This label may not be the latest approved by FDA.
For current labeling information, please visit https://www.fda.gov/drugsatfda
HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use
BONIVA Tablets safely and effectively. See full prescribing informationfor BONIVA Tablets.


BONIVA (ibandronate sodium) Tablets
Initial U.S. Approval: 2003--------------------------- INDICATIONS AND USAGE---------------------------­
BONIVA is a bisphosphonate indicated for the treatment and prevention of
postmenopausal osteoporosis. (1.1).
Limitations of Use
The 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).
-----------------------DOSAGE AND ADMINISTRATION ----------------------­•Take one 150 mg tablet once monthly on the same day each month (2.1)•
Instruct patient to: (2.2)
oSwallow whole tablet with 6-8 oz of plain water only, at least
60 minutes before the first food, beverage, or medication of day.
Avoid lying down for at least 60 minutes after taking BONIVA.
o
Do not eat, drink (except for water), or take other medication for
60 minutes after taking BONIVA.
•
Take supplemental calcium and vitamin D if dietary intake inadequate(2.3)--------------------- DOSAGE FORMS AND STRENGTHS---------------------­
Tablets: 150 mg (3)------------------------------ CONTRAINDICATIONS -----------------------------­•
Abnormalities of the esophagus which delay esophageal emptying suchas stricture or achalasia (4, 5.1)•
Inability to stand or sit upright for at least 60 minutes (4, 5.1)••

Hypocalcemia (4)Hypersensitivity to BONIVA (4)----------------------- WARNINGS AND PRECAUTIONS ----------------------­•
Upper gastrointestinal Adverse Reactions can occur. Instruct patients tofollow dosing instructions and discontinue use if new or worsening
symptoms occur. (5.1)•
Hypocalcemia may worsen during treatment. Correct hypocalcemia
before use. (5.2)•
Severe Bone, Joint, and Muscle Pain may occur. Consider
discontinuing use if symptoms develop. (5.3)•
Osteonecrosis of the Jaw has been reported. (5.4)•
Atypical Femur Fractures have been reported. Patients with new thighor groin pain should be evaluated to rule out a femoral fracture. (5.5)------------------------------ ADVERSE REACTIONS -----------------------------­The most common adverse reactions (greater than 5%) are back pain,
dyspepsia, pain in extremity, diarrhea, headache, and myalgia. (6)To report SUSPECTED ADVERSE REACTIONS, contact Genentech at
1-888-835-2555 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
------------------------------ DRUG INTERACTIONS------------------------------­•
Calcium supplements, antacids and some oral medications may interferewith absorption of ibandronate. Do not take within 60 minutes of dosing(7.1)•
Use caution when co-prescribing aspirin/nonsteroidal anti-inflammatory
drugs that may worsen gastrointestinal irritation. (7.2)----------------------- USE IN SPECIFIC POPULATIONS ----------------------­
BONIVA is not recommended in patients with severe renal impairment(creatinine clearance less than 30 mL/min). (5.6, 8.6)

See 17 for PATIENT COUNSELING INFORMATION and FDAapproved Medication Guide.
Revised: 12/2016____________________________________________________________________________________________________________________________________

FULL PRESCRIBING INFORMATION: CONTENTS*
1

8

USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.2 Lactation
8.4 Pediatric Use
8.5 Geriatric Use
8.6 Renal Impairment
OVERDOSAGEDESCRIPTION
CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.2 Pharmacodynamics
12.3 Pharmacokinetics
NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
13.2 Animal Pharmacology
CLINICAL STUDIES
14.1 Treatment of Postmenopausal Osteoporosis
14.2 Prevention of Postmenopausal Osteoporosis
HOW SUPPLIED/STORAGE AND HANDLING
16.1 How Supplied
16.2 Storage and Handling
PATIENT COUNSELING INFORMATION
17.1 Information for Patients

INDICATIONS AND USAGE
1.1 Treatment and Prevention of Postmenopausal Osteoporosis
1.2 Important Limitations of Use
2 DOSAGE AND ADMINISTRATION
2.1 Dosage Information
10
2.2 Important Administration Instructions
11
2.3 Recommendations for Calcium and Vitamin D Supplementation
12
2.4 Administration Instructions for Missed Once-Monthly Doses
3 DOSAGE FORMS AND STRENGTHS
4 CONTRAINDICATIONS
13
5 WARNINGS AND PRECAUTIONS
5.1 Upper Gastrointestinal Adverse Reactions
5.2 Hypocalcemia and Mineral Metabolism
5.3 Musculoskeletal Pain
14
5.4 Jaw Osteonecrosis
5.5 Atypical Subtrochanteric and Diaphyseal Femoral Fractures
5.6 Severe Renal Impairment
16
6 ADVERSE REACTIONS
6.1 Clinical Trials Experience
6.2 Postmarketing Experience
17
7 DRUG INTERACTIONS
7.1 Calcium Supplements/Antacids
7.2 Aspirin/Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)*Sections or subsections omitted from the full prescribing information are not
7.3 H2 Blockers
listed.
7.4 Drug/Laboratory Test Interactions____________________________________________________________________________________________________________________________________

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FULL PRESCRIBING INFORMATION
1

INDICATIONS AND USAGE

1.1
Treatment and Prevention of Postmenopausal Osteoporosis
BONIVA is indicated for the treatment and prevention of osteoporosis in postmenopausal women. BONIVA
increases bone mineral density (BMD) and reduces the incidence of vertebral fractures.
1.2
Important Limitations of Use
The optimal duration of use has not been determined. The safety and effectiveness of BONIVA for thetreatment of osteoporosis are based on clinical data of three years duration. 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.
2

DOSAGE AND ADMINISTRATION

2.1
Dosage Information
The dose of BONIVA is one 150 mg tablet taken once monthly on the same date each month.
2.2
Important Administration Instructions
Instruct Patients to do the following:o Take BONIVA at least 60 minutes before the first food or drink (other than water) of the day or
before taking any oral medication or supplementation, including calcium, antacids, or vitamins tomaximize absorption and clinical benefit, (see DRUG INTERACTIONS [7.1]). Avoid the use ofwater with supplements including mineral water because they may have a higher concentrationof calcium.
o Swallow BONIVA tablets whole with a full glass of plain water (6 to 8 oz) while standing or
sitting in an upright position to reduce the potential for esophageal irritation. Avoid lying downfor 60 minutes after taking BONIVA (see WARNINGS AND PRECAUTIONS [5.1]). Do notchew or suck the tablet because of a potential for oropharyngeal ulceration.
o Do not eat, drink anything except plain water, or take other medications for at least 60 minutes
after taking BONIVA.
2.3
Recommendations for Calcium and Vitamin D Supplementation
Instruct patients to take supplemental calcium and vitamin D if their dietary intake is inadequate. Avoid the useof calcium supplements within 60 minutes of BONIVA administration because co-administration of BONIVA
and calcium may interfere with the absorption of ibandronate sodium (see DRUG INTERACTIONS [7.1]).
2.4
Administration Instructions for Missed Once-Monthly Doses
If the once-monthly dose is missed, instruct patients to do the following:• If the next scheduled BONIVA day is more than 7 days away, take one BONIVA 150 mg tablet in themorning following the date that it is remembered.
• If the next scheduled BONIVA day is only 1 to 7 days away, wait until the subsequent month’sscheduled BONIVA day to take their tablet.
For subsequent monthly doses for both of the above scenarios, instruct patients to return to their originalschedule by taking one BONIVA 150 mg tablet every month on their previous chosen day.
3

DOSAGE FORMS AND STRENGTHSBONIVA 150 mg tablets: white, oblong, engraved with "BNVA" on one side and "150" on the other side.

