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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 6 - Endocrine system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing

06.06.02 Bisphosphonates and other drugs affecting bone metabolism
06.06.02 Bisphosphonates

Alendronic Acid
(Tablets)

Formulary

For osteoporosis

70mg once weekly is the preferred choice.

Not licensed for use in men, but is commonly used off label. 

10mg once daily.

Entry reviewed May 2025

Risedronate
(Tablets)

Formulary

For osteoporosis treatment.

35mg once weekly is the preferred choice.

5mg daily.

Entry reviewed May 2025

Ibandronic Acid
(Tablets)

Formulary

Alternative if compliance is an issue.

150mg MONTHLY tablets.

See BLMK Osteoporosis Guideline for further information.

Entry reviewed: May 2025

Zoledronic Acid 5mg
(Intravenous infusion)

RED
Formulary

Preferred IV option for osteoporosis treatment in line with NICE guidelines

2x4mg vials are used for a 5mg dose due to cost of the 5mg preparation (approved by DTC).

Entry reviewed May 2025

Ibandronic Acid injection

RED
Formulary

3mg/3ml solution for injection pre-filled syringes

3mg every 3 months

See BLMK Osteoporosis Guideline for further details.

Entry reviewed May 2025

Pamidronate Disodium Injection

RED
Formulary

Hypercalcaemia of malignancy in patients that cannot have zoledronic acid.

15mg, 30mg, 60mg, 90mg

Entry reviewed May 2025

Zoledronic Acid 4mg
(Injection for infusion)

RED
Formulary

FIRST CHOICE when used as when used as adjuvant for breast cancer (restricted to consultant oncologist use only)

 

Entry reviewed: May 2025

Sodium Clodronate
(Tablets)

Formulary

SECOND CHOICE after zoledronic acid when used as adjuvant for breast cancer

400mg, 520mg, 800mg.

 

Entry reviewed: May 2025

Non formulary items

Ibandronic Acid 50mg (Tablets)

 
Non Formulary

Removed from Formulary November 2023. Can continue for existing patients only.

Zoledronic acid 4mg is first line

 

Entry reviewed: November 2023

06.06.02 Denosumab
06.06.02 Strontium renelate
Classifications
May be initiated in any care setting
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.