This kit is indicated for the treatment and prevention of osteoporosis. It increases Bone Mineral Density (BMD) and reduces the incidence of vertebral fractures.

Ibandronic Acid (Ibandronate Sodium Monohydrate is a nitrogen-containing bisphosphonate that inhibits osteoclast-mediated bone resorption. The action of ibandronate on bone tissue 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.

The combination of Coral Calcium and Colecalciferol is composed of calcium carbonate with small amounts of magnesium and other trace minerals. Coral calcium ensures better absorption than calcium from other calcium carbonate origins due to its chemical structure that is very similar to the composition of human bone calcium carbonate. Vitamin D₃ aids in the absorption of calcium from the GI tract and helps to maintain calcium balance in the body.

কোরাল ক্যালসিয়াম এবং কোলেক্যালসিফেরলের সংমিশ্রণ ক্যালসিয়াম কার্বনেটের সাথে অল্প পরিমাণে ম্যাগনেসিয়াম এবং অন্যান্য ট্রেস খনিজ পদার্থ নিয়ে গঠিত। কোরাল ক্যালসিয়ামের রাসায়নিক গঠন মানব হাড়ের ক্যালসিয়াম কার্বনেটের সংমিশ্রণের সাথে খুব মিল থাকার কারণে এটি অন্যান্য ক্যালসিয়াম কার্বনেট উৎসের ক্যালসিয়ামের চেয়ে ভাল শোষণ নিশ্চিত করে। ভিটামিন ডি₃ গ্যাস্ট্রোইনটেস্টাইনাল ট্র্যাক্ট থেকে ক্যালসিয়ামের শোষণে সহায়তা করে এবং শরীরে ক্যালসিয়ামের ভারসাম্য বজায় রাখতে সাহায্য করে।

One tablet of Ibandronic Acid 150 mg once monthly on the same date of each month is recommended. To maximize the clinical benefit of Ibandronic acid, two tablets of Calcium 500 mg and Vitamin D₃ 200 IU per day are usually recommended in divided dosage or as directed by the physician.

Day 1: Take the Ibandronic Acid tablet on an empty stomach 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, antacid and/or vitamins.

• Swallow the tablet whole with a glass of plain water while standing or sitting in an upright position.
• Avoid lying down for 60 minutes.
• Do not chew or suck the tablet.

Day 2-31: One tablet of Calcium and Vitamin D should be taken in the morning and one in the evening after meals.

• Tablets should be taken in the order as directed on the blister strip for ease of dose tracking.

Pediatric Use:Safety and effectiveness in pediatric patients have not been established.

Ibandronic Acid: Products containing calcium and other multivalent cations (such as aluminum, magnesium, iron), including milk, food, and antacids, are likely to interfere with the absorption of ibandronate. It is also found to interact with H₂ blockers such as ranitidine in several clinical trials.

Calcium (Coral) and Vitamin D₃: Oral calcium can reduce the absorption of tetracycline and fluoride preparations, and a minimum of 3 hours should be allowed between ingestion of these medications. Thiazide diuretics reduce the renal excretion of calcium. Phenytoin, barbiturates, and glucocorticoids may induce the metabolism of vitamin D. Concomitant intake of certain foods like spinach, cereals, milk and its derivatives may reduce the intestinal uptake of calcium.

Ibandronic Acid is contraindicated in conditions such as: Abnormalities of the esophagus which delay esophageal emptying, such as stricture or achalasia Inability to stand or sit upright for at least 60 minutes Hypocalcemia  Known hypersensitivity to ibandronic acid

Calcium & Vitamin D₃: Hypersensitivity to any component of this preparation Also contraindicated in cases of hypercalcemia, hyperparathyroidism, hypercalciuria, nephrolithiasis, severe renal insufficiency, concomitant digoxin therapy (requires careful monitoring of serum calcium level), renal calculi, and Zollinger-Ellison syndrome

Ibandronic Acid: Common side effects include hypertension, dyspepsia, nausea, diarrhea, abdominal pain, arthralgia, back pain, localized osteoarthritis, myalgia, muscle cramp, influenza, nasopharyngitis, bronchitis, urinary tract infection, upper respiratory tract infection, headache, dizziness, skin rash, insomnia, etc.

Calcium & Vitamin D₃: Most common side effects are flatulence, diarrhea, constipation, upper GI discomfort, etc. Hypercalciuria and hypercalcemia due to prolonged use have rarely been reported.

Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. This kit should be used during pregnancy only if the potential benefit justifies the potential risk to the mother and fetus.

Nursing Mother: It is not known whether this kit is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when this kit is administered to a nursing woman.

Ibandronic Acid:

• Upper Gastrointestinal Adverse Reactions: Ibandronic acid, like other bisphosphonates administered orally, may cause local irritation of the upper gastrointestinal mucosa. Because of these possible irritant effects, caution should be used when ibandronic acid is given to patients with active upper gastrointestinal problems (such as known Barrett's esophagus, dysphagia, other esophageal diseases, gastritis, duodenitis or ulcers).
• Hypocalcemia and Mineral Metabolism: Treat hypocalcemia and other disturbances of bone and mineral metabolism before starting therapy.
• Musculoskeletal Pain: Severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in patients taking ibandronic acid and other bisphosphonates.
• Jaw Osteonecrosis: Osteonecrosis, primarily in the jaw, has been reported in patients treated with bisphosphonates. Most cases have been in cancer patients undergoing dental procedures, but some have occurred in patients with postmenopausal osteoporosis or other diagnoses.

Calcium and Vitamin D₃: In mild hypercalciuria, reduction of dose is sufficient to return to normal serum calcium concentration. Plasma and serum calcium levels should be monitored in patients with mild to moderate renal impairment and also in cases of long-term use. Patients with renal stones or with such a previous history should be recommended to increase their fluid intake.

No specific information is available on the treatment of overdosage of ibandronic acid. However, based on knowledge of this class of compounds, oral overdosage may result in hypocalcemia, hypophosphatemia, and upper gastrointestinal adverse events.

Bisphosphonate preparations

Do not store above 30°C. Keep away from light and out of the reach of children.