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4
CONTRAINDICATIONSBONIVA is contraindicated in patients with the following conditions:o Abnormalities of the esophagus which delay esophageal emptying such as stricture or achalasia(see Warnings and Precautions [5.1])
o Inability to stand or sit upright for at least 60 minutes (see Dosage and Administration [2.2], andWarnings and Precautions [5.1])
o Hypocalcemia (see Warnings and Precautions [5.2])
o Known hypersensitivity to BONIVA or to any of its excipients. Cases of anaphylaxis have beenreported (see Adverse Reactions [6.2]).
5

WARNINGS AND PRECAUTIONS

5.1
Upper Gastrointestinal Adverse Reactions
BONIVA, like other bisphosphonates administered orally, may cause local irritation of the upper gastrointestinal
mucosa. Because of these possible irritant effects and a potential for worsening of the underlying disease,caution should be used when BONIVA is given to patients with active upper gastrointestinal problems (such as
known Barrett’s esophagus, dysphagia, other esophageal diseases, gastritis, duodenitis or ulcers).
Esophageal adverse experiences, such as esophagitis, esophageal ulcers and esophageal erosions, occasionallywith bleeding and rarely followed by esophageal stricture or perforation, have been reported in patients
receiving treatment with oral bisphosphonates. In some cases, these have been severe and required
hospitalization. Physicians should therefore be alert to any signs or symptoms signaling a possible esophageal
reaction and patients should be instructed to discontinue BONIVA and seek medical attention if they develop
dysphagia, odynophagia, retrosternal pain or new or worsening heartburn.
The risk of severe esophageal adverse experiences appears to be greater in patients who lie down after taking
oral bisphosphonates and/or who fail to swallow it with the recommended full glass (6-8 oz) of water, and/or
who continue to take oral bisphosphonates after developing symptoms suggestive of esophageal irritation.
Therefore, it is very important that the full dosing instructions are provided to, and understood by, the patient(see DOSAGE AND ADMINISTRATION [2.2]). In patients who cannot comply with dosing instructions due tomental disability, therapy with BONIVA should be used under appropriate supervision.
There have been post-marketing reports of gastric and duodenal ulcers with oral bisphosphonate use, somesevere and with complications, although no increased risk was observed in controlled clinical trials.
5.2
Hypocalcemia and Mineral Metabolism
Hypocalcemia has been reported in patients taking BONIVA. Treat hypocalcemia and other disturbances ofbone and mineral metabolism before starting BONIVA therapy. Instruct patients to take supplemental calcium
and vitamin D if their dietary intake is inadequate (see DOSAGE AND ADMINISTRATION [2.3]).
5.3
Musculoskeletal Pain
Severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in patients taking
BONIVA and other bisphosphonates (see ADVERSE REACTIONS [6]). The time to onset of symptoms varied
from one day to several months after starting the drug. Most patients had relief of symptoms after stopping. A
subset had recurrence of symptoms when rechallenged with the same drug or another bisphosphonate. Consider
discontinuing use if severe symptoms develop.
5.4
Jaw Osteonecrosis
Osteonecrosis of the jaw (ONJ), which can occur spontaneously, is generally associated with tooth extraction
and/or local infection with delayed healing, and has been reported in patients taking bisphosphonates, including
BONIVA. Known risk factors for osteonecrosis of the jaw include invasive dental procedures (e.g., tooth
extraction, dental implants, boney surgery), diagnosis of cancer, concomitant therapies (e.g., chemotherapy,
corticosteroids, angiogenesis inhibitors), poor oral hygiene, and co-morbid disorders (e.g., periodontal and/or
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other pre-existing dental disease, anemia, coagulopathy, infection, ill-fitting dentures). The risk of ONJ may
increase with duration of exposure to bisphosphonates.
For patients requiring invasive dental procedures, discontinuation of bisphosphonate treatment may reduce therisk for ONJ. Clinical judgment of the treating physician and/or oral surgeon should guide the management planof each patient based on individual benefit/risk assessment.
Patients who develop osteonecrosis of the jaw while on bisphosphonate therapy should receive care by an oral
surgeon. In these patients, extensive dental surgery to treat ONJ may exacerbate the condition. Discontinuationof bisphosphonate therapy should be considered based on individual benefit/risk assessment.
5.5
Atypical Subtrochanteric and Diaphyseal Femoral Fractures
Atypical, low-energy, or low-trauma fractures of the femoral shaft have been reported in bisphosphonate-treatedpatients. These fractures can occur anywhere in the femoral shaft from just below the lesser trochanter to above
the supracondylar flare and are transverse or short oblique in orientation without evidence of comminution.
Causality has not been established as these fractures also occur in osteoporotic patients who have not beentreated with bisphosphonates.
Atypical femur fractures most commonly occur with minimal or no trauma to the affected area. They may bebilateral and many patients report prodromal pain in the affected area, usually presenting as dull, aching thighpain, weeks to months before a complete fracture occurs. A number of reports note that patients were also
receiving treatment with glucocorticoids (e.g., prednisone) at the time of fracture.
Any patient with a history of bisphosphonate exposure who presents with thigh or groin pain should besuspected of having an atypical fracture and should be evaluated to rule out an incomplete femur fracture.
Patients presenting with an atypical fracture should also be assessed for symptoms and signs of fracture in thecontralateral limb. Interruption of bisphosphonate therapy should be considered, pending a risk/benefit
assessment, on an individual basis.
5.6
Severe Renal Impairment
BONIVA is not recommended for use in patients with severe renal impairment (creatinine clearance of less than
30 mL/min).
6

