netFormulary Coventry and Warwickshire 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 tablets
(Osteoporosis)
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Formulary
Preferred
 
   
Ibandronic Acid 150mg tablets
(Osteoporosis)
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Formulary
Preferred

Monthly dose

 
   
Ibandronic Acid 50 mg tablets
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Formulary
Amber SC
Reduction of bone damage in bone metastases in breast cancer 
Link  Ibandronic Acid - shared care agreement
   
Ibandronic Acid injection
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Formulary
Red SO
Treatment of osteoporosis, hypercalcaemia of malignancy and reduction of bone metastases in breast cancer
 
   
Risedronate tablets (weekly)
(Osteoporosis)
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Formulary
Second Line
Intolerance to alendronate 
   
Sodium clodronate oral
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Formulary
Green SA
Treatment of osteolytic lesions, hypercalcaemia and bone pain assosiated with skeletal metastases in patients with breast cancer or multiple myeloma
 
   
Disodium Pamidronate
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Formulary
Red SO
Treatment of hypercalcaemia of malignancy, osteolytic lesions and bone pain in bone metastases and Paget's disease of bone
 
   
Zoledronic Acid
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Formulary
Red SO
Reduction in bone damage in bone malignancies, treatment of osteoporosis, Paget's disease and hypercalcaemia of malignancy
 
   
06.06.02  Expand sub section  Denosumab
06.06.02  Expand sub section  Strontium renelate
 ....
 Non Formulary Items
Alendronic acid effervescent tablets & oral solution

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Non Formulary
Non Formulary
 
Alendronic Acid with colecalciferol  (Fosavance®)

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Non Formulary
Black BL
Not cost-effective

Advice: Prescribe as separate ingredients, vitamin D only if necessary

 
Risedronate daily formulation
(Osteoporosis)

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Non Formulary
Non Formulary
 
Risedronate with calcium & colecalciferol  (Actonel combi®)

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Non Formulary
Black BL

Not cost-effective

Advice: Prescribe alendroninc acid and additional vitamin D if appropriate

 
  
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
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Preferred

Clinicians are free to prescribe these drugs. They are regarded as cost effective choices which have evidence to support their use.  

Second Line

These drugs should only be prescribed in the scenarios described in the formulary after preferred drug(s) have been ruled out.  

Non Formulary

Non-formulary choice - the vast majority of a patient’s needs should be met by use of formulary preferred choices and second line options when appropriate. Therefore the Clinician should only use a non-formularly drug if this can be justified and it is recommended that all such instances are recorded in the patient record.  

Green SA

Specialist Advised – Specialists may simply advise a patient’s GP to initiate these drugs themselves after they have made an initial assessment. Note: SA drugs can be initiated by the specialist according to patient need and also depending on local commissioning arrangements which may mandate, through the contract between provider and commissioner, that all SA drugs are treated as SI.  

Green SI

Specialist Initiation - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patient’s GP following communication from the specialist.  

Amber SC

Shared Care - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

Red SO

Specialist Only - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Black BL

Black Listed Medicines - These drugs are considered inappropriate for prescribing in Coventry & Warwickshire as they are either not cost-effective or of proven benefit or both.   

Not Recommended

Not Recommended - These are specialist drugs that are not recommended for use.  

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