatric Disorders
Insomnia 3 1
Depression 2 1
General Disorders and Administration Site Conditions
Influenza-like IllnessCombination of influenza-like illness and acute phase reaction 1 5
Fatigue 1 3
Skin and Subcutaneous Tissue Disorders
RashCombination of rash, rash pruritic, rash macular, dermatitis, dermatitis allergic, exanthema, erythema, rash papular, rash generalized, dermatitis medicamentosa, rash erythematous 3 2
Table 2 Adverse Reactions Occurring at an Incidence greater than or equal to 2% and in More Patients Treated with Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily Oral Tablet than in Patients Treated with Placebo in the Osteoporosis Treatment and Prevention Studies
Body System Placebo % (n=1134) Ibandronate sodium Tablets 2.5 mg (ibandronate) daily % (n=1140)
Body as a Whole
Back Pain 12 14
Pain in Extremity 6 8
Asthenia 2 4
Allergic Reaction 2 3
Digestive System
Dyspepsia 10 12
Diarrhea 5 7
Tooth Disorder 2 4
Vomiting 2 3
Gastritis 2 2
Musculoskeletal System
Myalgia 5 6
Joint Disorder 3 4
Arthritis 3 3
Nervous System
Headache 6 7
Dizziness 3 4
Vertigo 3 3
Respiratory System
Upper Respiratory Infection 33 34
Bronchitis 7 10
Pneumonia 4 6
Pharyngitis 2 3
Urogenital System
Urinary Tract Infection 4 6

ibandronate sodium Drug Interactions

Information about and practical guidance on preventing clinically significant drug/drug and drug/food interactions that may occur in people taking the drug.
7 DRUG INTERACTIONS 7.1 Melphalan/Prednisolone Intravenous ibandronate (6 mg) did not interact with intravenous melphalan (10 mg/m 2 ) or oral prednisolone (60 mg/m 2 ) [see Clinical Pharmacology (12.3) ] . 7.2 Tamoxifen There was no interaction between oral 30 mg tamoxifen and intravenous 2 mg ibandronate [see Clinical Pharmacology (12.3) ] . 7.3 Bone Imaging Agents Bisphosphonates are known to interfere with the use of bone-imaging agents. Specific studies with ibandronate sodium have not been performed.

Clinical pharmacology

Information about the clinical pharmacology and actions of the drug in humans.
12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action The action of ibandronate on bone is based on its affinity for hydroxyapatite, which is part of the mineral matrix of bone. Ibandronate inhibits osteoclast activity and reduces bone resorption and turnover. In postmenopausal women, it reduces the elevated rate of bone turnover, leading to, on average, a net gain in bone mass. 12.2 Pharmacodynamics In studies of postmenopausal women, ibandronate sodium injection at doses of 0.5 mg to 3 mg produced biochemical changes indicative of inhibition of bone resorption, including decreases of biochemical markers of bone collagen degradation (cross-linked C-telopeptide of Type I collagen [CTX]). Changes in markers of bone formation (osteocalcin) were observed later than changes in resorption markers, as expected, due to the coupled nature of bone resorption and formation. Year 1 results from an efficacy and safety study comparing ibandronate sodium injection 3 mg every 3 months and ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet demonstrated that both dosing regimens significantly suppressed serum CTX levels at Months 3, 6, and 12. The median pre-dose or trough serum CTX levels in the intent-to-treat population reached a nadir of 57% (ibandronate sodium injection) and 62% (ibandronate sodium tablets 2.5 mg (ibandronate) below baseline values by Month 6, and remained stable at Month 12 of treatment. 12.3 Pharmacokinetics Distribution Area under the serum ibandronate concentrations versus time curve increases in a dose proportional manner after administration of 2 mg to 6 mg by intravenous injection. After administration, ibandronate either rapidly binds to bone or is excreted into urine. In humans, the apparent terminal volume of distribution is at least 90 L, and the amount of dose removed from the circulation into the bone is estimated to be 40% to 50% of the circulating dose. In one study, in vitro protein binding in human serum was approximately 86% over an ibandronate concentration range of 20 to 2,000 ng/mL (approximate range of maximum serum ibandronate concentrations upon intravenous bolus administration). Metabolism There is no evidence that ibandronate is metabolized in humans. Ibandronate does not inhibit human P450 1A2, 2A6, 2C9, 2C19, 2D6, 2E1, and 3A4 isozymes in vitro . Ibandronate does not undergo hepatic metabolism and does not inhibit the hepatic cytochrome P450 system. Ibandronate is eliminated by renal excretion. Based on a rat study, the ibandronate secretory pathway does not appear to include known acidic or basic transport systems involved in the excretion of other drugs. Elimination The portion of ibandronate that is not removed from the circulation via bone absorption is eliminated unchanged by the kidney (approximately 50% to 60% of the administered intravenous dose). The plasma elimination of ibandronate is multiphasic. Its renal clearance and distribution into bone accounts for a rapid and early decline in plasma concentrations, reaching 10% of C max within 3 or 8 hours after intravenous or oral administration, respectively. This is followed by a slower clearance phase as ibandronate redistributes back into the blood from bone. The observed apparent terminal half-life for ibandronate is generally dependent on the dose studied and on assay sensitivity. The observed apparent terminal half-life for intravenous 2 and 4 mg ibandronate after 2 hours of infusion ranges from 4.6 to 15.3 hours and 5 to 25.5 hours, respectively. Following intravenous administration, total clearance of ibandronate is low, with average values in the range 84 to 160 mL/min. Renal clearance (about 60 mL/min in healthy postmenopausal women) accounts for 50% to 60% of total clearance and is related to creatinine clearance. The difference between the apparent total and renal clearances likely reflects bone uptake of the drug. Pharmacokinetics in Specific Populations Pediatrics The pharmacokinetics of ibandronate have not been studied in patients less than 18 years of age. Gender The pharmacokinetics of ibandronate are similar in both men and women. Geriatric Since ibandronate is not known to be metabolized, the only difference in ibandronate elimination for geriatric patients versus younger patients is expected to relate to progressive age-related changes in renal function [ see Use in Specific Populations (8.5) ] . Race Pharmacokinetic differences due to race have not been studied. Renal Impairment Renal clearance of ibandronate in patients with various degrees of renal impairment is linearly related to creatinine clearance (CLcr). Following a single dose of 0.5 mg ibandronate by intravenous administration, patients with creatinine clearance 40 to 70 mL/min had 55% higher exposure (AUC ∞ ) than the exposure observed in patients with creatinine clearance higher than 90 mL/min. Patients with severe renal impairment (creatinine clearance below 30 mL/min) had more than a two-fold increase in exposure compared to the exposure for patients with creatinine clearance equal to or higher than 80 mL/min [see Dosage and Administration (2.6) and Use in Specific Populations (8.6) ] . Hepatic Impairment No studies have been performed to assess the pharmacokinetics of ibandronate in patients with hepatic impairment since ibandronate is not metabolized in the human liver. Drug Interaction Melphalan/Prednisolone A pharmacokinetic interaction study in multiple myeloma patients demonstrated that intravenous melphalan (10 mg/m 2 ) and oral prednisolone (60 mg/m 2 ) did not interact with 6 mg ibandronate upon intravenous coadministration. Ibandronate did not interact with melphalan or prednisolone. Tamoxifen A pharmacokinetic interaction study in healthy postmenopausal women demonstrated that there was no interaction between oral 30 mg tamoxifen and intravenous 2 mg ibandronate.

