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Ipswich and East Suffolk CCG
North East Essex CCG
East Suffolk and North East Essex NHS Foundation Trust
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 Formulary Chapter 6: Endocrine system - Full Chapter
06.06.02  Expand sub section  Bisphosphonates and other drugs affecting bone metabolism
 note 

Joint guidance

 
06.06.02  Expand sub section  Bisphosphonates
Alendronic Acid
(Once weekly tab)
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Formulary
Blue

The dispersible tablet is not approved for local use.

 
   
Risedronate
(once weekly)
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Formulary
Blue

Treatment has limited use in practice - it is second line treatment only utilised if patients are intolerant to alendronic acid therapy

 
   
Disodium Pamidronate
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Formulary
Red Hospital
 
   
Ibandronic Acid (50mg tablets)
(osteoporosis)
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Formulary
Green

Specialist initiation


Reduction of bone damage in bone metastases in breast cancer

 
   
Ibandronic Acid injection
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Formulary
Red Hospital

Ipswich Hospital

Ibandronic acid injection is a formulary medicine - for postmenopausal osteoporosis for patients unable to take/intolerant to oral medicines

Colchester Hospital

Ibandronate acid injection is considered non-formulary

 
   
Sodium Clodronate
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Formulary
Green

Specialist initiated


Bone pain only

 
   
Zoledronic Acid (4mg injection)
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Formulary
Red Hospital

Note 2 different strengths of Zolendronic acid


For oncology related indications

 
   
Zoledronic Acid (5mg injection)
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Formulary
Red Hospital

Note 2 different strengths of Zolendronic acid


 For osteoporosis and Paget's disease

 
   
06.06.02  Expand sub section  Denosumab
Prolia (Denosumab )
(osteoporosis)
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Restricted Drug Restricted
Red Hospital

MHRA:Osteonecrosis of the external auditory canal

MHRA: Osteonecrosis of the jaw


Note two different brands

Prolia is indicated for 

  • Treatment of osteoporosis in postmenopausal women and in men at increased risk of fractures
  • Treatment of bone loss associated with hormone ablation in men with prostate cancer at increased risk of fractures

For osteoporosis-NICE TA204

Ipswich Hospital/IESCCG

Denosumab (for osteoporosis) is considered a "hospital-only" medicine

Colchester Hospital/NEECCG

Denosumab (for osteoporosis) is available for Primary Care prescribing under a Shared Care Agreement

 
Link  NICE TA204: Osteoporotic fractures - denosumab
   
XGEVA (Denosumab )
(metastases)
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Formulary
Red Hospital

MHRA:Osteonecrosis of the external auditory canal

MHRA: Osteonecrosis of the jaw

MHRA:Denosumab (Xgeva▼) for giant cell tumour of bone: risk of clinically significant hypercalcaemia following discontinuation

MHRA:Denosumab (Xgeva▼) for advanced malignancies involving bone: study data show new primary malignancies reported more frequently compared to zoledronate


Note two different brands

XGEVA is indicated for 

  • Prevention of skeletal related events in patients with bone metastases from solid tumours
 
Link  NICE TA265: Bone metastases from solid tumours - denosumab: guidance
Link  NICE TA549 Denosumab for preventing skeletal-related events in multiple myeloma (terminated appraisal)
   
06.06.02  Expand sub section  Strontium renelate
 ....
 Non Formulary Items
Abaloparatide

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Non Formulary
 
Disodium Etidronate  (Didronel PMO)

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Non Formulary
 
Disodium Etidronate  (Didronel)

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Non Formulary
 
Disodium Pamidronate  (Aredia Dry Powder)

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Non Formulary
 
Ibandronic acid IV infusion  (Bondronat)

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Non Formulary
 
Strontium Ranelate  (Protelos)

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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
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

Blue

For routine prescribing in primary and secondary care.   

Green

Initiated (if clinically urgent) or advised (if non-urgent) by specialist in secondary care, prescribing can be continued in primary care.   

Amber

Shared care  

Red Hospital

Hospital only  

Double Red

There should be no prescribing of these drugs  

Mixed

The traffic light of the drug is dependant on the indication. Please see individual drug entry for details  

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