ADVERSE REACTIONS

6.1
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in theclinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may notreflect the rates observed in practice.
Treatment and Prevention of Postmenopausal Osteoporosis
Daily Dosing
The safety of BONIVA 2.5 mg once daily in the treatment and prevention of postmenopausal osteoporosis wasassessed in 3577 patients aged 41 – 82 years. The duration of the trials was 2 to 3 years, with 1134 patients
exposed to placebo and 1140 exposed to BONIVA 2.5 mg. Patients with pre-existing gastrointestinal diseaseand 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 BONIVA 2.5 mg dailygroup. The incidence of serious adverse reactions was 20% in the placebo group and 23% in the BONIVA 2.5
mg daily group. The percentage of patients who withdrew from treatment due to adverse reactions wasapproximately 17% in both the BONIVA 2.5 mg daily group and the placebo group. Table 1 lists adverse

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reactions from the treatment and prevention studies reported in greater than or equal to 2% of patients and more
frequently in patients treated daily with BONIVA than patients treated with placebo.
Table 1Adverse Reactions Occurring at an Incidence Greater Than or Equal to 2% and in More
Patients Treated with BONIVA Than in Patients Treated with Placebo Daily in the
Osteoporosis Treatment and Prevention Studies
Body System
Placebo
BONIVA 2.5 mg%%(n=1134)(n=1140)
Body as a Whole
Back Pain
1214
Pain in Extremity
68Asthenia
2
4
Allergic Reaction
2
3
Digestive System
Dyspepsia
1012
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
Vertigo3
3
Respiratory System
Upper Respiratory Infection
33
34
Bronchitis
7
10
Pneumonia
46
Pharyngitis
2
3
Urogenital System
Urinary Tract Infection
4
6

Gastrointestinal Adverse Reactions
The incidence of selected gastrointestinal adverse reactions in the placebo and BONIVA 2.5 mg 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 BONIVA 2.5 mg daily groups
were: back pain (12% vs. 14%), arthralgia (14% vs. 14%) and myalgia (5% vs. 6%).
Ocular Adverse Events
Reports in the medical literature indicate that bisphosphonates may be associated with ocular inflammation suchas iritis and scleritis. In some cases, these events did not resolve until the bisphosphonate was discontinued.
There were no reports of ocular inflammation in studies with BONIVA 2.5 mg daily.

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Monthly Dosing
The safety of BONIVA 150 mg once monthly in the treatment of postmenopausal osteoporosis was assessed ina two year trial which enrolled 1583 patients aged 54 – 81 years, with 395 patients exposed to BONIVA 2.5 mg
daily and 396 exposed to BONIVA 150 mg monthly. Patients with active or significant pre-existing
gastrointestinal disease were excluded from this trial. Patients with dyspepsia or concomitant use of nonsteroidal anti-inflammatory drugs, proton pump inhibitors and H2 antagonists were included in this study. All
patients received 500 mg calcium plus 400 international units vitamin D supplementation daily.
After one year, the incidence of all-cause mortality was 0.3% in both the BONIVA 2.5 mg daily group and the
BONIVA 150 mg monthly group. The incidence of serious adverse events was 5% in the BONIVA 2.5 mg
daily group and 7% in the BONIVA 150 mg monthly group. The percentage of patients who withdrew fromtreatment due to adverse events was 9% in the BONIVA 2.5 mg daily group and 8% in the BONIVA 150 mg
monthly group. Table 2 lists the adverse events reported in greater than or equal to 2% of patients.

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Table 2Adverse Events with an Incidence of at Least 2% in Patients Treated with BONIVA
2.5 mg Daily or 150 mg Once-Monthly for Treatment of Postmenopausal Osteoporosis
BONIVA
BONIVA
2.5 mg Daily
150 mg Monthly%%
Body System/Adverse Event(n=395)(n=396)
Vascular Disorders
Hypertension
7.3
6.3
Gastrointestinal Disorders
Dyspepsia
7.1
5.6
Nausea4.8
5.1
Diarrhea
4.1
5.1
Constipation
2.5
4.0
Abdominal Paina
5.3
7.8
Musculoskeletal and Connective
Tissue Disorders
Arthralgia
3.5
5.6
Back Pain
4.3
4.5
Pain in Extremity
1.3
4.0
Localized Osteoarthritis
1.3
3.0
Myalgia0.8
2.0
Muscle Cramp
2.0
1.8
Infections and Infestations
Influenza
3.8
4.0
Nasopharyngitis
4.3
3.5
Bronchitis
3.5
2.5
Urinary Tract Infection
1.8
2.3
Upper Respiratory Tract Infection
2.0
2.0
Nervous System Disorders
Headache
4.1
3.3
Dizziness
1.0
2.3
General Disorders andAdministration Site Conditions
Influenza-like Illnessb
0.8
3.3
Skin and Subcutaneous Tissue
Disorders
Rashc
1.3
2.3
Psychiatric Disorders
Insomnia
0.8
2.0

a

Combination of abdominal pain and abdominal pain upper
Combination of influenza-like illness and acute phase reactioncCombination of rash pruritic, rash macular, rash papular, rash generalized, rash erythematous, dermatitis, dermatitis allergic,
dermatitis medicamentosa, erythema and exanthemab

Gastrointestinal Adverse Events
The incidence of adverse events in the BONIVA 2.5 mg daily and BONIVA 150 mg monthly groups were:
dyspepsia (7% vs. 6%), diarrhea (4% vs. 5%), and abdominal pain (5% vs. 8%).
Musculoskeletal Adverse Events
The incidence of adverse events in the BONIVA 2.5 mg daily and BONIVA 150 mg monthly groups were:back pain (4% vs. 5%), arthralgia (4% vs. 6%) and myalgia (1% vs. 2%).
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Acute Phase Reactions
Symptoms consistent with acute phase reactions have been reported with bisphosphonate use. Over the twoyears of the study, the overall incidence of acute phase reaction symptoms was 3% in the BONIVA 2.5 mg
daily group and 9% in the BONIVA 150 mg monthly group. These incidence rates are based on the reporting of
any of 33 acute-phase reaction like symptoms within 3 days of the monthly dosing and lasting 7 days or less.
Influenza like illness was reported in no patients in the BONIVA 2.5 mg daily group and 2% in the BONIVA
150 mg monthly group.
Ocular Adverse Events
Two patients who received BONIVA 150 mg once-monthly experienced ocular inflammation, one was a case ofuveitis and the other scleritis.
One hundred sixty (160) postmenopausal women without osteoporosis participated in a 1-year, double-blind,placebo-controlled study of BONIVA 150 mg once-monthly for prevention of bone loss. Seventy-sevensubjects received BONIVA and 83 subjects received placebo. The overall pattern of adverse events was similar
to that previously observed.
6.2
Postmarketing Experience
The following adverse reactions have been identified during postapproval use of BONIVA. Because thesereactions 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 anaphylactic reaction/shock with fatalities, angioedema, bronchospasm, asthma
exacerbations, rash, Stevens-Johnson syndrome, erythema multiforme, and dermatitis bullous have beenreported (see CONTRAINDICATIONS [4]).
Hypocalcemia
Hypocalcemia has been reported in patients treated with BONIVA (see WARNINGS AND PRECAUTIONS[5.2]).
Musculoskeletal Pain
Bone, joint, or muscle pain (musculoskeletal pain), described as severe or incapacitating, has been reported (seeWARNINGS AND PRECAUTIONS [5.3]).
Jaw Osteonecrosis
Osteonecrosis of the jaw and other oro-facial sites, including the external auditory canal, have been reported inpatients treated with BONIVA (see WARNINGS AND PRECAUTIONS [5.4]).
Atypical Femoral Shaft Fracture
Atypical, low-energy, or low-trauma fractures of the femoral shaft (see WARNINGS AND PRECAUTIONS[5.5]).
7

