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 Formulary Chapter 6: Endocrine system - Full Chapter
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06.06.02  Expand sub section  Bisphosphonates and other drugs affecting bone metabolism
06.06.02  Expand sub section  Bisphosphonates
Alendronic Acid
(Osteoporosis prevention and treatment)
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First Choice Tablets: 10mg, 70mg  
Risedronate
(Osteoporosis prevention and treatment)
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Second Choice Tablets: 5mg, 30mg, 35mg 
   
Ibandronic Acid
(Osteoporosis prevention and treatment)
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Formulary
Green +
Tablets: 50mg

Pre-filled syringe*: 3mg/3mL

*Only for use where oral bisphosphonates are not appropriate (not tolerated, contra-indicated because of upper gastro-intestinal problems or insufficiently effective).
 
   
Sodium Clodronate
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Formulary
Green +
Capsules: 400mg*
*For breast pain/breast cancer/myeloma patients only 
   
Alendronic Acid (Binosto)
(Osteoporosis prevention and treatment)
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Formulary

Effervescent tablets: 70mg

 
   
Disodium Pamidronate
(Treatment of hypercalcaemia)
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Formulary
Red
IV infusion: 15mg/1mL, 15 mg/5mL, 30 mg/2mL, 30 mg/10mL, 60 mg/4mL, 60 mg/10mL, 90 mg/6mL, 90 mg/10mL
Injection: 15mg, 30mg, 90mg
 
   
Zoledronic Acid (Aclasta®)
(Osteoporosis prevention and treatment)
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Formulary
Red
Infusion: 50mcg/1mL (Aclasta®)

For the treatment of postmenopausal osteoporosis, osteoporosis in men and Paget’s disease

N.B. prescribe by brand name (Aclasta®) to avoid confusion with a different strength product used to treat hypercalcaemia of malignancy and the prevention of skeletal events in patients with metastatic breast cancer.
 
   
Zoledronic Acid (Zometa)
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Formulary
Red
Concentrate for intravenous infusion, vial: 4mg

Indication:prevention of treatment associated osteoporosis and to reduce the risk of recurrence in post-menopausal patients with early breast cancer (note: unlicensed for this indication) 
   
06.06.02  Expand sub section  Denosumab
06.06.02  Expand sub section  Strontium renelate
 ....
 Non Formulary Items
Disodium Etidronate  (Didronel®)

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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
click to search medicines.org.uk
Link to adult BNF
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Link to SPCs
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 or use by a specialist within specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the appropriate hospital clinician or specialist. These drugs should only be prescribed under the direct supervision of that clinician or specialist and are not suitable for shared care arrangements. The drug should be supplied via the hospital or specialist centre for the duration of treatment.   

Amber

These are specialist drugs which must be initiated by secondary care specialist prescribers, but with the potential to transfer prescribing to primary care within written and agreed shared care protocols and according to the agreed process for transfer of care. For these drugs, in order to ensure patient safety, some aspects of care must remain with the specialist due to their complexity e.g. monitoring of disease or drug response. Other more routine aspects can be transferred to the GP e.g. monitoring of adverse effects and supply of the medicine. The specific responsibilities of the specialist and GP are defined in the shared care agreement for each drug. Shared care agreements are still under development for some amber drugs. Until these are available, it would be expected that any shared care request from secondary care to a GP would be accompanied by written information which defines prescribing and monitoring responsibilities. The hospital specialist should also provide the GP with enough information and support to allow the safe transfer and ongoing management of prescribing into primary care.   

Green +

Drugs which should usually be initiated in secondary care, or by a specialist clinician, but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case.  

Green

These are defined as new and established drugs, which may be prescribed, initiated, changed or maintained on FP10 by the GP and, if appropriate, discontinued without recourse to secondary care. N.B. DRUGS NOT IDENTIFIED IN THE FORMULARY BY A RED, AMBER OR GREEN+ SYMBOL ARE CLASSIFIED AS GREEN.   

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