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 Formulary Chapter 6: Endocrine system - Full Chapter
06.06.02  Expand sub section  Bisphosphonates and other drugs affecting bone metabolism
Dibotermin Alfa, rhBMP-2
(Inductos)
View childrens BNF
Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Complex spinal fusion surgeries in line with NHSE commissioning policy
    • This product is currently unavailable in the UK
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE 16063/P: Bone morphogenetic protein-2 in spinal fusion
Link  RNOH: Commissioning and Prescribing of Bone Morphogenic Protein
06.06.02  Expand sub section  Bisphosphonates
Alendronic Acid
View adult BNF View SPC online View childrens BNF
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
View adult BNF View SPC online View childrens BNF
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)
View adult BNF View SPC online View childrens BNF
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 injection
(Osteoporosis)
View adult BNF View SPC online View childrens BNF
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
View adult BNF View SPC online View childrens BNF
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
View adult BNF View SPC online View childrens BNF
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:
    • 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 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:
    • Approved for treatment of hypercalcaemia of malignancy 1st line.
    • For prevention of skeletal-related events in patients who have bone metastases.
    • For the prevention of skeletal-related events zoledronic acid is prescribed on Chemocare. (RFL electronic chemotherapy prescribing system)
    • 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)
      • For adjuvant indication -this is prescribed on Chemocare (RFL electronic chemotherapy prescribing system)
  • 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)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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Red (hospital only prescribing) for osteoporotic men or women with renal impairment

Grey for osteoporotic women when used in line with NICE TA

 

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 in line with NICE TA by Endocrinology and Rheumatology
    • See links below
  • RNOH:
    • See links below for Transfer of Care Guideline and Template Letter with Hertfordshire
  • UCLH:
  • WH:
    • Also approved for osteoporosis in men unable to take oral bisphosphonates 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
Link  RNOH + Hertfordshire Transfer of Care Letter Template
Link  RNOH + Hertfrodshire Transfer of Care Guideline
Denosumab (XGEVA)
(Metastases)
View adult BNF View SPC online View childrens BNF
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 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 TA265.

      • This drug must be prescribed on chemocare (RFL electronic chemotherapy prescribing system)
  • 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
Denosumab (XGEVA)
(Malignant hypercalcaemia)
View adult BNF View SPC online View childrens BNF
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 hypercalcaemia of malignancy who are either refractory to bisphosphonates or have creatinine clearance <30mL/min in whom bisphosphonates are contraindicated (JFC August 2018).

Only on the advice of oncology or palliative care consultants.

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • As per above agreed indication
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above
 
06.06.02  Expand sub section  Strontium renelate
 ....
 Non Formulary Items
Abaloparatide

View adult BNF View SPC online View childrens BNF
Non Formulary
Alendronic acid + Colecalciferol
(Fosavance)

View adult BNF View SPC online View childrens BNF
Non Formulary
Alendronic acid soluble
(Binosto)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Not approved for osteoporosis (July 2016)

Burosumab injection

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red

See NICE HST for eligibility criteria

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Link  NICE HST8: Burosumab for treating X-linked hypophosphataemia in children and young people
Ibandronic acid IV infusion
(Metastases)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red

Approved for prevention of skeletal events (pathological fractures, bone complications requiring radiotherapy or surgery) in patients with breast cancer and bone metastases (July 2013).

Link  NCL JFC: Summary of MHRA Alerts for Bisphosphonates and Denosumab
Risedronate daily
(Paget's)

View adult BNF View SPC online View childrens BNF
Non Formulary
Strontium Ranelate

View adult BNF View SPC online View childrens BNF
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)

View adult BNF View SPC online View childrens BNF
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
Homecare
Homecare

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.

See link for the complete NCL Red List https://www.ncl-mon.nhs.uk/wp-content/uploads/2017/08/ncl_red_list.pdf

  

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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