DRUG INTERACTIONS

7.1
Calcium Supplements/Antacids
Products containing calcium and other multivalent cations (such as aluminum, magnesium, iron) are likely tointerfere with absorption of BONIVA. Therefore, instruct patients to take BONIVA at least 60 minutes before
any oral medications, including medications containing multivalent cations (such as antacids, supplements orvitamins). Also, patients should wait at least 60 minutes after dosing before taking any other oral medications(see Dosage and Administration [2.3]).
7.2
Aspirin/Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Because aspirin, NSAIDs, and bisphosphonates are all associated with gastrointestinal irritation, caution should
be exercised in the concomitant use of aspirin or NSAIDs with BONIVA.
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7.3
H2 Blockers
In healthy volunteers, co-administration with ranitidine resulted in a 20% increased bioavailability of
ibandronate, which was not considered to be clinically relevant (see CLINICAL PHARMACOLOGY [12.3]).
7.4
Drug/Laboratory Test Interactions
Bisphosphonates are known to interfere with the use of bone-imaging agents. Specific studies with ibandronate
have not been performed.
8

USE IN SPECIFIC POPULATIONS

8.1

Pregnancy

Risk Summary
BONIVA is not indicated for use in women of reproductive potential. There are no data with BONIVA use inpregnant women to inform any drug-associated risks.
In reproductive toxicity studies in the rat, BONIVA caused post-implantation loss and obstruction of labor withmaternal and fetal periparturient mortality at greater than or equal to 3 times human exposure at therecommended 2.5 mg daily oral dose, or at greater than or equal to 1 times human exposure at therecommended 150 mg once-monthly oral dose. In pregnant rats, kidney developmental toxicity occurred inoffspring at greater than or equal to 30 times the daily 2.5 mg human dose or at greater than or equal to 9 times
the once-monthly 150 mg human dose. In rat reproductive studies, impaired pup neuromuscular development
was observed at 45 times the daily 2.5 mg dose and 13 times the once-monthly 150 mg dose. In reproductive
studies in the rabbit, BONIVA caused maternal mortality at greater than or equal to 8 times the daily 2.5 mg
dose and greater than or equal to 4 times the once-monthly 150 mg dose (see Data).
Data
Animal Data
In female rats given ibandronate at oral doses greater than or equal to 3 times human exposure at therecommended daily oral dose of 2.5 mg or greater than or equal to 1 times human exposure at the recommended
once-monthly oral dose of 150 mg beginning 14 days before mating and continuing through lactation, maternal
deaths were observed at the time of delivery in all dose groups. Perinatal pup loss in dams given doses
producing 45 times human exposure at the recommended daily dose and 13 times human exposure at therecommended once-monthly dose was likely related to maternal dystocia. Calcium supplementation did notcompletely prevent dystocia and periparturient mortality in any of the treated groups at greater than or equal to
16 times the recommended daily dose and greater than or equal to 4.6 times the recommended once-monthly
dose. A low incidence of postimplantation loss was observed in rats treated from 14 days before mating
throughout lactation or during gestation, only at doses causing maternal dystocia and periparturient mortality. In
pregnant rats dosed orally from gestation day 17 through lactation day 21 (following closure of the hard palate
through weaning), maternal toxicity, including dystocia and mortality, fetal perinatal and postnatal mortality,
were observed at doses equivalent to human exposure at the recommended daily dose and greater than or equal
to 4 times the recommended once-monthly dose. Periparturient mortality has also been observed with otherbisphosphonates 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 oral doses producing 30 times human exposure at the recommended daily oral
dose of 2.5 mg and greater than or equal to 9 times human exposure at the recommended once-monthly oral
dose of 150 mg. Impaired pup neuromuscular development (cliff avoidance test) was observed at 45 times
human exposure at the daily dose and 13 times the once-monthly dose.

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In pregnant rabbits treated orally with ibandronate during gestation at doses greater than or equal to 8 times therecommended human daily oral dose of 2.5 mg and greater than or equal to 4 times the recommended humanonce-monthly oral dose of 150 mg, dose-related maternal mortality was observed in all treatment groups. The
deaths occurred prior to parturition and were associated with lung edema and hemorrhage. No significant fetal
anomalies were observed.
Exposure multiples for the rat studies were calculated for the recommended daily oral dose of 2.5 mg or oncemonthly dose of 150 mg based on area under the curve (AUC) comparison. Exposure multiples for the rabbit
study were calculated for the recommended human daily oral dose of 2.5 mg or once-monthly dose of 150 mg
based on dose/body surface area comparison. Doses used in pregnant animals were 1, 4, 5, 6, 16, 10, 20, 30, 60
or 100 mg/kg/day in rats, and 1, 4 or 20 mg/kg/day in rabbits.
8.2
Lactation
Risk Summary
BONIVA is not indicated for use in women of reproductive potential. There is no information on the presenceof 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 these data is unclear.
Data
Animal Data
In lactating rats treated with intravenous doses of 0.08 mg/kg, ibandronate was present in breast milk from 2 to
24 hours after dose administration. Concentrations in milk averaged 1.5 times plasma concentrations.
8.4
Pediatric Use
Safety and effectiveness in pediatric patients have not been established.
8.5
Geriatric Use
Of the patients receiving BONIVA 2.5 mg daily in postmenopausal osteoporosis studies, 52% were over
65 years of age, and 10% were over 75 years of age. Of the patients receiving BONIVA 150 mg once-monthly
in the postmenopausal osteoporosis 1-year study, 52% were over 65 years of age, and 9% were over 75 years ofage. No overall differences in effectiveness or safety were observed between these patients and younger patientsbut greater sensitivity in some older individuals cannot be ruled out.
8.6
Renal Impairment
BONIVA is not recommended for use in patients with severe renal impairment (creatinine clearance less than
30 mL/min).
10
OVERDOSAGENo specific information is available on the treatment of overdosage of BONIVA. However, based on
knowledge of this class of compounds, oral overdosage may result in hypocalcemia, hypophosphatemia, andupper gastrointestinal adverse events, such as upset stomach, dyspepsia, esophagitis, gastritis, or ulcer. Milk or
antacids should be given to bind BONIVA. Due to the risk of esophageal irritation, vomiting should not be
induced, and the patient should remain fully upright. Dialysis would not be beneficial.
11
DESCRIPTION
BONIVA (ibandronate sodium) is a nitrogen-containing bisphosphonate that inhibits osteoclast-mediated bone
resorption. The chemical name for ibandronate sodium is 3-(N-methyl-N-pentyl) amino-1-hydroxypropane-1,1­diphosphonic acid, monosodium salt, monohydrate with the molecular formula C9H22NO7P2Na⋅H2O and amolecular weight of 359.24. Ibandronate sodium is a white- to off-white powder. It is freely soluble in waterand practically insoluble in organic solvents. Ibandronate sodium has the following structural formula:
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For current labeling information, please visit https://www.fda.gov/drugsatfda
OH
O
CH3 CH2 CH2 CH2 CH2 N

