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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
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Formulary
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Provider notes

  • NMUH:
    • Positive NICE TA This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when in line with NICE recommendations and/or Local Trust Guidelines.
    • See links below
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Bisphosphonate Treatment Duration in Women Position Statement
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Link  NICE TA464: Bisphosphonates for treating osteoporosis
Link  NMUH: Trust Guidelines on Prevention and Treatment of Adult Osteoporosis
   
Risedronate
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Formulary
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Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • See link below
    • To be initiated by rheumatologists only
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Tabs 5mg only (daily preparation)
 
Link  NCL JFC: Bisphosphonate Treatment Duration in Women Position Statement
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Link  NICE TA464: Bisphosphonates for treating osteoporosis
Link  NMUH: Trust Guidelines on Prevention and Treatment of Adult Osteoporosis
   
Ibandronic Acid 150mg tablets
(Osteoporosis)
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Bisphosphonate Treatment Duration in Women Position Statement
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Link  NICE TA464: Bisphosphonates for treating osteoporosis
   
Ibandronic Acid 50mg tablets
(Metastases)
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Formulary
GP - Red
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Approved as second-line adjuvant therapy for post-menopausal (including those for whom it is chemically induced) women with breast cancer to prevent bone recurrence and cancer mortality, for patients without IV access/zolendronic acid toxicity (JFC February 2019).

Provider notes

  • NMUH:
    • 1st line bisphosphonate for the Prevention of skeletal events (pathological fractures, bone complications requiring radiotherapy or surgery) in patients with breast cancer and bone metastases.
  • RFL:
    • See above
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above
 
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Link  NMUH: Trust Guidelines for Prevention and Management of Skeletal Related Events in Solid Tumour Cancer Patients
   
Ibandronic acid IV infusion
(Metastases)
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Restricted Drug Restricted
GP - Red
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Approved for prevention of skeletal events (pathological fractures, bone complications requiring radiotherapy or surgery) in patients with breast cancer and bone metastases (July 2013).

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • As per above inidication
  • RNOH:
    • ???
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
   
Ibandronic Acid IV injection
(Osteoporosis)
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Formulary
GP - Red
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Link  NICE TA464: Bisphosphonates for treating osteoporosis
   
Pamidronate disodium
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Formulary
GP - Red
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Provider notes

  • NMUH:
    • See links below
    • See MHRA Drug Safety Updates
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Link  NMUH: Trust Guidelines on Prevention and Treatment of Adult Osteoporosis
Link  NMUH: Trust guidelines Prevention and Management of Skeletal Related Events in Solid Tumour Cancer Patients
   
Sodium Clodronate
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Formulary
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Not a preferred choice for adjuvant breast cancer; intravenous zolendronic acid and oral ibrandronic acid are preferred agents (JFC February 2019)

Provider notes

  • NMUH:
    • 400mg and 800mg tablets only
  • RFL:
    • 400mg, 800mg and 520mg tablets
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
   
Zoledronic Acid
(Osteoporosis)
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Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • We stock the generic zoledronic acid preparation - 4mg/5ml for all indications where zoledronic acid is required. See link below for further details.
    • Check MHRA Drug Safety Updates
  • RFL:
    • Restricted to Endocrine and Rheumatology use only
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Bisphosphonate Treatment Duration in Women Position Statement
Link  NCL JFC: Summary of antiplatelet options in cardiovascular disease
Link  NICE TA464: Bisphosphonates for treating osteoporosis
Link  NMUH: Pharmacy information bulletin on generic zoledronic acid
Link  NMUH: Trust Guidelines on Prevention and Treatment of Adult Osteoporosis
   
Zoledronic acid
(Metastases)
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Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for adjuvant therapy for post-menopausal (including those for whom it is chemically induced) women with breast cancer to prevent bone recurrence and cancer mortality [unlicensed indication] (JFC February 2016)

Provider notes

  • NMUH:
  • RFL:
    • As per above indication
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Added to the NCL Joint Formulary as an adjuvant treatment for post-menopausal women with early breast cancer (Feb 2016)
 
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Link  NMUH: Pharmacy information bulletin on generic zoledronic acid
Link  NMUH: Trust guidelines Prevention and Management of Skeletal Related Events in Solid Tumour Cancer Patients
   
06.06.02  Expand sub section  Denosumab
Denosumab (Prolia)
(Osteoporosis)
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Restricted Drug Restricted
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Approved for osteoporosis in women (see NICE TA) and men unable to take oral bisphosphonates (either due to intolerance or unable to comply with administration instructions) and unable to receive IV zoledronic acid due to renal dysfunction (JFC October 2017)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • See links below
    • To be prescribed by Rheumatology and Care of the Elderly Consultants ONLY.
    • Check MHRA Drugs Safety Updates
  • RFL:
    • Approved for osteoporosis treatment by Endocrinology, Rheumatology
  • RNOH:
    • Store in a refrigerator
  • UCLH:
  • WH:
    • Also approved for osteoporosis in men unable to take oral biphosphonates and unable to receive IV zoledronic acid due to renal dysfunction (November 2017)
 
Link  NCL JFC Fact Sheet: Denosumab for the treatment of osteoporosis in postmenopausal women
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Link  NICE TA204: Osteoporotic fractures - denosumab
Link  NMUH: Trust Guidelines on Prevention and Treatment of Adult Osteoporosis
   
Denosumab (XGEVA)
(Metastases)
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Restricted Drug Restricted
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for preventing skeletal related events for oncology patients subject to service redevelopment (November 2015)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • See links below
    • To be prescribed by the Oncology team ONLY.
    • Check MHRA Drugs Safety Updates
  • RFL:
    • As per NICE guidance
  • RNOH:
    • Giant cell tumour of bone
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Link  NICE TA265: Bone metastases from solid tumours - denosumab: guidance
Link  NMUH: Trust guidelines Prevention and Management of Skeletal Related Events in Solid Tumour Cancer Patients
   
06.06.02  Expand sub section  Strontium renelate
 ....
 Non Formulary Items
Abaloparatide

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Non Formulary
 
Alendronic Acid soluble  (Binosto)

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Non Formulary
Black

Not approved for osteoporosis (July 2016)

 
Alendronic Acid with colecalciferol  (Fosavance)

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Non Formulary
 
Risedronate daily
(Paget's)

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Non Formulary
 
Strontium Ranelate

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Non Formulary

Strontium ranelate was discontinued in August 2017. Patients admitted on this medicine must be reviewed by the Specialist managing their osteoporosis.

 
Tiludronic Acid  (Skelid)

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Non Formulary
 
  
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
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

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.

  

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

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