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 Formulary Chapter 6: Endocrine system - Full Chapter
06.06.02  Expand sub section  Bisphosphonates and other drugs affecting bone metabolism
06.06.02  Expand sub section  Bisphosphonates
Alendronic Acid
(Once-Weekly, Tablet, Oral Solution. )
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First Choice
Green

  • 70mg once WEEKLY dosing. 



  • Treatment of post menopausal osteoporosis.



  • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis. 


  • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.



 
Alendronic Acid
(Once Daily)
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First Choice
Green

  • 10mg once DAILY dosing. 



  • Treating postmenopausal osteoporosis.



  • Treatment of osteoporosis in men.



  • Prevention and treatment of corticosteroid induced osteoporosis in postmenopausal women not receiving hormone replacement therapy. 



  • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis.


  • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.



 
Risedronate
(once weekly, Tablet )
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Second Choice
Green

  • 35mg once WEEKLY dosing. 



  • Treating postmenopausal osteoporosis to reduce risk of vertebral or hip fractures.



  • Treating osteoporosis in men at high risk of fractures.



  • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis. 


  • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.



 
Link  NICE TA464: Bisphosphonates for treating osteoporosis
   
Ibandronic Acid
(Tablet)
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Restricted Drug Restricted
Green

  • 150mg once MONTHLY dosing.



  • Treating postmenopausal osteoporosis.



  • Restricted to use as second line option for patients unable to swallow normal tablets for osteoporosis on daily or weekly basis but can manage to swallow a once monthly tablet and are able to remain upright for 1 hour post dosing.



  • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis. 


  • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.




 

 
Link  NICE TA464: Bisphosphonates for treating osteoporosis
   
Alendronic Acid (Binosto)
(Effervescent tablet, Once Weekly)
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Restricted Drug Restricted
Green

  • Treating postmenopausal osteoporosis.



  • Restricted to use as third line option in patients who are unable to swallow normal tablets either, daily, weekly or monthly but are able to remain upright for 30 minutes' post dosing. 


  • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.



 
   
Disodium Pamidronate
(Infusion)
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Restricted Drug Restricted
Red Hospital
 
Link  MHRA: osteonecrosis of the jaw - risk minimisation (July 15)
   
Risedronate
(Tablets, Daily )
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Restricted Drug Restricted
Amber No SCG

  • For Paget's disease of the bone - DAILY.



  • Treating postmenopausal osteoporosis to reduce risk of vertrbral or hip fractures - 5mg daily dosing. 



  • Preventing osteoporosis (including corticosteroid-induced osteoporosis) in postmenopausal women - 5mg daily dosing. 



  • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis.



  • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.

 
Link  NICE TA464: Bisphosphonates for treating osteoporosis
   
Zoledronic Acid
(5mg - Osteoporosis/Paget's, Infusion)
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Restricted Drug Restricted
Red Hospital

  • Infusion 5mg/100mL.



  • CUHFT - For the Metabolic Bone Unit consultants ONLY and in line with Trust Guidelines.



  • RPH - Prophylaxis of osteoporosis by annual injection for transplant and other conditions requiring chronic steroid use.



  • NWAFT - Treatment of postmenopausal osteoporosis and osteoporosis in men (including corticosteroid-induced osteoporosis), treatment of Paget's diease of the bone.



  • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis.



  • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.


 

 
Link  MHRA Drug Safety Update July 2015: Denosumab and intravenous bisphosphonates - osteonecrosis of the jaw further measures to minimise risk
Link  NICE TA464: Bisphosphonates for treating osteoporosis
   
Ibandronic Acid
(osteoporosis, 3mg solution for injection)
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Restricted Drug Restricted
Red Hospital

  • Metabolic bone unit in line with Trust guidelines for osteoporosis ONLY if iv bisphosphonates are required and zolendronic acid is considered inappropriate. 



  • Zoledronic acid (5mg) has replaced ibandronic acid (Bonviva) as 1st choice iv medication for patients fulfilling criteria for iv bisphosphonates as per Trust guidelines (for use by Metabolic Bone Unit consultants only).



  • NOTE difference in strength for use in cancer and for osteoporosis.



  • For oncology see chapter 8.



  • Approved for use in accordance with NICE TA464 - Bisphosphonates for treating osteoporosis. 



  • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.

 
Link  NICE TA464: Bisphosphonates for treating osteoporosis
   
Ibandronic acid  (Bondronat)
(Intravenous infusion )
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Restricted Drug Restricted
Red Hospital

  • Reduction of bone damage in bone metastases in breast cancer.



  • For use by oncologists in patients with breast cancer.

 
   
Sodium Clodronate
(Capsules, Tablets)
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Formulary
Red Hospital

  • Capsule - Bonefos®.



  • Tablet - Loron®.



  • Hypercalcaemia, bone pain associated with metastases. 



  • Not licensed for osteoporosis.

 
   
Zoledronic Acid
(4mg - hypercalcaemia/malignancy, Infusion)
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Restricted Drug Restricted
Red Hospital

  • Infusion - 4mg

  • Gaucher's Disease patients only instead of pamidronate infusion.As per WACN guidelines for patients with prostate or breast cancer who develop bone disease. Haematologists for those patients with myeloma who are either hypercalcaemia or who have osteolytic lesions.

  • Ibandronic acid IV (Bondronat only) has replaced zoledronic acid for patients with breast cancer.

 
   
06.06.02  Expand sub section  Denosumab
06.06.02  Expand sub section  Strontium renelate
 ....
 Non Formulary Items
Alendronic Acid  (Generic)
(70mg/100ml once a week oral solution)

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Non Formulary
Black

 

  • Effervescent tablets (Binosto®) is the preferred formulation of alendronic acid restricted to those unable to swallow normal tablets but are able to remain upright for 30 minutes' post dosing. Refer for intravenous bisphosphonates if patients unable to swallow effervescent tablet formulations. Intravenous bisphosphonates are preferred clinically and more cost effective than alendronic acid oral solution. 
  • Patients should be prescribed EITHER an oral bisphosphonate OR an intravenous bisphosphonate. Patients should NOT be co-prescribed both.

 

Link  NICE TA464: Bisphosphonates for treating osteoporosis
 
Alendronic Acid with colecalciferol  (Fosavance)

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Non Formulary
Grey
Tablet
  • Needs to be given with daily calcium, and Adcal D3 contains sufficient vit D.
  • Costs 23pm. (vs 1.30 for alendronate alone)
  •  
    Disodium Etidronate  (Didronel)

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    Non Formulary
    Grey
     
    Disodium Pamidronate  (Aredia Dry Powder)

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    Non Formulary
    Grey
     
    Sodium Clodronate  (Clasteon)

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    Non Formulary
    Grey
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    OTC

    Available Over the Counter. Consider Self Care   

    Green

    Formulary - Can be prescribed in both secondary and primary care.   

    Advice

    Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

    Amber No SCG

    Formulary - Specialist initiation without shared care guidance.  

    Amber SCG

    Formulary - Specialist initiation with shared care guidance.  

    Red Hospital

    Restricted - Hospital only, not to be prescribed in primary care.  

    Switch

    Not recommended for prescribing. Switch to alternative cost-effective option.   

    Black

    Not recommended for prescribing in primary or secondary care.  

    Grey

    Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

    Non Formulary

    Non-Formulary (category under review).  

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