| Formulary Chapter 6: Endocrine system - Full Chapter
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| Chapter Links... |
 NICE Guidance on prescribing |
| NICE NG28: Type 2 diabetes in adults: management |
| DVLA guidance |
| Details... |
| 06.06 |
Drugs affecting bone metabolism |
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Calcitriol
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Second Choice
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Disodium Pamidronate
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Formulary
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MHRA: Bisphosphonates: atypical femoral fractures
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Alendronic Acid
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Formulary
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MHRA: Bisphosphonates: atypical femoral fractures
NICE TA464: Bisphosphonates for treating osteoporosis
TA160: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (amended)
TA161: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (amended)
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CALCITONIN
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Formulary
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CALCITONIN (SALMON)/SALCATONIN - Red
CALCITONIN SALMON/ CALCITONIN - Red
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Ibandronic acid
(Injection)
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Formulary
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MHRA: Bisphosphonates: atypical femoral fractures
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Ibandronic acid
(150mg tabs )
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Formulary
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MHRA: Bisphosphonates: atypical femoral fractures
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Ibandronic acid
(50mg tabs)
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Formulary
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Dudley
Sandwell
ESCA Sandwell only
Walsall
Wolverhampton
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ESCA: Ibandronic acid 50mg-Sandwell only
MHRA: Bisphosphonates: atypical femoral fractures
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PAMIDRONATE DISODIUM
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Formulary
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RISEDRONATE SODIUM 30mg
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Formulary
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ROMOSOZUMAB
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Formulary
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Evenity - Red
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NICE TA 791: Romosozumab for treating severe osteoporosis
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Sodium Clodronate (Calsteon®, Loron 520® )
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Formulary
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Dudley
Sandwell
ESCA- Sandwell
Walsall
Wolverhampton
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ESCA: Sodium clodronate-Sandwell only
MHRA: Bisphosphonates: atypical femoral fractures
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Teriparatide
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Formulary
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Red - Forsteo
Red - Movymia
Red - Terrosa
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NICE TA161: Osteoporosis - secondary prevention (including Teriparatide)
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Zoledronic acid
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Formulary
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Red - Aclasta
Red - Zometa
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MHRA: Bisphosphonates: atypical femoral fractures
NICE TA464: Bisphosphonates for treating osteoporosis
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| 06.06 |
Osteoporosis |
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| 06.06.01 |
Calcitonin and parathyroid hormone |
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Calcitonin (salmon) / Salcatonin
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Formulary
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Injection
Nasal spray
For hospital use only
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NICE TA161: Osteoporosis - secondary prevention (including strontium ranelate)
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| 06.06.02 |
Bisphosphonates and other drugs affecting bone metabolism |
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| 06.06.02 |
Bisphosphonates |
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Alendronic acid (Binosto®)
(effervescent tablets)
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Third Choice
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MHRA: Bisphosphonates: atypical femoral fractures
NICE TA464:Bisphosphonates for treating osteoporosis
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Etidronate disodium
(tablets)
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Formulary
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In line with NICE
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MHRA; Bisphosphonates: atypical femoral fractures
NICE TA160: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women
NICE TA161: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
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| 06.06.02 |
Denosumab |
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Denosumab (Prolia®)
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Formulary
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Dudley
Sandwell
ESCA-Denosumab-Sandwell only
Walsall
Wolverhampton
 with RiCaD
Wolverhampton only
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ESCA: Denosumab (Prolia)-Sandwell only
NICE TA204: Denosumab for the prevention of osteoporotic fractures in postmenopausal women
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Denosumab (Xgeva®)
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Formulary
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For specialist use only in line with NICE TA265
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NICE TA265: Bone metastases from solid tumours - denosumab: guidance (TA265 )
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| 06.06.02 |
Strontium renelate |
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Strontium ranelate
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Formulary
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| Non Formulary Items |
ALENDRONIC ACID
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Non Formulary
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ALENDRONIC ACID / Fosamax Once Week - Black
ALENDRONIC ACID/COLECALCIFEROL - Black
ALENDRONIC ACID/COLECALCIFEROL / Bentexo - Black
ALENDRONIC ACID/COLECALCIFEROL / Fosavance - Black |
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Alendronic Acid
(Oral solution)
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Non Formulary
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Removed from formulary in Decemeber 2016, replaced by effervescent tablets |
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Alendronic Acid (Fosamax®)
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Non Formulary
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Alendronic Acid (Fosamax® Once Weekly)
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Non Formulary
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Alendronic Acid with colecalciferol (Fosavance®)
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Non Formulary
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CALCITRIOL (Rocaltrol®)
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Non Formulary
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Disodium Eitdronate (Didronel PMO®)
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Non Formulary
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Disodium Etidronate (Didronel®)
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Non Formulary
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PARATHYROID HORMONE
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Non Formulary
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Preotact - BLACK |
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RISEDRONATE 5MG
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Non Formulary
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Risedronate Sodium (Actonel®)
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Non Formulary
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Actonel - Black
RISEDRONATE/CALCIUM CARBONATE/COLECALCIFEROL - Black
RISEDRONATE/CALCIUM CARBONATE/COLECALCIFEROL / Actonel Combi - Black
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UKMI Q&A: Can oral bisphosphonates be given to people with renal impairment to treat osteoporosis?
MHRA: Bisphosphonates: atypical femoral fractures
NICE TA464: Bisphosphonates for treating osteoporosis
TA 161: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (amended)
TA160: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (amended)
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Tiludronic Acid (Skelid®)
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Non Formulary
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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Cancer Drugs Fund |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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All Settings
Suitable for initiation, ongoing prescribing, and discontinuation in both primary and secondary care settings. They are generally familiar, frequently used therapies that can be started within their licensed indications without specialist oversight. |
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Specialist only
Designated for initiation, ongoing prescribing, monitoring, exclusively by a specialists either in a hospital or as part of a specialist service (to note this could be in a non-hospital setting). Primary care should neither start nor continue these treatments except as part of a specialist service. A specialist could be either a medical or non-medical prescriber. |
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Specialist advice
Prescribers in primary care should seek advice and a recommendation from a specialists prior to initiating a medicine. Once agreed with a specialist, medicines can be initiated, prescribed and monitored in primary care without a formal shared-care agreement. |
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Specialist initiation
Medicines in this category require a specialist to start therapy, titrate dosage, and assess initial efficacy or tolerability. Once stabilised, prescribing responsibility may transfer to primary care without the need for a formal shared-care agreement. |
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Shared care agreement
Prescribing responsibility can be shared across health settings and between specialists and GPs only when formal shared care arrangement has been made. For example, there may be extensive and complex monitoring requirements or significant safety concerns (note would need a national policy on this to define the criteria for requiring a formal SCA), this will be produced once nationally. |
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Do not prescribe
Not approved for routine prescribing in primary or secondary care. For example, because they are agents classified in the BNF as “not NHS” or “Drugs of Low Clinical Value”, or they are products on NICE’s “do not do” list or NHS England’s “should not routinely prescribe” list. |
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Self Care
Not for routine prescribed in primary or secondary care unless as part of care for a long term condition. Instead, patients should be encouraged to self care with support from community pharmacy. |
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Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications |
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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. |
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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. |
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Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
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Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
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Positive NICE TA and /or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
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Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
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