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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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Secondary care notes

  • NMUH approvals:
    • 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 approvals:
    • Nil
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
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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Secondary care notes

  • NMUH approvals:
    • 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 approvals:
    • Nil
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • 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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Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Not applicable
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
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).

Secondary care notes

  • NMUH approvals:
    • 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 approvals:
    • Not applicable
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • 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).

Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • As per above inidication
  • RNOH approvals:
    • ???
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
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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Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Not applicable
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
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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Secondary care notes

  • NMUH approvals:
    • See links below
    • See MHRA Drug Safety Updates
  • RFL approvals:
    • Nil
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
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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Not a preferred choice for adjuvant breast cancer; intravenous zolendronic acid and oral ibrandronic acid are preferred agents (JFC February 2019)

Secondary care notes

  • NMUH approvals:
    • 400mg and 800mg tablets only
  • RFL approvals:
    • 400mg, 800mg and 520mg tablets
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
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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Secondary care notes

  • NMUH approvals:
    • 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 approvals:
    • Restricted to Endocrine and Rheumatology use only
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
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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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)

Secondary care notes

  • NMUH approvals:
  • RFL approvals:
    • Restricted to Myeloma patients only
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • 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
06.06.02  Expand sub section  Strontium renelate
 ....
 Non Formulary Items
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
 
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
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Link to adult BNF
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Link to children's BNF
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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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