Lancashire and South Cumbria
Formulary
Formulary
6 Endocrine system
06-06-02 Bisphosphonates
| Alendronic Acid |
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Formulary
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70mg tablets are once weekly. First line for osteoporosis. |
 MHRA: Bisphosphonates: atypical femoral fractures MHRA: Bisphosphonates: osteonecrosis of the jaw MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal |
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| Disodium Pamidronate |
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Formulary
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Intravenous infusion 30mg/10mL, 60mg/10mL, 90mg/10mL First line for osteolytic lesions and bone pain Treatment option for hypercalcaemia of malignancy Paget's disease |
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MHRA: Bisphosphonates: atypical femoral fractures MHRA: Bisphosphonates: osteonecrosis of the jaw MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal MHRA: Denosumab (Xgeva▼, Prolia); intravenous bisphosphonates: osteonecrosis of the jaw—further measures to minimise risk |
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| Ibandronic Acid injection Bonviva® |
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Formulary
|
Injection 3mg/3mL pre-filled syringe |
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MHRA: Bisphosphonates: atypical femoral fractures MHRA: Bisphosphonates: osteonecrosis of the jaw MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal |
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| Ibandronic Acid Tablets |
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Formulary
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Alternative monthly bisphosphonate when alendronic acid is not appropriate. |
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MHRA: Bisphosphonates: atypical femoral fractures MHRA: Bisphosphonates: osteonecrosis of the jaw MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal |
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| Ibandronic Acid Tablets Bondronat® |
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Formulary
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(Bondronat®) Tablets 50mg: Oral alternative bisphosphonate for patients with breast cancer |
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LSCMMG: Ibandronic acid tablets MHRA: Bisphosphonates: atypical femoral fractures MHRA: Bisphosphonates: osteonecrosis of the jaw MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal |
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| Risedronate |
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Formulary
|
Second line for osteoporosis. Alternative weekly preparation when alendronic acid is not appropriate. |
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MHRA: Bisphosphonates: atypical femoral fractures MHRA: Bisphosphonates: osteonecrosis of the jaw MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal |
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| Sodium Clodronate |
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Formulary
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Capsules 400mg Tablets 800mg Oral alternative for patients with multiple myeloma |
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MHRA: Bisphosphonates: atypical femoral fractures MHRA: Bisphosphonates: osteonecrosis of the jaw MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal |
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| Zoledronic Acid |
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Formulary
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(Aclasta®) Specialist use in osteoporosis Second choice treatment in Paget's disease (Zometa ®) Second line for osteolytic lesions and bone pain treatment option for hypercalcaemia of malignancy |
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MHRA: Bisphosphonates: atypical femoral fractures MHRA: Bisphosphonates: osteonecrosis of the jaw MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal MHRA: Denosumab (Xgeva▼, Prolia); intravenous bisphosphonates: osteonecrosis of the jaw—further measures to minimise risk |
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Links
LSCMMG: Denosumab as a second line treatment option for the prevention of osteoporotic fragility fractures position statement- LSCMMG: Ibandronic acid tablets
- LSCMMG: Shared care guideline (Denosumab 120mg injection (Xgeva®))
- LSCMMG: Shared care guideline (Denosumab 60mg injection (Prolia®))
- MHRA Drug Safety Update Aug 2020: Denosumab 60mg (Prolia): increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment
- MHRA Drug Safety Update June 2017: Denosumab (Prolia, Xgeva): reports of osteonecrosis of the external auditory canal
- MHRA Drug Safety Update June 2017: Denosumab (Prolia, Xgeva): reports of osteonecrosis of the external auditory canal
- MHRA Drug Safety Update June 2018: Denosumab (Xgeva) for advanced malignancies involving bone: study data show new primary malignancies reported more frequently compared to zoledronate
- MHRA Drug Safety Update June 2018: Denosumab (Xgeva) for giant cell tumour of bone: risk of clinically significant hypercalcaemia following discontinuation
- MHRA Drug Safety Update May 2022: Denosumab 60mg (Prolia): should not be used in patients under 18 years due to the risk of serious hypercalcaemia
- MHRA safety update Dec 2014:Rare cases of atypical femoral fracture with long-term use
- MHRA: Bisphosphonates: atypical femoral fractures
- MHRA: Bisphosphonates: atypical femoral fractures
- MHRA: Bisphosphonates: atypical femoral fractures
- MHRA: Bisphosphonates: atypical femoral fractures
- MHRA: Bisphosphonates: atypical femoral fractures
- MHRA: Bisphosphonates: atypical femoral fractures
- MHRA: Bisphosphonates: atypical femoral fractures
- MHRA: Bisphosphonates: atypical femoral fractures
- MHRA: Bisphosphonates: osteonecrosis of the jaw
- MHRA: Bisphosphonates: osteonecrosis of the jaw
- MHRA: Bisphosphonates: osteonecrosis of the jaw
- MHRA: Bisphosphonates: osteonecrosis of the jaw
- MHRA: Bisphosphonates: osteonecrosis of the jaw
- MHRA: Bisphosphonates: osteonecrosis of the jaw
- MHRA: Bisphosphonates: osteonecrosis of the jaw
- MHRA: Bisphosphonates: osteonecrosis of the jaw
- MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal
- MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal
- MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal
- MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal
- MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal
- MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal
- MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal
- MHRA: Bisphosphonates: very rare reports of osteonecrosis of the external auditory canal
- MHRA: Denosumab (Xgeva▼, Prolia); intravenous bisphosphonates: osteonecrosis of the jaw—further measures to minimise risk
- MHRA: Denosumab (Xgeva▼, Prolia); intravenous bisphosphonates: osteonecrosis of the jaw—further measures to minimise risk
- MHRA: Denosumab (Xgeva▼, Prolia); intravenous bisphosphonates: osteonecrosis of the jaw—further measures to minimise risk
- MHRA: Denosumab (Xgeva▼, Prolia); intravenous bisphosphonates: osteonecrosis of the jaw—further measures to minimise risk
- MHRA: Denosumab: updated recommendations
- MHRA: Denosumab: updated recommendations
- MHRA: Strontium: cardiovascular risk—restricted indication and new monitoring requirements
- NICE TA204: Osteoporotic fractures - denosumab
- NICE TA265: Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours
- NICE TA464: Bisphosphonates for treating osteoporosis
- NICE TA791: Romosozumab for treating severe osteoporosis
- Osteoporosis Guideline (NOGG 2021)