Mechanism of action

Information about the established mechanism(s) of the drugÕs action in humans at various levels (for example receptor, membrane, tissue, organ, whole body). If the mechanism of action is not known, this field contains a statement about the lack of information.
12.1 Mechanism of Action The action of ibandronate on bone is based on its affinity for hydroxyapatite, which is part of the mineral matrix of bone. Ibandronate inhibits osteoclast activity and reduces bone resorption and turnover. In postmenopausal women, it reduces the elevated rate of bone turnover, leading to, on average, a net gain in bone mass.

Pharmacodynamics

Information about any biochemical or physiologic pharmacologic effects of the drug or active metabolites related to the drugÕs clinical effect in preventing, diagnosing, mitigating, curing, or treating disease, or those related to adverse effects or toxicity.
12.2 Pharmacodynamics In studies of postmenopausal women, ibandronate sodium injection at doses of 0.5 mg to 3 mg produced biochemical changes indicative of inhibition of bone resorption, including decreases of biochemical markers of bone collagen degradation (cross-linked C-telopeptide of Type I collagen [CTX]). Changes in markers of bone formation (osteocalcin) were observed later than changes in resorption markers, as expected, due to the coupled nature of bone resorption and formation. Year 1 results from an efficacy and safety study comparing ibandronate sodium injection 3 mg every 3 months and ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet demonstrated that both dosing regimens significantly suppressed serum CTX levels at Months 3, 6, and 12. The median pre-dose or trough serum CTX levels in the intent-to-treat population reached a nadir of 57% (ibandronate sodium injection) and 62% (ibandronate sodium tablets 2.5 mg (ibandronate) below baseline values by Month 6, and remained stable at Month 12 of treatment.

Pharmacokinetics

Information about the clinically significant pharmacokinetics of a drug or active metabolites, for instance pertinent absorption, distribution, metabolism, and excretion parameters.
12.3 Pharmacokinetics Distribution Area under the serum ibandronate concentrations versus time curve increases in a dose proportional manner after administration of 2 mg to 6 mg by intravenous injection. After administration, ibandronate either rapidly binds to bone or is excreted into urine. In humans, the apparent terminal volume of distribution is at least 90 L, and the amount of dose removed from the circulation into the bone is estimated to be 40% to 50% of the circulating dose. In one study, in vitro protein binding in human serum was approximately 86% over an ibandronate concentration range of 20 to 2,000 ng/mL (approximate range of maximum serum ibandronate concentrations upon intravenous bolus administration). Metabolism There is no evidence that ibandronate is metabolized in humans. Ibandronate does not inhibit human P450 1A2, 2A6, 2C9, 2C19, 2D6, 2E1, and 3A4 isozymes in vitro . Ibandronate does not undergo hepatic metabolism and does not inhibit the hepatic cytochrome P450 system. Ibandronate is eliminated by renal excretion. Based on a rat study, the ibandronate secretory pathway does not appear to include known acidic or basic transport systems involved in the excretion of other drugs. Elimination The portion of ibandronate that is not removed from the circulation via bone absorption is eliminated unchanged by the kidney (approximately 50% to 60% of the administered intravenous dose). The plasma elimination of ibandronate is multiphasic. Its renal clearance and distribution into bone accounts for a rapid and early decline in plasma concentrations, reaching 10% of C max within 3 or 8 hours after intravenous or oral administration, respectively. This is followed by a slower clearance phase as ibandronate redistributes back into the blood from bone. The observed apparent terminal half-life for ibandronate is generally dependent on the dose studied and on assay sensitivity. The observed apparent terminal half-life for intravenous 2 and 4 mg ibandronate after 2 hours of infusion ranges from 4.6 to 15.3 hours and 5 to 25.5 hours, respectively. Following intravenous administration, total clearance of ibandronate is low, with average values in the range 84 to 160 mL/min. Renal clearance (about 60 mL/min in healthy postmenopausal women) accounts for 50% to 60% of total clearance and is related to creatinine clearance. The difference between the apparent total and renal clearances likely reflects bone uptake of the drug. Pharmacokinetics in Specific Populations Pediatrics The pharmacokinetics of ibandronate have not been studied in patients less than 18 years of age. Gender The pharmacokinetics of ibandronate are similar in both men and women. Geriatric Since ibandronate is not known to be metabolized, the only difference in ibandronate elimination for geriatric patients versus younger patients is expected to relate to progressive age-related changes in renal function [ see Use in Specific Populations (8.5) ] . Race Pharmacokinetic differences due to race have not been studied. Renal Impairment Renal clearance of ibandronate in patients with various degrees of renal impairment is linearly related to creatinine clearance (CLcr). Following a single dose of 0.5 mg ibandronate by intravenous administration, patients with creatinine clearance 40 to 70 mL/min had 55% higher exposure (AUC ∞ ) than the exposure observed in patients with creatinine clearance higher than 90 mL/min. Patients with severe renal impairment (creatinine clearance below 30 mL/min) had more than a two-fold increase in exposure compared to the exposure for patients with creatinine clearance equal to or higher than 80 mL/min [see Dosage and Administration (2.6) and Use in Specific Populations (8.6) ] . Hepatic Impairment No studies have been performed to assess the pharmacokinetics of ibandronate in patients with hepatic impairment since ibandronate is not metabolized in the human liver. Drug Interaction Melphalan/Prednisolone A pharmacokinetic interaction study in multiple myeloma patients demonstrated that intravenous melphalan (10 mg/m 2 ) and oral prednisolone (60 mg/m 2 ) did not interact with 6 mg ibandronate upon intravenous coadministration. Ibandronate did not interact with melphalan or prednisolone. Tamoxifen A pharmacokinetic interaction study in healthy postmenopausal women demonstrated that there was no interaction between oral 30 mg tamoxifen and intravenous 2 mg ibandronate.