POH

CH2 CH2 C

OH

O

ONa

CH3

P

.H O
2

OH

BONIVA is available as a white, oblong, 150 mg film-coated tablet for once-monthly oral administration. One
150 mg film-coated tablet contains 168.75 mg ibandronate monosodium monohydrate, equivalent to 150 mg
free acid. BONIVA also contains the following inactive ingredients: lactose monohydrate, povidone,
microcrystalline cellulose, crospovidone, purified stearic acid, colloidal silicon dioxide, and purified water. The
tablet film coating contains hypromellose, titanium dioxide, talc, polyethylene glycol 6000, and purified water.
12

CLINICAL PHARMACOLOGY

12.1
Mechanism of Action
The action of ibandronate on bone tissue is based on its affinity for hydroxyapatite, which is part of the mineralmatrix 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
Osteoporosis is characterized by decreased bone mass and increased fracture risk, most commonly at the spine,
hip, and wrist. The diagnosis can be confirmed by a finding of low bone mass, evidence of fracture on x-ray, ahistory of osteoporotic fracture, or height loss or kyphosis indicative of vertebral fracture. While osteoporosis
occurs in both men and women, it is most common among women following menopause. In healthy humans,bone formation and resorption are closely linked; old bone is resorbed and replaced by newly formed bone. In
postmenopausal osteoporosis, bone resorption exceeds bone formation, leading to bone loss and increased riskof fracture. After menopause, the risk of fractures of the spine and hip increases; approximately 40% of
50-year-old women will experience an osteoporosis-related fracture during their remaining lifetimes.
BONIVA produced biochemical changes indicative of dose-dependent inhibition of bone resorption, including
decreases of biochemical markers of bone collagen degradation (such as deoxypyridinoline, and cross-linked
C-telopeptide of Type I collagen) in the daily dose range of 0.25 mg to 5 mg and once-monthly doses from
100 mg to 150 mg in postmenopausal women.
Treatment with 2.5 mg daily BONIVA resulted in decreases in biochemical markers of bone turnover, including
urinary C-terminal telopeptide of Type I collagen (uCTX) and serum osteocalcin, to levels similar to those inpremenopausal women. Changes in markers of bone formation were observed later than changes in resorption
markers, as expected, due to the coupled nature of bone resorption and formation. Treatment with 2.5 mg daily
BONIVA decreased levels of uCTX within 1 month of starting treatment and decreased levels of osteocalcin
within 3 months. Bone turnover markers reached a nadir of approximately 64% below baseline values by
6 months of treatment and remained stable with continued treatment for up to 3 years. Following treatment
discontinuation, there is a return to pretreatment baseline rates of elevated bone resorption associated with
postmenopausal osteoporosis.
In a 1-year, study comparing once-monthly vs. once-daily oral dosing regimens, the median decrease frombaseline in serum CTX values was -76% for patients treated with the 150 mg once-monthly regimen and -67%
for patients treated with the 2.5 mg daily regimen. In a 1-year, prevention study comparing BONIVA 150 mg
once-monthly to placebo, the median placebo-subtracted decrease in sCTX was -49.8%.

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12.3

Pharmacokinetics

Absorption
The absorption of oral ibandronate occurs in the upper gastrointestinal tract. Plasma concentrations increase in adose-linear manner up to 50 mg oral intake and increases nonlinearly above this dose.
Following oral dosing, the time to maximum observed plasma ibandronate concentrations ranged from 0.5 to
2 hours (median 1 hour) in fasted healthy postmenopausal women. The mean oral bioavailability of 2.5 mg
ibandronate was about 0.6% compared to intravenous dosing. The extent of absorption is impaired by food orbeverages (other than plain water). The oral bioavailability of ibandronate is reduced by about 90% when
BONIVA is administered concomitantly with a standard breakfast in comparison with bioavailability observedin fasted subjects. There is no meaningful reduction in bioavailability when ibandronate is taken at least
60 minutes before a meal. However, both bioavailability and the effect on bone mineral density (BMD) are
reduced when food or beverages are taken less than 60 minutes following an ibandronate dose.
Distribution
After absorption, 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 via thebone is estimated to be 40% to 50% of the circulating dose. In vitro protein binding in human serum was 99.5%
to 90.9% over an ibandronate concentration range of 2 to 10 ng/mL in one study and approximately 85.7% overa concentration range of 0.5 to 10 ng/mL in another study.
Metabolism
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 notappear to include known acidic or basic transport systems involved in the excretion of other drugs. There is noevidence that ibandronate is metabolized in humans.
Elimination
The portion of ibandronate that is not removed from the circulation via bone absorption is eliminated unchangedby the kidney (approximately 50% to 60% of the absorbed dose). Unabsorbed ibandronate is eliminatedunchanged in the feces.
The plasma elimination of ibandronate is multiphasic. Its renal clearance and distribution into bone accounts fora rapid and early decline in plasma concentrations, reaching 10% of the Cmax 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 forthe 150 mg ibandronate tablet upon oral administration to healthy postmenopausal women ranges from 37 to
157 hours.
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 females) 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.
Specific Populations
Pediatrics
The pharmacokinetics of ibandronate has not been studied in patients less than 18 years of age.
Geriatric
Because ibandronate is not known to be metabolized, the only difference in ibandronate elimination for geriatricpatients versus younger patients is expected to relate to progressive age-related changes in renal function.
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Gender
The bioavailability and pharmacokinetics of ibandronate are similar in both men and women.
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 tocreatinine clearance (CLcr).
Following a single dose of 0.5 mg ibandronate by intravenous administration, patients with CLcr 40 to
70 mL/min had 55% higher exposure (AUC∞) than the exposure observed in subjects with CLcr greater than 90
mL/min. Patients with CLcr less than 30 mL/min had more than a two-fold increase in exposure compared tothe exposure for healthy subjects (see DOSAGE AND ADMINISTRATION [2.4]).
Hepatic Impairment
No studies have been performed to assess the pharmacokinetics of ibandronate in patients with hepatic
impairment because ibandronate is not metabolized in the human liver.
Drug Interaction Studies
Products containing calcium and other multivalent cations (such as aluminum, magnesium, iron), including
milk, food, and antacids are likely to interfere with absorption of ibandronate, which is consistent with findings
in animal studies.
H2 Blockers
A pharmacokinetic interaction study in healthy volunteers demonstrated that 75 mg ranitidine (25 mg injected
intravenously 90 and 15 minutes before and 30 minutes after ibandronate administration) increased the oral
bioavailability of 10 mg ibandronate by about 20%. This degree of increase is not considered to be clinically
relevant.
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 maleand female Wistar rats (systemic exposures up to 12 and 7 times, respectively, human exposure at therecommended daily oral dose of 2.5 mg, and cumulative exposures up to 3.5 and 2 times, respectively, human
exposure at the recommended once-monthly oral dose of 150 mg, based on AUC comparison). 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 male and female NMRI mice (exposures up to 475
and 70 times, respectively, human exposure at the recommended daily oral dose of 2.5 mg and cumulative
exposures up to 135 and 20 times, respectively, human exposure at the recommended once-monthly oral dose of
150 mg, based on AUC comparison). 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 (cumulative monthly exposures in males and females up to 70 and 115 times, respectively,
human exposure at the recommended dose of 150 mg, based on AUC comparison). A dose-related increased
incidence of adrenal subcapsular adenoma/carcinoma was observed in female mice, which was statisticallysignificant at 80 mg/kg/day (220 to 400 times human exposure at the recommended daily oral dose of 2.5 mg
and 115 times human exposure at the recommended once-monthly oral dose of 150 mg, based on AUC
comparison). The relevance of these findings to humans is unknown.

