Generic Boniva: A Welcome Addition to our Generic Drug Options

The bisphosphonates have been very popular for treatment of osteoporosis. On March 19th the FDA approved several manufacturers to sell generic Boniva, ibandronate, at the 150 mg monthly dosage that is commonly used. Unlike many drugs that go generic Boniva has been approved for several manufacturers from the start, so we should expect prices to drop as soon as this gets to market. Boniva has the primary advantage over the other commonly used drugs in its class of needing to be used only once monthly vs. once weekly. This may not seem like a big advantage until you understand how the drug has to be taken. All of the bisphosphonates need to be taken on an empty stomach the first thing in the morning with a large glass of water, and then the patient has to neither eat nor lie down for at least 30 minutes. The reason for this is that these drugs are very caustic to the lower esophagus lining cells if the pill refluxes back up into the esophagus and that if taken with food absorption is very poor. This means that for the first hour after taking the pill a patient has to remain upright and not eat nor drink.

Having to plan their morning around this ritual once a month is less of a hassle than once a week. In addition one of the common side effects of Fosamax, Actonel and Boniva, the three drugs in this class approved for use in the U.S. is dyspepsia or reflux esophagitis. These symptoms are usually most severe for a day or so after taking the medication, and having Boniva side effects for a day a month is more likely to be tolerated than having Fosamax or Actonel side effects every week.

I expect that if the cost of generic Boniva approaches the cost of generic Fosamax or Actonel many patients will prefer the monthly generic Boniva. It will be interesting to see how generic Boniva is positioned in comparison to the other drugs in the class regarding pricing.

2 Responses to Generic Boniva: A Welcome Addition to our Generic Drug Options

  1. Craig: The flying nun aside, the differences in efficacy between the bisphosphonates at various locations is far from clear. You are correct, the initial studies only showed a reduction in spine fracture reduction with Boniva, but there have been no head-to-head studies of any of these drugs, so which is better at which location is unclear. Per FDA recommendations all three require the patient to take the medicine with water on an empty stomach and not eat or lie down for at least 30 minutes. DrP.

  2. Doc, I think the dosing regimen you mentioned in this article is false for “all bisphosphonates” because Actonel, for one, does not require waiting an hour. What about Atelvia (?)’ too? Also, one of the biggest DISADVANTAGES of Boniva is it is not indicated to cover any fractures other than the spine. You tell me, do most happen at the spine or would it be nice to have the wrist, hip and other non-vertebral sites protected? The only reason Bomiva was a success is because the Flying Nun was its spokesperson.

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