Contraindications

Information about situations in which the drug product is contraindicated or should not be used because the risk of use clearly outweighs any possible benefit, including the type and nature of reactions that have been reported.
4 CONTRAINDICATIONS Ibandronate sodium is contraindicated in patients with the following conditions: Hypocalcemia [see Warnings and Precautions (5.1) ] Known hypersensitivity to ibandronate sodium injection or to any of its excipients. Cases of anaphylaxis, including fatal events, have been reported. [ see Warnings and Precautions (5.2) , Adverse Reactions (6.2) ] Hypocalcemia ( 4 ) Hypersensitivity to ibandronate sodium injection ( 4 )

Description

General information about the drug product, including the proprietary and established name of the drug, the type of dosage form and route of administration to which the label applies, qualitative and quantitative ingredient information, the pharmacologic or therapeutic class of the drug, and the chemical name and structural formula of the drug.
11 DESCRIPTION Ibandronate sodium is a nitrogen-containing bisphosphonate that inhibits osteoclast-mediated bone resorption. The chemical name for ibandronate sodium is 1-Hydroxy-3-(methylpentylamino) propylidene]bisphosphonic acid sodium salt. Monohydrate with the molecular formula C 9 H 22 NO 7 P 2 Na•H 2 O and a molecular weight of 359.21. Ibandronate sodium is a white- to off-white powder. It is freely soluble in water and practically insoluble in organic solvents. Ibandronate sodium has the following structural formula: Ibandronate sodium Injection is intended for intravenous administration only. Ibandronate sodium Injection is available as a sterile, clear, colorless, ready-to-use solution in a prefilled syringe that delivers 3.375 mg of ibandronate monosodium salt monohydrate in 3 mL of solution, equivalent to a dose of 3 mg ibandronate free acid. Inactive ingredients include sodium chloride, glacial acetic acid, sodium acetate trihydrate and water for injection. Chemical Structure

Dosage and administration

Information about the drug product’s dosage and administration recommendations, including starting dose, dose range, titration regimens, and any other clinically sigificant information that affects dosing recommendations.
2 DOSAGE AND ADMINISTRATION 3 mg every 3 months administered intravenously over a period of 15 to 30 seconds ( 2.2 ) Dosing Instructions: Only administer intravenously by a health care professional. ( 2.1 ) Do not mix with calcium-containing solutions or other intravenously administered drugs. ( 2.1 ) Do not administer more frequently than once every 3 months. ( 2.2 ) Instruct patients to take supplemental calcium and vitamin D if dietary intake is inadequate. 2.1 Important Administration Instructions Ibandronate sodium Injection must be administered intravenously only by a health care professional. Care must be taken not to administer intra-arterially or paravenously as this could lead to tissue damage [see Warnings and Precautions (5.4) ] . Appropriate medical support and monitoring measures should be readily available when ibandronate sodium injection is administered. If anaphylactic or other severe hypersensitivity/allergic reactions occur, immediately discontinue the injection and initiate appropriate treatment [see Warnings and Precautions (5.2) ]. Visually inspect the liquid in the prefilled syringe for particulate matter and discoloration before administration. Do not use prefilled syringes with particulate matter or discoloration. Administer only with the enclosed needle. Discard any unused portion. Do not mix with calcium-containing solutions or other intravenously administered drugs. Prefilled syringes are for single use only. 2.2 Dosage Information The recommended dose of ibandronate sodium injection for the treatment of postmenopausal osteoporosis is 3 mg every 3 months administered intravenously over a period of 15 to 30 seconds. Do not administer more frequently than once every 3 months. 2.3 Laboratory Testing and Oral Examination Prior to Administration Prior to administration of each dose obtain a serum creatinine [see Warnings and Precautions (5.3) ] . Given that bisphosphonates have been associated with osteonecrosis of the jaw (ONJ), perform a routine oral examination prior to administration of ibandronate sodium injection. 2.4 Calcium and Vitamin D Supplementation Instruct patients to take supplemental calcium and vitamin D if their dietary intake is inadequate. [see Warnings and Precautions (5.1) ] . 2.5 Dosing After Missed Dose If the dose is missed, administer as soon as it can be re-scheduled. Thereafter, ibandronate sodium injection should be scheduled every 3 months from the date of the last injection. 2.6 Dosage Modifications in Patients with Renal Impairment Do not administer to patients with severe renal impairment (creatinine clearance less than 30 mL/minute) [see Warnings and Precautions (5.3) and Clinical Pharmacology (12.3) ] . No dose adjustment is necessary for patients with mild or moderate renal impairment (creatinine clearance greater than or equal to 30 mL/min) [see Clinical Pharmacology (12.3) ] .

Dosage forms and strengths

Information about all available dosage forms and strengths for the drug product to which the labeling applies. This field may contain descriptions of product appearance.
3 DOSAGE FORMS AND STRENGTHS Ibandronate sodium Injection is supplied as a kit containing: a 3 mg/3 mL single-use prefilled syringe. a 25-gauge, 3/4 inch needle with wings, needle-stick protection device, and a 9 cm plastic tubing for attachment Ibandronate sodium Injection is supplied as a kit containing: a 3 mg/3 mL single-use prefilled syringe. a 25-gauge, 3/4 inch needle with wings, needle-stick protection device, and a 9 cm plastic tubing for attachment ( 3 )

Indications and usage

A statement of each of the drug products indications for use, such as for the treatment, prevention, mitigation, cure, or diagnosis of a disease or condition, or of a manifestation of a recognized disease or condition, or for the relief of symptoms associated with a recognized disease or condition. This field may also describe any relevant limitations of use.
1 INDICATIONS AND USAGE Ibandronate sodium injection is a bisphosphonate indicated for the treatment of osteoporosis in postmenopausal women. ( 1.1 ) Limitations of Use Optimal duration of use has not been determined. For patients at low-risk for fracture, consider drug discontinuation after 3 to 5 years of use ( 1.2 ) 1.1 Treatment of Postmenopausal Osteoporosis Ibandronate sodium Injection is indicated for the treatment of osteoporosis in postmenopausal women. In postmenopausal women with osteoporosis, ibandronate sodium injection increases bone mineral density (BMD) and reduces the incidence of vertebral fractures [see Clinical Studies (14) ] . 1.2 Important Limitations of Use The safety and effectiveness of ibandronate sodium injection for the treatment of osteoporosis are based on clinical data of one year duration. The optimal duration of use has not been determined. All patients on bisphosphonate therapy should have the need for continued therapy re-evaluated on a periodic basis. Patients at low-risk for fracture should be considered for drug discontinuation after 3 to 5 years of use. Patients who discontinue therapy should have their risk for fracture re-evaluated periodically.

Spl product data elements

Usually a list of ingredients in a drug product.
Ibandronate Sodium ibandronate sodium IBANDRONATE SODIUM IBANDRONIC ACID SODIUM CHLORIDE ACETIC ACID SODIUM ACETATE WATER Ibandronate-05

Animal pharmacology and or toxicology

Information from studies of the drug in animals, if the data were not relevant to nor included in other parts of the labeling. Most labels do not contain this field.
13.2 Animal Pharmacology Animal studies have shown that ibandronate is an inhibitor of osteoclast-mediated bone resorption. In the Schenk assay in growing rats, ibandronate inhibited bone resorption and increased bone volume, based on histologic examination of the tibial metaphyses. There was no evidence of impaired mineralization at the highest dose of 5 mg/kg/day (subcutaneously), which is 1,000 times the lowest antiresorptive dose of 0.005 mg/kg/day in this model, and 5,000 times the optimal antiresorptive dose of 0.001 mg/kg/day in the aged ovariectomized rat. This indicates that ibandronate sodium injection administered at a therapeutic dose is unlikely to induce osteomalacia. Long-term daily or intermittent administration of ibandronate to ovariectomized rats or monkeys was associated with suppression of bone turnover and increases in bone mass. Vertebral BMD, trabecular density, and biomechanical strength were increased dose-dependently in rats and monkeys, at doses up to 8 to 4 times the human intravenous dose of 3 mg every 3 months, based on cumulative dose normalized for body surface area (mg/m 2 ) and area under the curve (AUC) comparison, respectively. Ibandronate maintained the positive correlation between bone mass and strength at the ulna and femoral neck. New bone formed in the presence of ibandronate had normal histologic structure and did not show mineralization defects.

