NHS Dudley Health Economy Medicines Formulary
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9.5.1 Calcium and magnesium

Recommended drugs

Magnesium –L aspartate (Magnaspartate®) sachets

Comments to support switch/ extended use

Dose: Recommended dose – 24 mmol/ daily

2 sachets of Magnaspartate 10mmol sachet

Use of Magnaspartate ® classified as a food for special medical purposes to replace the unlicensed magnesium glycerophosphate tablets would reduce costs in both sectors. The sachets have the advantage that they can be given to patients with swallowing difficulties thus replacing the oral suspension

 

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

 

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low

Hyperparathyroidism - cinacalcet - NICE TAG TA117

1.1 Cinacalcet is not recommended for the routine treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy.

1.2 Cinacalcet is recommended for the treatment of refractory secondary hyperparathyroidism in patients with end-stage renal disease (including those with calciphylaxis) only in those:

  • who have 'very uncontrolled' plasma levels of intact parathyroid hormone (defined as greater than 85 pmol/litre [800 pg/ml]) that are refractory to standard therapy, and a normal or high adjusted serum calcium level, and

  • in whom surgical parathyroidectomy is contraindicated, in that the risks of surgery are considered to outweigh the benefits.

1.3 Response to treatment should be monitored regularly and treatment should be continued only if a reduction in the plasma levels of intact parathyroid hormone of 30% or more is seen within 4 months of treatment, including dose escalation as appropriate.

https://www.nice.org.uk/guidance/TA117

Etelcalcetide for treating secondary hyperparathyroidism - NICE TAG TA448

1.1Etelcalcetide is recommended as an option for treating secondary hyperparathyroidism in adults with chronic kidney disease on haemodialysis, only if:

  • treatment with a calcimimetic is indicated but cinacalcet is not suitable and

  • the company provides etelcalcetide with the discount agreed in the patient access scheme.

1.2This guidance is not intended to affect the position of patients whose treatment with etelcalcetide was started within the NHS before this guidance was published. Treatment of those patients may continue without change to whatever funding arrangements were in place for them before this guidance was published until they and their NHS clinician consider it appropriate to stop.

https://www.nice.org.uk/guidance/ta448

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