Medicine for the Elderly Specialist formulary list
**Other indications for particular drugs may be included on completion of further specialist lists**
The following medicines are approved for prescribing by or on the recommendation of a Medicine for the Elderly specialist (except botulinum toxin type A, human recombinant parathyroid hormone and teriparatide which are only prescribed by particular specialists – see below.) (Medicine for the Elderly specialists refer patients to these other specialists for these medicines):
| TAF SECTION | MEDICINE | SUMMARY OF RESTRICTED INDICATION | CATEGORY | PROTOCOL |
| 6.3 | Fludrocortisone acetate (unlicensed use ‘off-label’) | Orthostatic (postural) hypotension only after interventions as per guidance notes. |
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Link to Orthostatic Hypotension Guidance Notes See SIGN 113 Diagnosis and pharmacological management of Parkinson’s disease |
| 6.6 | Denosumab subcutaneous injection (Prolia®▼) every 6 months |
Postmenopausal osteoporosis. 2nd line option. Restricted to patients with a bone mineral density (BMD) T-score < -2.5 and > -4.0 for whom oral bisphosphonates are unsuitable due to contraindication, intolerance or inability to comply with administration instructions. See also protocol. |
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Local protocol |
| Zoledronic acid annual intravenous infusion (Aclasta®) |
2nd line option. Postmenopausal osteoporosis in women at increased risk of fractures in patients who are unsuitable for or unable to tolerate oral bisphosphonates. |
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Tayside MFE Osteoporosis Treatment Algorithm | |
| Strontium ranelate oral sachets |
3rd line - for patients who cannot be given oral bisphosphonates, denosumab or annual zoledronic acid. Postmenopausal osteoporosis in women at high risk of fracture, equivalent to age over 75 years with a previous fragility fracture and a T-score of < -2.4. See local guidance and MHRA advice for further restrictions/contra-indications/cautions. |
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Tayside MFE Osteoporosis Treatment Algorithm MHRA Drug Safety Update April 2013
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| Teriparatide (Forsteo®) |
Severe postmenopausal osteoporosis.
4th line. |
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Local protocol |
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| Human recombinant parathyroid hormone (Preotact®) |
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| 9.1 | Iron sucrose (Venofer®) | Treatment of iron deficiency when oral iron preparations are ineffective or cannot be used. First choice parenteral iron preparation. |
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| Ferric carboxymaltose (Ferinject®▼) |
Second choice parenteral iron preparation. Restricted to administration by intravenous infusion. |
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May be used on advice of Renal specialists or where administration is required as a total dose infusion to ensure full dosage received (e.g. out-patient clinics, in-patients when short expected length of stay). | |
| 10.2 | Baclofen | Relief of spasticity of voluntary muscle associated with neurological damage including stroke. |
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See SIGN 118 Management of patients with stroke: Rehabilitation, prevention and management of complications, and discharge planning. |
| Tizanidine | Treatment of spasticity associated with stroke (unlicensed use ‘off-label’). |
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| Botulinum toxin type A (Botox®) | Focal spasticity, including the treatment of wrist and hand disability due to upper limb spasticity associated with stroke in adults. |
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Only prescribed by and administered by the consultant from the Centre for Brain Injury Rehabilitation |
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May be prescribed by Hospital Specialists only |
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May be prescribed in General Practice under the direction of a Specialist |
