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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:

This chapter is mostly updated. The section still outstanding is 6.4.1.1 (oestrogens and HRT). 

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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 tablets
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First Choice
Green
  • The need for continued bisphosphonate treatment should be re-evaluated periodically particularly after 5 or more years of use
 
Risedronate
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Second Choice
Green
  • The need for continued bisphosphonate treatment should be re-evaluated periodically particularly after 5 or more years of use
 
Link  Bisphosphonates: atypical femoral fractures
   
Alendronic Acid  (Binosto®)
(70mg effervescent tablets)
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Formulary
Green
  • £££
  • Third line option in individuals who have not tolerated first line alendronate tablets and second line risedronate tablets and in whom a bone-sparing agent is still considered clinically necessary.
  • The need for continued bisphosphonate treatment should be re-evaluated periodically particularly after 5 or more years of use
 
Link  Bisphosphonates: atypical femoral fractures
   
Disodium Pamidronate
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Formulary
Red
 
Link  Bisphosphonates: atypical femoral fractures
   
Ibandronic Acid 150mg
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Formulary
Amber Recommended
 
Link  Bisphosphonates: atypical femoral fractures
   
Ibandronic Acid 50mg
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Formulary
Amber SC
  • For skeletal events in metastatic breast cancer.
  • Supported by an ESCA, see link below.
 
Link  Bisphosphonates: atypical femoral fractures
Link  ESCA: Ibandronic acid 50mg
   
Ibandronic Acid injection
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Formulary
Red
 
Link  Bisphosphonates: atypical femoral fractures
   
Sodium Clodronate
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Formulary
Amber SC
  • For the management of osteolytic lesions, bone pain and hypercalcaemia associated with multiple myeloma or breast cancer.
  • Supported by an ESCA, see link below.
 
Link  ESCA: Sodium clodronate
   
Zoledronic Acid
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Formulary
Red
 
Link  Bisphosphonates: atypical femoral fractures
   
06.06.02  Expand sub section  Denosumab
06.06.02  Expand sub section  Strontium renelate
 ....
 Non Formulary Items
Alendronic Acid
(oral solution )

View adult BNF View SPC online View childrens BNF
Non Formulary
Black
  • Removed from formulary in December 2016, replaced by effervescent tablets.
  •  
    Alendronic Acid with colecalciferol  (Fosavance®)

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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
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    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

    Prescribing in children

    The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

    The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.
      

    Green

    Medicines suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians.   

    Amber Initiation

    Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry.  

    Amber Recommended

    Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.  

    Amber SC

    Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry.  

    Red

    Medicines for initiation and maintenance prescribing by Specialists only.  

    Black

    Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use.  

    Grey

    Positive NICE TA and/or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information.  

    The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest.  

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