Carcinogenesis and mutagenesis and impairment of fertility

Information about carcinogenic, mutagenic, or fertility impairment potential revealed by studies in animals. Information from human data about such potential is part of the warnings field.
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis In a 104-week carcinogenicity study, doses of 3, 7, or 15 mg/kg/day were administered by oral gavage to Wistar rats (systemic exposures in males and females up to 3 and 1 times, respectively, human exposure). There were no significant drug-related tumor findings in male or female rats. In a 78-week carcinogenicity study, doses of 5, 20, or 40 mg/kg/day were administered by oral gavage to NMRI mice (exposures in males and females up to 96 and 14 times, respectively, human exposure). There were no significant drug-related tumor findings in male or female mice. In a 90-week carcinogenicity study, doses of 5, 20, or 80 mg/kg/day were administered in the drinking water to NMRI mice. A dose-related increased incidence of adrenal subcapsular adenoma/carcinoma was observed in female mice, which was statistically significant at 80 mg/kg/day (32 to 51 times human exposure). The relevance of these findings to humans is unknown. Exposure multiples comparing human and rodent doses were calculated using human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison. Mutagenesis There was no evidence for a mutagenic or clastogenic potential of ibandronate in the following assays: in vitr o bacterial mutagenesis assay in Salmonella typhimurium and Escherichia coli (Ames test), mammalian cell mutagenesis assay in Chinese hamster V79 cells, and chromosomal aberration test in human peripheral lymphocytes, each with and without metabolic activation. Ibandronate was not genotoxic in the in vivo mouse micronucleus tests for chromosomal damage. Impairment of Fertility In female rats treated from 14 days prior to mating through gestation, decreases in fertility, corpora lutea and implantation sites, and increased preimplantation loss were observed at an intravenous dose of 1.2 mg/kg/day (117 times human exposure). In male rats treated for 28 days prior to mating, a decrease in sperm production and altered sperm morphology were observed at intravenous doses greater than or equal to 0.3 mg/kg/day (greater than or equal to 40 times human exposure). Exposure multiples comparing human and rat doses were calculated using human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison. Carcinogenesis In a 104-week carcinogenicity study, doses of 3, 7, or 15 mg/kg/day were administered by oral gavage to Wistar rats (systemic exposures in males and females up to 3 and 1 times, respectively, human exposure). There were no significant drug-related tumor findings in male or female rats. In a 78-week carcinogenicity study, doses of 5, 20, or 40 mg/kg/day were administered by oral gavage to NMRI mice (exposures in males and females up to 96 and 14 times, respectively, human exposure). There were no significant drug-related tumor findings in male or female mice. In a 90-week carcinogenicity study, doses of 5, 20, or 80 mg/kg/day were administered in the drinking water to NMRI mice. A dose-related increased incidence of adrenal subcapsular adenoma/carcinoma was observed in female mice, which was statistically significant at 80 mg/kg/day (32 to 51 times human exposure). The relevance of these findings to humans is unknown. Exposure multiples comparing human and rodent doses were calculated using human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison. Mutagenesis There was no evidence for a mutagenic or clastogenic potential of ibandronate in the following assays: in vitr o bacterial mutagenesis assay in Salmonella typhimurium and Escherichia coli (Ames test), mammalian cell mutagenesis assay in Chinese hamster V79 cells, and chromosomal aberration test in human peripheral lymphocytes, each with and without metabolic activation. Ibandronate was not genotoxic in the in vivo mouse micronucleus tests for chromosomal damage. Impairment of Fertility In female rats treated from 14 days prior to mating through gestation, decreases in fertility, corpora lutea and implantation sites, and increased preimplantation loss were observed at an intravenous dose of 1.2 mg/kg/day (117 times human exposure). In male rats treated for 28 days prior to mating, a decrease in sperm production and altered sperm morphology were observed at intravenous doses greater than or equal to 0.3 mg/kg/day (greater than or equal to 40 times human exposure). Exposure multiples comparing human and rat doses were calculated using human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison.

Nonclinical toxicology

Information about toxicology in non-human subjects.
13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis In a 104-week carcinogenicity study, doses of 3, 7, or 15 mg/kg/day were administered by oral gavage to Wistar rats (systemic exposures in males and females up to 3 and 1 times, respectively, human exposure). There were no significant drug-related tumor findings in male or female rats. In a 78-week carcinogenicity study, doses of 5, 20, or 40 mg/kg/day were administered by oral gavage to NMRI mice (exposures in males and females up to 96 and 14 times, respectively, human exposure). There were no significant drug-related tumor findings in male or female mice. In a 90-week carcinogenicity study, doses of 5, 20, or 80 mg/kg/day were administered in the drinking water to NMRI mice. A dose-related increased incidence of adrenal subcapsular adenoma/carcinoma was observed in female mice, which was statistically significant at 80 mg/kg/day (32 to 51 times human exposure). The relevance of these findings to humans is unknown. Exposure multiples comparing human and rodent doses were calculated using human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison. Mutagenesis There was no evidence for a mutagenic or clastogenic potential of ibandronate in the following assays: in vitr o bacterial mutagenesis assay in Salmonella typhimurium and Escherichia coli (Ames test), mammalian cell mutagenesis assay in Chinese hamster V79 cells, and chromosomal aberration test in human peripheral lymphocytes, each with and without metabolic activation. Ibandronate was not genotoxic in the in vivo mouse micronucleus tests for chromosomal damage. Impairment of Fertility In female rats treated from 14 days prior to mating through gestation, decreases in fertility, corpora lutea and implantation sites, and increased preimplantation loss were observed at an intravenous dose of 1.2 mg/kg/day (117 times human exposure). In male rats treated for 28 days prior to mating, a decrease in sperm production and altered sperm morphology were observed at intravenous doses greater than or equal to 0.3 mg/kg/day (greater than or equal to 40 times human exposure). Exposure multiples comparing human and rat doses were calculated using human exposure at the recommended intravenous dose of 3 mg every 3 months, based on cumulative AUC comparison. 13.2 Animal Pharmacology Animal studies have shown that ibandronate is an inhibitor of osteoclast-mediated bone resorption. In the Schenk assay in growing rats, ibandronate inhibited bone resorption and increased bone volume, based on histologic examination of the tibial metaphyses. There was no evidence of impaired mineralization at the highest dose of 5 mg/kg/day (subcutaneously), which is 1,000 times the lowest antiresorptive dose of 0.005 mg/kg/day in this model, and 5,000 times the optimal antiresorptive dose of 0.001 mg/kg/day in the aged ovariectomized rat. This indicates that ibandronate sodium injection administered at a therapeutic dose is unlikely to induce osteomalacia. Long-term daily or intermittent administration of ibandronate to ovariectomized rats or monkeys was associated with suppression of bone turnover and increases in bone mass. Vertebral BMD, trabecular density, and biomechanical strength were increased dose-dependently in rats and monkeys, at doses up to 8 to 4 times the human intravenous dose of 3 mg every 3 months, based on cumulative dose normalized for body surface area (mg/m 2 ) and area under the curve (AUC) comparison, respectively. Ibandronate maintained the positive correlation between bone mass and strength at the ulna and femoral neck. New bone formed in the presence of ibandronate had normal histologic structure and did not show mineralization defects.

