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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:

Chapter complete - updated July 18

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06.06.02  Expand sub section  Bisphosphonates and other drugs affecting bone metabolism
06.06.02  Expand sub section  Bisphosphonates
 note 

Bisphosphonates have an important role in the prophylaxis and treatment of osteoporosis and corticosteroid induced osteoporosis.

Tablets should be swallowed whole with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast (or other medicine); patient should stand or sit upright for at least 30 minutes after administration.

Patients (or their carers) should be advised to stop taking and to seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.

MHRA/CHM ADVICE: Bisphosphonates: Atypical femoral fractures - patients should be advised to report any thigh, hip or groin pain during treatment with a bisphosphonate.

MHRA/CHM ADVICE: Bisphosphonates: Osteonecrosis of the jaw - during bisphosphonate treatment patients shold maintain good oral hygeine, receive routine dental check-ups, and report any oral symptoms.

MHRA/CHM ADVICE: Bisphosphonates: Osteonecrosis of the exernal auditory canal - patients should be advised to report any ear pain, discharge from ear or an ear infection during treatment with a bisphosphonate.

 

Alendronic Acid
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Link  NICE TA464: Bisphosphonates for treating osteoporosis
   
Alendronic acid effervescent tablets (Binosto)
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Restricted Drug Restricted
  • For use in patients who are unable to swallow tablets where Alendronic acid is the appropriate treatment choice
 
   
Disodium Pamidronate
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Sodium Clodronate
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06.06.02  Expand sub section  Denosumab
06.06.02  Expand sub section  Strontium renelate
 ....
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
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

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.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

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]   

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