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Mutagenesis
There was no evidence for a mutagenic or clastogenic potential of ibandronate in the following assays: in vitro
bacterial mutagenesis assay in Salmonella typhimurium and Escherichia coli (Ames test), mammalian cellmutagenesis 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 mousemicronucleus tests for chromosomal damage.
Impairment of Fertility
In female rats treated from 14 days prior to mating through gestation, decreases in fertility, corpora lutea, andimplantation sites were observed at an oral dose of 16 mg/kg/day (45 times human exposure at therecommended daily oral dose of 2.5 mg and 13 times human exposure at the recommended once-monthly oral
dose of 150 mg, based on 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 thehighest dose of 5 mg/kg/day (subcutaneously), which is 1000 times the lowest antiresorptive dose of
0.005 mg/kg/day in this model, and 5000 times the optimal antiresorptive dose of 0.001 mg/kg/day in the aged
ovariectomized rat. This indicates that BONIVA administered at therapeutic doses is unlikely to induce
osteomalacia.
Long-term daily or once-monthly intermittent administration of ibandronate to ovariectomized rats or monkeys
was associated with suppression of bone turnover and increases in bone mass. In both rats and monkeys,
vertebral BMD, trabecular density, and biomechanical strength were increased dose-dependently at doses up to
15 times the recommended human daily oral dose of 2.5 mg, or cumulative monthly doses up to 8 times (rat) or
6 times (monkey) the recommended human once-monthly oral dose of 150 mg, based on body surface area
(mg/m2) or area under the curve (AUC) comparison. In monkeys, 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.
14

CLINICAL STUDIES

14.1

Treatment of Postmenopausal Osteoporosis

Daily Dosing
The effectiveness and safety of BONIVA 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 lumbar spine BMD 2 to 5 SD below the premenopausal mean (T-score) in at least one
vertebra [L1-L4], and who had 1 to 4 prevalent vertebral fractures. BONIVA was evaluated at oral doses of
2.5 mg daily and 20 mg intermittently. The main outcome measure was the occurrence of new radiographicallydiagnosed vertebral fractures after 3 years of treatment. The diagnosis of an incident vertebral fracture wasbased on both qualitative diagnosis by the radiologist and quantitative morphometric criterion. The
morphometric criterion required the dual occurrence of 2 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 Fracture Incidence
BONIVA 2.5 mg daily significantly reduced the incidence of new vertebral (primary efficacy measure) and of
new and worsening vertebral fractures. Over the course of the 3-year study, the risk for vertebral fracture was
9.6% in the placebo-treated women and 4.7% in the women treated with BONIVA 2.5 mg (p<0.001) (seeTable 3).

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Table 3

Effect of BONIVA on the Incidence of Vertebral Fracture in the 3-Year
Osteoporosis Treatment Study*
Proportion of Patients with Fracture (%)

New Vertebral Fracture

Placebo
n=975

BONIVA
2.5 mgDaily
n=977

Absolute Risk
Reduction(%)
95% CI

Relative
Risk
Reduction(%)
95% CI

9.6

4.7

4.9

52 **

(2.3, 7.4)

(29, 68)

5.3

52(2.6, 7.9)(30, 67)2.5

49(0.6, 4.5)

(14, 69)

0-3 Year
New and Worsening
Vertebral Fracture

10.4

5.1

0-3 Year
Clinical (Symptomatic)
Vertebral Fracture
0-3 Year

5.3

2.8*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

BONIVA 2.5 mg 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
BONIVA 2.5 mg daily [9.1%, (95% CI: 7.1%, 11.1%)] and placebo [8.2%, (95% CI: 6.3%, 10.2%)]. The twotreatment groups were also similar with regard to the number of fractures reported at the individual nonvertebral
sites: pelvis, femur, wrist, forearm, rib, and hip.
Bone Mineral Density (BMD)
BONIVA significantly increased BMD at the lumbar spine and hip relative to treatment with placebo. In the
3-year osteoporosis treatment study, BONIVA 2.5 mg daily 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 alllater time points. Lumbar spine BMD increased by 6.4% after 3 years of treatment with 2.5 mg daily BONIVA
compared with 1.4% in the placebo group. Table 4 displays the significant increases in BMD seen at the lumbar
spine, total hip, femoral neck, and trochanter compared to placebo.

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Table 4

Mean Percent Change in BMD from Baseline to Endpoint in Patients Treated Daily with
BONIVA 2.5 mg or Placebo in the 3-Year Osteoporosis Treatment Study*
Placebo
BONIVA 2.5 mg
Daily
Lumbar Spine

Total Hip

Femoral Neck

Trochanter

1.4

6.4

(n=693)(n=712)-0.7

3.1(n=638)(n=654)-0.7

2.6(n=683)(n=699)0.2

5.3(n=683)(n=699)*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.