Package label principal display panel

The content of the principal display panel of the product package, usually including the product’s name, dosage forms, and other key information about the drug product.
PRINCIPAL DISPLAY PANEL - Syringe label NDC 60505-6097-0 Ibandronate Sodium Injection 3 mg/3 mL (1 mg/mL) Sterile FOR INTRAVENOUS USE ONLY Single-Use Prefilled Syringe PRINCIPAL DISPLAY PANEL - 3 mL Syringe Carton NDC 60505-6097-0 Ibandronate sodium Injection 3 mg/3 mL (1 mg/mL) PHARMACIST: Dispense the enclosed Medication Guide to each patient. Package contains: 1 Single-Use Prefilled Syringe, Ibandronate sodium Injection 3 mg/3 mL NDC 60505-6097-0 1 Needle Sterile. For I.V. Use Only. Each Carton Contains: 1 Single-Use Prefilled Syringe Rx only Ibandronate-04

Spl unclassified section

Information not classified as belonging to one of the other fields. Approximately 40% of labeling with effective_time between June 2009 and August 2014 have information in this field.
Manufactured by Manufactured for Gland Pharma Limited, Apotex Corp. India Weston, Florida M.L.No.103/AP/RR/97/F/R 33326 January 2017, Rev. 01 TERUMO ® Surshield™ Safety Winged Infusion Set – Instructions for Use: IV Administration Aseptic technique, proper skin preparation and continued protection of the site are essential. Observe Universal Precautions on all patients. Caution: Keep hands behind the needle at all times during use and disposal. Instructions for Device Assembly Open the package. Remove the rubber cap from the tip of the syringe containing the ibandronate sodium injection and the protective SV cap from hub at the end of the tubing opposite the butterfly needle. Insert the tip of the syringe into the hub and twist as firm pressure is applied to assure a tight connection. Proceed with priming and confirm that administration fluid comes from the needle. Venipuncture and Administration Flip the safety shield back away from the needle towards the tubing. Grasp wings securely. Remove the needle protector. Caution: Care should be taken not to touch the needle. Perform venipuncture and confirm proper positioning of the needle in the vein. Carefully allow wings to return to starting position and conform to the shape of the skin. Further secure the position of the winged infusion set per facility protocol. After Use Remove tape, if present, from wings. Flip the safety shield forward toward the needle. Grasp a wing and the safety shield between your thumb and index finger. Completely remove the needle from the puncture site and apply digital pressure to the site using a sterile gauze pad held in the opposite hand ( Fig. 1 ). With the wing and shield between your thumb and index finger pinch together (or press the safety shield against a hard surface such as a bedside table) until an audible click is heard ( Fig. 2 ). Visually confirm activation of the safety feature ( Fig. 3 ). Dispose of used needles and materials following the policies and procedures of your facility, as well as federal and local regulations for "Sharps Disposal." ® Registered Trademark. Surshield is a trademark of TERUMO CORPORATION. Figures 2
Manufactured by Manufactured for
Gland Pharma Limited, Apotex Corp.
India Weston, Florida
M.L.No.103/AP/RR/97/F/R 33326

ibandronate sodium: Information for patients

Information necessary for patients to use the drug safely and effectively, such as precautions concerning driving or the concomitant use of other substances that may have harmful additive effects.
17 PATIENT COUNSELING INFORMATION "See FDA-approved patient labeling (Medication Guide) " Inform patients that ibandronate sodium injection must be administered intravenously by a health care professional. Patients should be instructed to read the Medication Guide carefully before ibandronate sodium injection is administered and to re-read it each time the prescription is renewed because it contains important information the patient should know about ibandronate sodium injection. Inform patients that ibandronate sodium injection is administered once every 3 months. If the dose is missed, the injection should be administered as soon as it can be rescheduled. Thereafter, injections should be scheduled every 3 months from the date of the last injection. Do not administer ibandronate sodium injection more frequently than once every 3 months. Inform patients that they should take supplemental calcium and vitamin D if their dietary intake is inadequate [see Warnings and Precautions (5.1) ] . Inform patients ibandronate sodium injection should not be administered to patients with creatinine clearance less than 30 mL/min. A serum creatinine should be measured prior to each dose [see Warnings and Precautions (5.3) ] . Inform patients that the most common side effects of ibandronate sodium include arthralgia, back pain, hypertension, and abdominal pain. Flu-like symptoms (acute phase reaction) may occur within 3 days following infusion, and usually subside within 24 to 48 hours without specific therapy. Inform patients that there have been reports of persistent pain and/or a non-healing sore of the mouth or jaw, primarily in patients treated with bisphosphonates for other illnesses. If they experience these symptoms, they should inform their physician or dentist. Inform patients that severe bone, joint, and/or muscle pain have been reported in patients taking bisphosphonates, including ibandronate sodium. Patients should report severe symptoms if they develop. Inform patients that atypical femur fractures in patients on bisphosphonate therapy have been reported. Patients should report new thigh or groin pain and undergo evaluation to rule out a femoral fracture.

