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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
 note  MHRA Drug Safety Alert: minimising the risk of osteonecrosis of the jaw with denosumab and intravenous bisphosphonates
06.06.02  Expand sub section  Bisphosphonates
Alendronic Acid
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First Choice 70mg tablets (once weekly preparation)

 
Risedronate
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Formulary 35mg tablets (once weekly preparation) 
   
Sodium Clodronate
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Formulary Tablets

Restricted Item Specialist Initiation Only 
   
Disodium Pamidronate
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Formulary Concentrate for Intravenous Infusion

note Refer to Electrolyte Disturbances Guidelines for dosage in hypercalcaemia 
Link  PAT: Electrolyte Disturbances Guidance
   
Ibandronic Acid (Bondronat®)
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Formulary
Amber
50mg Tablets
Concentrate for infusion

note Approved for reduction of bone damage in bone metastases in advanced breast cancer

 
   
Zoledronic Acid (Aclasta®)
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Formulary
Red
Intravenous infusion

note For:
Paget's disease of bone,
Postmenopausal osteoporosis (Restricted ItemSee GMMMG NTS recommendation),
and osteoporosis in men 
Link  GMMMG NTS: Aclasta for postmenopausal osteoporosis
Link  Patient alert card: osteonecrosis of the jaw
   
Zoledronic Acid (Zometa®)
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Formulary
Red
Intravenous infusion

note For reduction of bone damage in advanced malignancies involving bone, and hypercalcaemia of malignancy 
Link  Patient alert card: osteonecrosis of the jaw
   
06.06.02  Expand sub section  Denosumab
 note   
Denosumab (Prolia®)
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Formulary
Amber
Injection

 
Link  MHRA Safety Update: minimising the risk of osteonecrosis of the jaw
Link  Patient alert card: osteonecrosis of the jaw
Link  MHRA Safety Update: risk of severe hypocalcaemia
Link  NICE TA204: Osteoporotic fractures - denosumab
Link  GMMMG NTG: Use in Prostate Cancer (NOT recommended)
   
Denosumab (XGEVA®)
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Formulary
Amber
Injection 
Link  MHRA Safety Update: minimising the risk of osteonecrosis of the jaw
Link  Patient alert card: osteonecrosis of the jaw
Link  MHRA Safety Update: risk of severe hypocalcaemia
Link  NICE TA265: Bone metastases from solid tumours - denosumab: guidance (TA265 )
   
06.06.02  Expand sub section  Strontium renelate
Strontium Ranelate (Protelos®)
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Formulary Granules

Restricted Item Specialist Initiation Only 
Link  MHRA Drug Safety Update - Strontium (cardiovascular risk) 2014
Link  NICE TA161: Osteoporosis - secondary prevention
   
 ....
 Non Formulary Items
Alendronic Acid

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Non Formulary 10mg once daily tablets
 
Alendronic Acid with colecalciferol  (Fosavance®)

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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
 
Ibandronic acid  (Bonviva®)

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Non Formulary 150mg tablets (once a month preparation)

 
Sodium Clodronate  (Clasteon®)

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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
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

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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