netFormulary North of Tyne and Gateshead Area Prescribing Committee NHS
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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
(osteoporosis)
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First Choice
Green
  • Approved alendronic acid formulations include:
    • 10mg tablets (taken daily)
    • 70mg tablets (taken once weekly) – preferred
    • 70mg effervescent tablets (Binosto®) - for use only in patients with documented swallowing difficulties

  • Alendronic acid is approved for the primary prevention of osteoporosis in postmenopausal women in line with NICE
  • Approved for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis primary in line with NICE.
  • Approved for the treatment of osteoporosis in line with NICE
 
Disodium Pamidronate 30mg injection
(hypercalcaemia)
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Formulary
Red
 
   
Ibandronic Acid
(osteoporosis)
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Alternatives
Green
  • Ibandronic acid 50mg tablets are approved for use in the reduction of bone damage in patients with metastatic breast cancer. Not approved for use in the treatment of patients with other forms of cancer (e.g. prostate) or for the treatment of osteoporosis. 
  • Ibandronic acid 3mg in 3ml injection is approved for use where oral bisphosphonates are not appropriate (not tolerated, contra-indicated because of upper gastro-intestinal problems or insufficiently effective)
  • Approved for the treatment of osteoporosis in line with NICE
 
Link  NICE TA464 Bisphosphonates for treating osteoporosis
   
Risedronate
(Osteoporosis/Paget's)
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Alternatives
Green
  • Approved risedronate formulations include:
    • 5mg tablets (taken daily);
    • 35mg tablets (taken once weekly for osteoporosis) -preferred.

  • Risedronate is approved for the primary prevention of osteoporosis in line with NICE, and for for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis in line with NICE. 
  • Risedronate 30mg tablets are also approved for Paget’s disease.
  • Approved for the treatment of osteoporosis in line with NICE
 
Link  NICE TA464 Bisphosphonates for treating osteoporosis
   
Sodium Clodronate
(Hypercalcaemia)
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Alternatives
Green plus
  • 520mg and 800mg tablets
 
   
Zoledronic Acid 4mg injection
(Hypercalcaemia/breast cancer)
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Alternatives
Red
  • Approved for use in treating hypercalcaemia of malignancy and the prevention of skeletal events in patients with metastatic breast cancer.
  • Approved for the adjuvant treatment of post-menopausal  women with early breast cancer (subject to agreement with the CCGs and provider trusts regarding the extra activity). 
  • Not approved for preventing skeletal events in patients with prostate cancer.
  • To avoid confusion it is recommended that this product is prescribed by brand name i.e. Zometa®
 
   
Zoledronic Acid 5mg injection
(Osteoporosis/Paget's)
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Alternatives
Red
  • Prescribe by brand name
  • Approved for the treatment of osteoporosis in line with NICE
 
Link  NICE TA464 Bisphosphonates for treating osteoporosis
   
06.06.02  Expand sub section  Denosumab
06.06.02  Expand sub section  Strontium renelate
 ....
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

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.   

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.  

Green

Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.  

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