Spl medguide

Information about the patient medication guide that accompanies the drug product. Certain drugs must be dispensed with an accompanying medication guide. This field may contain information about when to consult the medication guide and the contents of the medication guide.
MEDICATION GUIDE Ibandronate sodium Injection for intravenous use (eye" ban droe' nate soe' dee um) Read the Medication Guide that comes with ibandronate sodium injection before you start taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking with your doctor about your medical condition or treatment. Talk to your doctor if you have any questions about ibandronate sodium injection. What is the most important information I should know about ibandronate sodium injection? Ibandronate sodium Injection is given in your vein (intravenously) and only given by a healthcare provider. Do not give ibandronate sodium injection to yourself. Ibandronate sodium Injection may cause serious side effects including: Low calcium levels in your blood (hypocalcemia) Severe allergic reaction (anaphylactic reaction) Severe kidney problems Severe jaw bone problems (osteonecrosis) Bone, joint or muscle pain Unusual thigh bone fractures 1. Low calcium levels in your blood (hypocalcemia). Ibandronate sodium may lower the calcium levels in your blood. If you have low blood calcium before you start taking ibandronate sodium, it may get worse during treatment. Your low blood calcium must be treated before you receive ibandronate sodium. Most people with low blood calcium levels do not have symptoms, but some people may have symptoms. Call your doctor right away if you have symptoms of low blood calcium such as: Spasms, twitches, or cramps in your muscles Numbness or tingling in your fingers, toes, or around your mouth Your doctor may prescribe calcium and vitamin D to help prevent low calcium levels in your blood, while you receive ibandronate sodium injection. Take calcium and vitamin D as your doctor tells you to. 2. Severe allergic reactions. Some people who received ibandronate sodium injection had severe allergic reactions (anaphylactic reactions) that led to death. Get medical help right away if you have any of the symptoms of a serious allergic reaction such as: Swelling of your face, lips, mouth or tongue Trouble breathing Wheezing Severe itching Skin rash, redness or swelling Dizziness or fainting Fast heartbeat or pounding in your chest Sweating 3. Severe kidney problems. Severe kidney problems, including kidney failure, may happen when you receive ibandronate sodium. Your doctor should do blood tests to check your kidneys before you receive each dose of ibandronate sodium. 4. Severe jaw bone problems (osteonecrosis). Severe jaw bone problems may happen when you receive ibandronate sodium. Your doctor may examine your mouth before you start ibandronate sodium. Your doctor may tell you to see your dentist before you start ibandronate sodium. It is important for you to practice good mouth care during treatment with ibandronate sodium. 5. Bone, joint, or muscle pain. Some people who receive ibandronate sodium develop severe bone, joint, or muscle pain. 6. Unusual thigh bone fractures. Some people have developed unusual fractures in their thigh bone. Symptoms of a fracture may include new or unusual pain in your hip, groin, or thigh. Call your doctor right away if you have any of these side effects. What is Ibandronate sodium Injection? Ibandronate sodium Injection is a prescription medicine used to treat osteoporosis in women after menopause. Ibandronate sodium Injection helps increase bone mass and helps reduce the chance of having a spinal fracture (break). It is not known how long i bandronate sodium injection works for the treatment of osteoporosis. You should see your doctor regularly to determine if i bandronate sodium injection is still right for you. It is not known if i bandronate sodium injection is safe and effective in children. Who should not receive I bandronate sodium Injection ? Do not receive i bandronate sodium injection if you: Have low levels of calcium in your blood Are allergic to ibandronate sodium or any of the ingredients in i bandronate sodium injection . See the end of this leaflet for a complete list of ingredients in i bandronate sodium injection . What should I tell my healthcare provider before receiving I bandronate sodium Injection ? Before you receive ibandronate sodium injection, tell your doctor if you: Have low blood calcium Plan to have dental surgery or teeth removed Have kidney problems or other problems that may affect your kidneys Have been told you have trouble absorbing minerals in your stomach or intestines (malabsorption syndrome) Are pregnant or plan to become pregnant. It is not known if i bandronate sodium injection can harm your unborn baby. Are breast-feeding or plan to breast-feed. It is not known if i bandronate sodium passes into your milk and may harm your baby. Tell your doctor and dentist about all the medicines you take, including prescription and non-prescription medicines, vitamins and herbal supplements. Know the medicines you take. Keep a list of them and show it to your healthcare provider and pharmacist each time you get a new medicine. How should I receive Ibandronate sodium Injection? I bandronate sodium Injection is given 1 time every 3 months by a healthcare provider. If you miss a dose of i bandronate sodium injection , call your doctor or healthcare provider to schedule your next dose. What are the possible side effects of i bandronate sodium injection ? I bandronate sodium injection may cause serious side effects. See " What is the most important information I should know about ibandronate sodium injection ?" The most common side effects of i bandronate sodium injection include: Pain in your bones, joints or muscles Back pain Abdominal pain Flu-like symptoms may happen within 3 days after you receive ibandronate sodium injection. Symptoms include: fever chills bone, joint, or muscle pain fatigue If you have flu-like symptoms, they should get better within 24 to 48 hours. Some people have pain or a sore that will not heal in their mouth or jaw while they receive ibandronate sodium . Tell your doctor or dentist if you have mouth or jaw problems. Tell your doctor if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of ibandronate sodium . For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. How should I store ibandronate sodium injection if I need to pick it up from a pharmacy? Store at 25°C (77°F); excursions permitted between 15°C and 30°C (59°F and 86°F) [see USP Controlled Room Temperature]. Keep ibandronate sodium injection and all medicines out of the reach of children. General information about the safe and effective use of ibandronate sodium injection. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use ibandronate sodium injection for a condition for which it was not prescribed. Do not give ibandronate sodium injection to other people, even if they have the same symptoms you have. It may harm them. This Medication Guide summarizes the most important information about ibandronate sodium injection. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about ibandronate sodium injection that is written for health professionals. What are the ingredients in ibandronate sodium injection? Active ingredient: ibandronate sodium Inactive ingredients: glacial acetic acid, sodium chloride, sodium acetate trihydrate and water for injection. This Medication Guide has been approved by the U.S. Food and Drug Administration.