Bone Histology
The effects of BONIVA 2.5 mg daily 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 amineralization defect.
Once-Monthly Dosing
The effectiveness and safety of BONIVA once-monthly were demonstrated in a randomized, double-blind,multinational, noninferiority trial in 1602 women aged 54 to 81 years, who were on average 18 years
postmenopause, and had L2-L4 lumbar spine BMD T-score below -2.5 SD at baseline. The main outcome
measure was the comparison of the percentage change from baseline in lumbar spine BMD after 1 year oftreatment with once-monthly ibandronate (100 mg, 150 mg) to daily ibandronate (2.5 mg). All patients received
400 international units vitamin D and 500 mg calcium supplementation per day.
BONIVA 150 mg once-monthly (n=327) was shown to be noninferior to BONIVA 2.5 mg daily (n=318) inlumbar spine BMD in a 1-year, double-blind, multicenter study of women with postmenopausal osteoporosis. In
the primary efficacy analysis (per-protocol population), the mean increases from baseline in lumbar spine BMD
at 1 year were 3.86% (95% CI: 3.40%, 4.32%) in the 2.5 mg daily group and 4.85% (95% CI: 4.41%, 5.29%) in
the 150 mg once-monthly group; the mean difference between 2.5 mg daily and 150 mg once-monthly was
0.99% (95% CI: 0.38%, 1.60%), which was statistically significant (p=0.002). The results of the intent-to-treat
analysis were consistent with the primary efficacy analysis. The 150 mg once-monthly group also had
consistently higher BMD increases at the other skeletal sites compared to the 2.5 mg daily group.
14.2

Prevention of Postmenopausal Osteoporosis

Daily Dosing
The safety and effectiveness of BONIVA 2.5 mg daily for the prevention of postmenopausal osteoporosis were
demonstrated in a randomized, double-blind, placebo-controlled 2-year study (Prevention Study) of
653 postmenopausal women without osteoporosis at baseline. Women were aged 41 to 82 years, were on
average 8.5 years postmenopause, and had lumbar spine BMD T-scores greater than -2.5. Women werestratified according to time since menopause (1 to 3 years, greater than 3 years) and baseline lumbar spine BMD
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For current labeling information, please visit https://www.fda.gov/drugsatfda(T-score: greater than -1, -1 to -2.5). The study compared daily BONIVA at three dose levels (0.5 mg, 1.0 mg,
2.5 mg) with placebo. All women received 500 mg of supplemental calcium per day.
The primary efficacy measure was the change in BMD of lumbar spine after 2 years of treatment. BONIVA
2.5 mg daily resulted in a mean increase in lumbar spine BMD of 3.1% compared with placebo following
2 years of treatment. Increases in BMD were seen at 6 months and at all later time points. Irrespective of thetime since menopause or the degree of pre-existing bone loss, treatment with BONIVA resulted in a higher
BMD response at the lumbar spine compared with placebo across all four baseline strata [time since menopause(1 to 3 years, greater than 3 years) and baseline lumbar spine BMD (T-score: greater than -1, -1 to -2.5)].
Compared with placebo, treatment with BONIVA 2.5 mg daily increased BMD of the total hip by 1.8%, thefemoral neck by 2.0%, and the trochanter by 2.1%.
Once-Monthly Dosing
The safety and effectiveness of BONIVA 150 mg once-monthly for the prevention of postmenopausal
osteoporosis were demonstrated in a randomized, double-blind, placebo-controlled 1-year study (Monthly
Prevention Study) of 160 postmenopausal women with low bone mass at baseline (T-score of -1 to -2.5).
Women, aged 46 to 60 years, were on average 5.4 years postmenopause. All women received 400 international
units of vitamin D and 500 mg calcium supplementation daily.
The primary efficacy measure was the relative change in BMD at the lumbar spine after 1 year of treatment.
BONIVA 150 mg once-monthly resulted in a mean increase in lumbar spine BMD of 4.12% (95% confidence
interval 2.96 – 5.28) compared with placebo following 1 year of treatment (p<0.0001), based on a 3.73%
and -0.39% mean change in BMD from baseline in the 150 mg once-monthly BONIVA and placebo treatmentgroups, respectively. BMD at other skeletal sites was also increased relative to baseline values.
16

HOW SUPPLIED/STORAGE AND HANDLING

16.1
How Supplied
BONIVA 150 mg tablets: supplied as white, oblong, film-coated tablets, engraved with "BNVA" on one sideand "150" on the other side. Packaged as a three-month supply in:
A box of 3 blister packs containing 1 tablet each (NDC 0004-0186-82) or a box with 1 blister pack containing 3
tablets (NDC 0004-0186-83).
16.2
Storage and HandlingStore at 25°C (77°F); excursions permitted between 15° and 30°C (59° and 86°F) [see USP Controlled Room
Temperature].
17
PATIENT COUNSELING INFORMATION“See FDA-approved patient labeling (Medication Guide)”17.1
Information for Patients
Instruct patients to read the Medication Guide carefully before taking BONIVA and to re-read it each time theprescription is renewed because it contains important information the patient should know about BONIVA. The
Medication Guide also includes the dosing instructions in order to maximize absorption and clinical benefit.
••

BONIVA should be taken at least 60 minutes before the first food or drink (other than water) of the day andbefore taking any oral medication or supplementation including calcium, antacids or vitamins (see DRUG
INTERACTIONS [7.1]).
To facilitate delivery to the stomach, and thus reduce the potential for esophageal irritation, BONIVA
tablets should be swallowed whole with a full glass of plain water (6 to 8 oz) while the patient is standing or
sitting in an upright position. Patients should not lie down for 60 minutes after taking BONIVA.

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•
•
•
•
•
•

•

Patients should not eat, drink anything except for water, or take other medications for 60 minutes after
taking BONIVA.
Plain water is the only drink that should be taken with BONIVA. Note that some mineral waters may have ahigher concentration of calcium and therefore should not be used.
Patients should not chew or suck the tablet because of a potential for oropharyngeal ulceration.
The BONIVA 150 mg tablet should be taken on the same date each month (i.e., the patient’s BONIVA day).
The patient must not take two 150 mg tablets within the same week.
If the once-monthly dose is missed, and the patient’s next scheduled BONIVA day is more than 7 days
away, the patient should be instructed to take one BONIVA 150 mg tablet in the morning following the datethat it is remembered (see DOSAGE AND ADMINISTRATION [2.3]). The patient should then return totaking one BONIVA 150 mg tablet every month in the morning of their chosen day, according to their
original schedule.
If the once-monthly dose is missed, and the patient’s next scheduled BONIVA day is only 1 to 7 days away,
the patient must wait until the subsequent month’s scheduled BONIVA day to take their tablet. The patient
should then return to taking one BONIVA 150 mg tablet every month in the morning of their chosen day,according to their original schedule.

