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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 70mg tablets
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First Choice
Green

First line treatment for osteoporosis, see Guidance for Fracture Risk Assessment and Prevention in Primary Care.

APCO May 2018.

 
Risedronate Sodium 35mg tablets
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Second Choice
Green

For patients who cannot tolerate alendronic acid, as per Guidance for Fracture Risk Assessment and Prevention in Primary Care

APCO May 2018.

 
   
Sodium Clodronate
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Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation for breast cancer or myeloma patients with hypercalcaemia associated with skeletal metasteses.

APCO November 2006.

 
   
Ibandronic Acid
(50mg tablets)
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Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation:

 
Link  NICE Evidence Summary: Early breast cancer (preventing recurrence and improving survival): adjuvant bisphosphonates
   
Ibandronic Acid
(150mg tablets)
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Formulary
Green

Alternative option if Alendronate or Risedronate is not suitable, as per Guidance for Fracture Risk Assessment and Prevention in Primary Care.

APCO May 2018.

 
Link  NICE TA464: Bisphosphonates for treating osteoporosis
   
Ibandronic Acid 3mg injection (Bonviva®)
(Osteoporosis )
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Formulary
Red

For treating osteoporosis in line with Guidance for fracture risk assessment and prevention in primary care, as per NICE TA464.

APCO May 2018.

 
Link  NICE TA464: Bisphosphonates for treating osteoporosis
Link  MHRA: Osteonecrosis of the jaw - risk minimisation
   
Pamidronate Disodium
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Formulary
Red
 
Link  MHRA: Osteonecrosis of the jaw - risk minimisation
   
Zoledronic Acid 4mg (Zometa®)
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Formulary
Red

For hypercalcaemia and skeletal events linked with malignancy.

See Guidelines for adjuvant biphosphonate treatment for post-menopausal women with early breast cancer (APCO November 2017). 

 
Link  MHRA: Osteonecrosis of the jaw - risk minimisation
Link  Osteonecrosis of the jaw patient reminder cards
   
Zoledronic Acid 5mg (Aclasta®)
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Formulary
Red

Specialist prescribing for:

  • Treating osteoporosis as per NICE TA464 (APCO November 2017).
  • Steroid induced osteoporosis (third-line), if not tolerating risedronate 35mg. (APCO March 2010).
  • TPN induced osteoporosis (unlicensedunlicensed) (APCO June 2007).
  • Prevention and treatment of steroid induced osteoporosis and secondary prevention in men (APCO July 2017). 
 
Link  NICE TA464: Bisphosphonates for treating osteoporosis
Link  MHRA: Osteonecrosis of the jaw - risk minimisation
Link  Osteonecrosis of the jaw patient reminder cards
   
06.06.02  Expand sub section  Denosumab
06.06.02  Expand sub section  Strontium renelate
 ....
 Non Formulary Items
Alendronic Acid with Colecalciferol  (Fosavance®)

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Non Formulary
 
Ibandronic Acid IV infusion  (Bondronat®)

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Non Formulary
Black

Not included in guideline.

APCO September 2014.

Link  MHRA: Osteonecrosis of the jaw - risk minimisation
Link  NICE TA464: Bisphosphonates for treating osteoporosis
 
  
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
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

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred.   

Amber Shared Care Protocol

Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO).   

Green

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

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