Clinical studies

This field may contain references to clinical studies in place of detailed discussion in other sections of the labeling.
14 CLINICAL STUDIES 14.1 Treatment of Postmenopausal Osteoporosis Quarterly Intravenous Injection The effectiveness and safety of ibandronate sodium injection 3 mg once every 3 months were demonstrated in a randomized, double-blind, multinational, noninferiority study in 1358 women with postmenopausal osteoporosis (L2 to L4 lumbar spine BMD, T-score below -2.5 SD at baseline). The control group received ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablets. The primary efficacy parameter was the relative change from baseline to 1 year of treatment in lumbar spine BMD, which was compared between the intravenous injection and the daily oral treatment groups. All patients received 400 international units vitamin D and 500 mg calcium supplementation per day. Effect on BMD In the intent-to-treat (ITT) efficacy analysis, the least-squares mean increase at 1 year in lumbar spine BMD in patients (n=429) treated with ibandronate sodium injection 3 mg once every 3 months (4.5%) was statistically superior to that in patients (n=434) treated with daily oral tablets (3.5%). The mean difference between groups was 1.1% (95% confidence interval: 0.5%, 1.6%; p<0.001; see Figure 1 ). The mean increase from baseline in total hip BMD at 1 year was 2.1% in the ibandronate sodium injection 3 mg once every 3 months group and 1.5% in the ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet group. Consistently higher BMD increases at the femoral neck and trochanter were also observed following ibandronate sodium injection 3 mg once every 3 months compared to ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet. Figure 1 Mean Percent Change (95% Confidence Interval) from Baseline in Lumbar Spine BMD at One Year in Patients Treated with Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily Oral Tablet or Ibandronate sodium Injection 3 mg Once Every 3 Months Figure 1 Bone Histology The histological analysis of bone biopsies after 22 months of treatment with 3 mg intravenous ibandronate every 3 months (n=30) or 23 months of treatment with 2 mg intravenous ibandronate every 2 months (n=27) in women with postmenopausal osteoporosis showed bone of normal quality and no indication of a mineralization defect. Daily Oral Tablets The effectiveness and safety of ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablets were demonstrated in a randomized, double-blind, placebo-controlled, multinational study (Treatment Study) of 2946 women aged 55 to 80 years, who were on average 21 years postmenopause, who had a lumbar spine BMD 2 to 5 SD below the premenopausal mean (T-score) in at least one vertebra [L1 to L4], and who had one to four prevalent vertebral fractures. Ibandronate sodium was evaluated at oral doses of 2.5 mg daily and 20 mg intermittently. The main outcome measure was the occurrence of new radiographically diagnosed, vertebral fractures after 3 years of treatment. The diagnosis of an incident vertebral fracture was based on both qualitative diagnosis by the radiologist and quantitative morphometric criterion. The morphometric criterion required the dual occurrence of two events: a relative height ratio or relative height reduction in a vertebral body of at least 20%, together with at least a 4 mm absolute decrease in height. All women received 400 international units vitamin D and 500 mg calcium supplementation per day. Effect on Vertebral Fracture Ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet significantly reduced the incidence of new vertebral fractures compared to placebo. Over the course of the 3-year study, the risk for new vertebral fracture was 9.6% in the placebo-treated women and 4.7% in the women treated with ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet (p<0.001) (see Table 3 ). Table 3 Effect of Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily Oral Tablet on the Incidence of Vertebral Fracture in the 3-Year Osteoporosis Treatment Study* Proportion of Patients with Fracture (%) Placebo n=975 Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily n=977 Absolute Risk Reduction (%) 95% CI Relative Risk Reduction (%) 95% CI New Vertebral Fracture 0-3 Year 9.6 4.7 4.9 (2.3, 7.4) 52** (29, 68) New and WorseningVertebral Fracture*** 0-3 Year 10.4 5.1 5.3 (2.6, 7.9) 52 (30, 67) Clinical (Symptomatic) Vertebral Fracture 0-3 Year 5.3 2.8 2.5 (0.6, 4.5) 49 (14, 69) *The endpoint value is the value at the study's last time point, 3 years, for all patients who had a fracture identified at that time; otherwise, the last postbaseline value prior to the study's last time point is used. **p=0.0003 vs. placebo ***"Worsening vertebral fracture" defined as a new fracture in a vertebral body with a prevalent fracture Effect on Nonvertebral Fractures Ibandronate sodium tablets 2.5 mg (ibandronate) daily did not reduce the incidence of nonvertebral fractures (secondary efficacy measure). There was a similar number of nonvertebral osteoporotic fractures at 3 years reported in women treated with ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet [9.1%, (95% CI: 7.1%, 11.1%)] and placebo [8.2%, (95% CI: 6.3%, 10.2%)]. The two treatment groups were also similar with regard to the number of fractures reported at the individual non-vertebral sites: pelvis, femur, wrist, forearm, rib, and hip. Effect on BMD Ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet significantly increased BMD at the lumbar spine and hip relative to treatment with placebo. In the 3-year osteoporosis treatment study, ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet produced increases in lumbar spine BMD that were progressive over 3 years of treatment and were statistically significant relative to placebo at 6 months and at all later time points. Lumbar spine BMD increased by 6.4% after 3 years of treatment with ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet compared with 1.4% in the placebo group (p<0.0001). Table 4 displays the significant increases in BMD seen at the lumbar spine, total hip, femoral neck, and trochanter compared to placebo. Table 4 Mean Percent Change in BMD from Baseline to Endpoint in Patients Treated with Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily Oral Tablet or Placebo in the 3-Year Osteoporosis Treatment Study The endpoint value is the value at the study's last time point, 3 years, for all patients who had BMD measured at that time; otherwise the last postbaseline value prior to the study's last time point is used. Placebo Ibandronate sodium Tablets 2.5 mg (ibandronate) Lumbar Spine 1.4 (n=693) 6.4 (n=712) Total Hip -0.7 (n=638) 3.1 (n=654) Femoral neck -0.7 (n=683) 2.6 (n=699) Trochanter 0.2 (n=683) 5.3 (n=699) Bone Histology The effects of ibandronate sodium tablets 2.5 mg (ibandronate) daily oral tablet on bone histology were evaluated in iliac crest biopsies from 16 women after 22 months of treatment and 20 women after 34 months of treatment. The histological analysis of bone biopsies showed bone of normal quality and no indication of osteomalacia or a mineralization defect.
Proportion of Patients with Fracture (%)
Placebo n=975 Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily n=977 Absolute Risk Reduction (%) 95% CI Relative Risk Reduction (%) 95% CI
New Vertebral Fracture 0-3 Year 9.6 4.7 4.9 (2.3, 7.4) 52** (29, 68)
New and WorseningVertebral Fracture*** 0-3 Year 10.4 5.1 5.3 (2.6, 7.9) 52 (30, 67)
Clinical (Symptomatic) Vertebral Fracture 0-3 Year 5.3 2.8 2.5 (0.6, 4.5) 49 (14, 69)
Table 4 Mean Percent Change in BMD from Baseline to Endpoint in Patients Treated with Ibandronate sodium Tablets 2.5 mg (ibandronate) Daily Oral Tablet or Placebo in the 3-Year Osteoporosis Treatment StudyThe endpoint value is the value at the study's last time point, 3 years, for all patients who had BMD measured at that time; otherwise the last postbaseline value prior to the study's last time point is used.
Placebo Ibandronate sodium Tablets 2.5 mg (ibandronate)
Lumbar Spine 1.4 (n=693) 6.4 (n=712)
Total Hip -0.7 (n=638) 3.1 (n=654)
Femoral neck -0.7 (n=683) 2.6 (n=699)
Trochanter 0.2 (n=683) 5.3 (n=699)

Geriatric use

Information about any limitations on any geriatric indications, needs for specific monitoring, hazards associated with use of the drug in the geriatric population.
8.5 Geriatric Use Of the patients receiving ibandronate sodium injection 3 mg every 3 months for 1 year, 51% were over 65 years of age. No overall differences in effectiveness or safety were observed between these patients and younger patients, but greater sensitivity in some older individuals cannot be ruled out.

Nursing mothers

Information about excretion of the drug in human milk and effects on the nursing infant, including pertinent adverse effects observed in animal offspring.
8.2 Lactation Risk Summary Ibandronate sodium is not indicated for use in women of reproductive potential. There is no information on the presence of ibandronate in human milk, the effects of ibandronate on the breastfed infant, or the effects of ibandronate on milk production. Ibandronate is present in rat milk (see Data). The clinical relevance of this data is unclear. Data Animal Data In lactating rats treated with intravenous doses of 0.08 mg/kg, ibandronate was present in breast milk at concentrations of 8.1 to 0.4 ng/mL from 2 to 24 hours after dose administration. Concentrations in milk averaged 1.5 times plasma concentrations.

Pediatric use

Information about any limitations on any pediatric indications, needs for specific monitoring, hazards associated with use of the drug in any subsets of the pediatric population (such as neonates, infants, children, or adolescents), differences between pediatric and adult responses to the drug, and other information related to the safe and effective pediatric use of the drug.
8.4 Pediatric Use Safety and effectiveness of ibandronate sodium injection in pediatric patients have not been established.

