Gastrointestinal bleeding following intravenous ibandronate administration

Gastrointestinal (GI) adverse effects have been reported with oral bisphosphonate formulations and are the primary adverse effects influencing their tolerability. New intermittent formulations, including intravenous (IV) ibandronate, may increase compliance and decrease the rate of GI adverse effects. We describe a 67-year-old woman with a 2-day history of hematemesis and melena 1 week after administration of IV ibandronate.

The patient was initially stable but began to develop a small bowel obstruction for which a nasogastric (NG) tube was placed. During placement of the NG tube, the patient vomited and aspirated. Due to continued nausea and vomiting with the NG tube and shortness of breath, the patient was intubated and an orogastric tube was placed. Despite the use of a ventilator, the patient's blood pressure and oxygen saturation began to fall. Even with the use of mechanical ventilation and 3 pressors, her condition deteriorated, she was made DNR/DNI (do not resuscitate or intubate) and subsequently expired. The Naranjo adverse drug reaction score was 2, indicating a possible association between GI bleed and IV ibandronate. The exact mechanism of this is not known.

Clinicians should be aware of this possible adverse effect and monitor high-risk patients for bleeding when administering IV bisphosphonates.