Patients should receive supplemental calcium and vitamin D if dietary intake is inadequate. Intake ofsupplemental calcium and vitamin D should be delayed for at least 60 minutes following oral administration of
BONIVA in order to maximize absorption of BONIVA.
Physicians should be alert to signs or symptoms signaling a possible esophageal reaction during therapy, andpatients should be instructed to discontinue BONIVA and seek medical attention if they develop symptoms ofesophageal irritation such as new or worsening dysphagia, pain on swallowing, retrosternal pain, or heartburn.

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MEDICATION GUIDE
Boniva® (bon-EE-va)(ibandronate)

Read the Medication Guide that comes with BONIVA 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 your treatment. Talk to your doctor if you have any questions about BONIVA.
What is the most important information I should know about BONIVA?
BONIVA may cause serious side effects including:
1. Esophagus problems
2. Low calcium levels in your blood (hypocalcemia)
3. Bone, joint or muscle pain
4. Severe jaw bone problems (osteonecrosis)
5. Unusual thigh bone fractures
1. Esophagus problems.
Some people who take BONIVA may develop problems in the esophagus (the tube that connects
the mouth and the stomach). These problems include irritation, inflammation, or ulcers of theesophagus which may sometimes bleed.
• It is important that you take BONIVA exactly as prescribed to help lower your chance ofgetting esophagus problems (see the section “How should I take BONIVA?”).
• Stop taking BONIVA and call your doctor right away if you get chest pain, new or worsening
heartburn, or have trouble or pain when you swallow.
2. Low calcium levels in your blood (hypocalcemia).
BONIVA may lower the calcium levels in your blood. If you have low blood calcium before you starttaking BONIVA, it may get worse during treatment. Your low blood calcium must be treated before you
take BONIVA. 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 mouthYour doctor may prescribe calcium and vitamin D to help prevent low calcium levels in your blood,
while you take BONIVA. Take calcium and vitamin D as your doctor tells you to.
3. Bone, joint, or muscle pain.
Some people who take BONIVA develop severe bone, joint, or muscle pain.
4. Severe jaw bone problems (osteonecrosis).
Severe jaw bone problems may happen when you take BONIVA. Your doctor may examine your mouth
before you start BONIVA. Your doctor may tell you to see your dentist before you start BONIVA. It is
important for you to practice good mouth care during treatment with BONIVA.
5. 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 BONIVA?
BONIVA is a prescription medicine used to treat or prevent osteoporosis in women after menopause. BONIVA
helps increase bone mass and helps reduce the chance of having a spinal fracture (break).
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It is not known how long BONIVA works for the treatment and prevention of osteoporosis. You should see
your doctor regularly to determine if BONIVA is still right for you.
It is not known if BONIVA is safe and effective in children.
Who should not take BONIVA?
Do not take BONIVA if you:• Have certain problems with your esophagus, the tube that connects your mouth with your stomach• Cannot stand or sit upright for at least 60 minutes• Have low levels of calcium in your blood• Are allergic to BONIVA or any of its ingredients. A list of ingredients is at the end of this leaflet
What should I tell my doctor before taking BONIVA?
Before you start BONIVA, be sure to talk to your doctor if you:• Have problems with swallowing• Have stomach or digestive problems• Have low blood calcium• Plan to have dental surgery or teeth removed• Have kidney problems• 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 BONIVA can harm your unborn baby.
• Are breast-feeding or plan to breast-feed. It is not known if BONIVA 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. Certain medicines may affect how BONIVA works.
Especially tell your doctor if you take:• antacids• aspirin• Nonsteroidal Anti-Inflammatory (NSAID) medicines
Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist each time you get
a new medicine.
How should I take BONIVA?
• Take BONIVA exactly as your doctor tells you.
• Take 1 BONIVA 150 mg tablet 1 time every month on the same day each month.
• BONIVA works only if taken on an empty stomach.
• Take 1 BONIVA tablet, after you get up for the day and before taking your first food, drink, orother medicine.
• Take BONIVA while you are sitting or standing.
• Do not chew or suck on a tablet of BONIVA.
• Swallow BONIVA tablet with a full glass (6-8 oz) of plain water only.
• Do not take BONIVA with mineral water, coffee, tea, soda, or juice.
After swallowing BONIVA tablet, wait at least 60 minutes:• Before you lie down. You may sit, stand or walk, and do normal activities like reading.
• Before you take your first food or drink except for plain water.
• Before you take other medicines, including antacids, calcium, and other supplements and vitamins.
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This label may not be the latest approved by FDA.
For current labeling information, please visit https://www.fda.gov/drugsatfda

Do not lie down for at least 60 minutes after you take BONIVA and do not eat your first foodof the day for at least 60 minutes after you take BONIVA.
If you miss a dose of BONIVA, do not take it later in the day. Call your doctor for instructions.
If you take too much BONIVA, call your doctor. Do not try to vomit. Do not lie down.
What are the possible side effects of BONIVA?
BONIVA may cause serious side effects.
•

See “What is the most important information I should know about BONIVA?”

The most common side effects of BONIVA are:
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Back pain
Heartburn
Stomach area (abdominal) pain
Pain in your arms and legs
Diarrhea
HeadacheMuscle pain
Flu-like symptoms

You may get allergic reactions, such as hives, breathing difficulties, swelling of your face, lips, tongue or throat,or feeling faint.
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 BONIVA. 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.
You may also report side effects to Genentech at 1-888-835-2555.
How do I store BONIVA?
• Store BONIVA at room temperature, 59°F to 86°F (15°C to 30°C).
• Keep BONIVA in a tightly closed container.
Keep BONIVA and all medicines out of the reach of children.
General information about the safe and effective use of BONIVA.
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use
BONIVA for a condition for which it was not prescribed. Do not give BONIVA 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 BONIVA. If you would like more
information, talk with your doctor. You can ask your doctor or pharmacist for information about BONIVA thatis written for health professionals.

What are the ingredients in BONIVA?
Active ingredient: ibandronate sodium

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This label may not be the latest approved by FDA.
For current labeling information, please visit https://www.fda.gov/drugsatfda

Inactive ingredients: lactose monohydrate, povidone, microcrystalline cellulose, crospovidone, purified stearicacid, colloidal silicon dioxide, and purified water. Tablet film coating contains: hypromellose, titanium dioxide,
talc, polyethylene glycol 6000 and purified water.
This Medication Guide has been approved by the U.S. Food and Drug Administration.

BONIVA is a registered trademark of Roche Therapeutics Inc.

Revised: December 2016
© 2016 Genentech, Inc. All rights reserved.

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