Pregnancy

Information about effects the drug may have on pregnant women or on a fetus. This field may be ommitted if the drug is not absorbed systemically and the drug is not known to have a potential for indirect harm to the fetus. It may contain information about the established pregnancy category classification for the drug. (That information is nominally listed in the teratogenic_effects field, but may be listed here instead.)
8.1 Pregnancy Risk Summary Ibandronate sodium is not indicated for use in women of reproductive potential. There are no data with ibandronate sodium use in pregnant women to inform any drug-associated risks. In reproductive toxicity studies in the rat, ibandronate sodium caused obstruction of labor, with maternal periparturient mortality, pup loss and reduced pup weight at greater than or equal to 2 times human exposure at the recommended human intravenous dose of 3 mg. Abnormal pup odontogeny was observed at greater than or equal to 18 times human exposure. In rats dosed during pregnancy, kidney developmental toxicity occurred in offspring at greater than or equal to 47 times human exposure. Also, fetal weight and pup growth were reduced at greater than or equal to 5 times human exposure. In reproductive studies in the rabbit, ibandronate sodium caused maternal mortality, reduced maternal body weight gain, decreased litter size due to increased resorption rate, and decreased fetal weight at 19 times the recommended human dose ( see Data ). Data Animal Data In pregnant rats given intravenous doses producing greater than or equal to 2 times human exposure from Day 17 post­-coitum until Day 20 post-partum, ibandronate treatment resulted in dystocia, maternal mortality, and early postnatal pup loss in all dose groups. Reduced body weight at birth was observed at greater than or equal to 4 times the human exposure. Pups exhibited abnormal odontogeny that decreased food consumption and body weight gain at greater than or equal to 18 times human exposure. Periparturient mortality has also been observed with other bisphosphonates and appears to be a class effect related to inhibition of skeletal calcium mobilization resulting in hypocalcemia and dystocia. Exposure of pregnant rats during the period of organogenesis resulted in an increased fetal incidence of RPU (renal pelvis ureter) syndrome at an intravenous dose producing greater than or equal to 47 times human exposure. In this spontaneous delivery study, dystocia was counteracted by perinatal calcium supplementation. In rat studies with intravenous dosing during gestation, fetal weight and pup growth were reduced at doses producing greater than or equal to 5 times human exposure. In pregnant rabbits given intravenous doses during the period of organogenesis, maternal mortality, reduced maternal body weight gain, decreased litter size due to increased resorption rate, and decreased fetal weight were observed at 19 times the recommended human intravenous dose. Exposure multiples for the rat studies were calculated using human exposure at the recommended intravenous dose of 3 mg every 3 months and were based on cumulative area under the curve (AUC) comparison. Exposure multiples for the rabbit study were calculated for the recommended human intravenous dose of 3 mg every 3 months and were based on cumulative dose/[body surface area] comparison. Doses in pregnant animals were 0.05, 0.1, 0.15, 0.3, 0.5 or 1 mg/kg/day in rats, and 0.03, 0.07, or 0.2 mg/kg/day in rabbits.

Use in specific populations

Information about use of the drug by patients in specific populations, including pregnant women and nursing mothers, pediatric patients, and geriatric patients.
8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Risk Summary Ibandronate sodium is not indicated for use in women of reproductive potential. There are no data with ibandronate sodium use in pregnant women to inform any drug-associated risks. In reproductive toxicity studies in the rat, ibandronate sodium caused obstruction of labor, with maternal periparturient mortality, pup loss and reduced pup weight at greater than or equal to 2 times human exposure at the recommended human intravenous dose of 3 mg. Abnormal pup odontogeny was observed at greater than or equal to 18 times human exposure. In rats dosed during pregnancy, kidney developmental toxicity occurred in offspring at greater than or equal to 47 times human exposure. Also, fetal weight and pup growth were reduced at greater than or equal to 5 times human exposure. In reproductive studies in the rabbit, ibandronate sodium caused maternal mortality, reduced maternal body weight gain, decreased litter size due to increased resorption rate, and decreased fetal weight at 19 times the recommended human dose ( see Data ). Data Animal Data In pregnant rats given intravenous doses producing greater than or equal to 2 times human exposure from Day 17 post­-coitum until Day 20 post-partum, ibandronate treatment resulted in dystocia, maternal mortality, and early postnatal pup loss in all dose groups. Reduced body weight at birth was observed at greater than or equal to 4 times the human exposure. Pups exhibited abnormal odontogeny that decreased food consumption and body weight gain at greater than or equal to 18 times human exposure. Periparturient mortality has also been observed with other bisphosphonates and appears to be a class effect related to inhibition of skeletal calcium mobilization resulting in hypocalcemia and dystocia. Exposure of pregnant rats during the period of organogenesis resulted in an increased fetal incidence of RPU (renal pelvis ureter) syndrome at an intravenous dose producing greater than or equal to 47 times human exposure. In this spontaneous delivery study, dystocia was counteracted by perinatal calcium supplementation. In rat studies with intravenous dosing during gestation, fetal weight and pup growth were reduced at doses producing greater than or equal to 5 times human exposure. In pregnant rabbits given intravenous doses during the period of organogenesis, maternal mortality, reduced maternal body weight gain, decreased litter size due to increased resorption rate, and decreased fetal weight were observed at 19 times the recommended human intravenous dose. Exposure multiples for the rat studies were calculated using human exposure at the recommended intravenous dose of 3 mg every 3 months and were based on cumulative area under the curve (AUC) comparison. Exposure multiples for the rabbit study were calculated for the recommended human intravenous dose of 3 mg every 3 months and were based on cumulative dose/[body surface area] comparison. Doses in pregnant animals were 0.05, 0.1, 0.15, 0.3, 0.5 or 1 mg/kg/day in rats, and 0.03, 0.07, or 0.2 mg/kg/day in rabbits. 8.2 Lactation Risk Summary Ibandronate sodium is not indicated for use in women of reproductive potential. There is no information on the presence of ibandronate in human milk, the effects of ibandronate on the breastfed infant, or the effects of ibandronate on milk production. Ibandronate is present in rat milk (see Data). The clinical relevance of this data is unclear. Data Animal Data In lactating rats treated with intravenous doses of 0.08 mg/kg, ibandronate was present in breast milk at concentrations of 8.1 to 0.4 ng/mL from 2 to 24 hours after dose administration. Concentrations in milk averaged 1.5 times plasma concentrations. 8.4 Pediatric Use Safety and effectiveness of ibandronate sodium injection in pediatric patients have not been established. 8.5 Geriatric Use Of the patients receiving ibandronate sodium injection 3 mg every 3 months for 1 year, 51% were over 65 years of age. No overall differences in effectiveness or safety were observed between these patients and younger patients, but greater sensitivity in some older individuals cannot be ruled out. 8.6 Renal Impairment Ibandronate sodium Injection should not be administered to patients with severe renal impairment (creatinine clearance less than 30 mL/min) [see Warnings and Precautions (5.3) ] .

How supplied

Information about the available dosage forms to which the labeling applies, and for which the manufacturer or distributor is responsible. This field ordinarily includes the strength of the dosage form (in metric units), the units in which the dosage form is available for prescribing, appropriate information to facilitate identification of the dosage forms (such as shape, color, coating, scoring, and National Drug Code), and special handling and storage condition information.
16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How Supplied Ibandronate sodium Injection is supplied as a kit containing a 3 mg/3 mL (1 mg/mL) single-use, clear glass, 5 mL (5 cc) prefilled syringe, a 25-gauge, 3/4 inch needle with wings, needle-stick protection device, and a 9 cm plastic tubing for attachment (NDC 60505-6097-0). 16.2 Storage and Handling Store at 25°C (77°F); excursions permitted between 15°C and 30°C (59°F and 86°F) [see USP Controlled Room Temperature].

Storage and handling

Information about safe storage and handling of the drug product.
16.2 Storage and Handling Store at 25°C (77°F); excursions permitted between 15°C and 30°C (59°F and 86°F) [see USP Controlled Room Temperature].

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