British National Formulary (BNF)

The British National Formulary is the unrivalled guidance on prescribing, dispensing and administering medicines.

The BNF is the only drug formulary in the world that is both independent, and has rigorous, accredited content creation processes. It is trusted by health professionals worldwide as their primary source for minimising medication errors.

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Always up-to-date: The content is revalidated, revised, and updated on a monthly basis, making sure you have access to the very latest prescribing knowledge

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Publication Updates

13 Aug

BNF August 2019 Update

This update contains 14 significant changes, 1 dose change and 6 new preparations.

See details

Significant Changes:

Atezolizumab in combination for treating metastatic non-squamous non-small-cell lung cancer [NICE guidance].
Contraceptives, hormonal: updated guidance on combined hormonal contraceptives.
Crohn’s disease: updated guidance on management.
Direct-acting oral anticoagulants (DOACs) (apixaban, dabigatran etexilate, edoxaban, and rivaroxaban): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome [MHRA/CHM advice].
Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes [NICE guidance].
Lenalidomide plus dexamethasone for multiple myeloma after 1 treatment with bortezomib [NICE guidance].
Lenalidomide plus dexamethasone for previously untreated multiple myeloma [NICE guidance].
Lenalidomide for the treatment of multiple myeloma in people who have received at least 2 prior therapies [NICE guidance].
Lenalidomide for treating myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality [NICE guidance].
GLP-1 receptor agonists (dulaglutide, exenatide, liraglutide (Victoza®), lixisenatide, and semaglutide): reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued [MHRA/CHM advice].
Ocrelizumab for treating primary progressive multiple sclerosis [NICE guidance].
Olaratumab (Lartruvo®): withdrawal of the EU marketing authorisation due to lack of efficacy [MHRA/CHM advice].
Oral retinoid medicines (acitretin, alitretinoin, bexarotene, isotretinoin, and tretinoin): revised and simplified pregnancy prevention educational materials for healthcare professionals and women [MHRA/CHM advice].
Urinary incontinence and pelvic organ prolapse in women: updated guidance on management.

Dose Changes:

Epipen® preparations (adrenaline/epinephrine) [body-weight ranges for children’s dosing updated].

New Preparations: Ajovy® [fremanezumab], Glyxambi® [empagliflozin with linagliptin], Brinavess® [vernakalant], Vizimpro® [dacomitinib], Betesil® [betamethasone], Blissel® [estriol].

For further details on changes in the BNF click on http://www.medicinescomplete.com/mc/bnf/current/PHP107699-changes.htm

09 Jul

BNF July 2019 Update

This update contains 9 significant changes, 2 dose changes and 5 new preparations.

See details

Significant Changes: 

Abemaciclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy [NICE guidance].
Alemtuzumab (Lemtrada®) and serious cardiovascular and immune-mediated adverse reactions: new restrictions to use and strengthened monitoring requirements [MHRA/CHM advice].
Cerebral palsy and spasticity: inclusion of overview.
Durvalumab for treating locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation [NICE guidance].
Enzalutamide for hormone-relapsed non-metastatic prostate cancer [NICE guidance].
Inotersen for treating hereditary transthyretin amyloidosis [NICE guidance].
Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy [MHRA/CHM advice].
Nivolumab with ipilimumab for untreated advanced renal cell carcinoma [NICE guidance].
Tofacitinib (Xeljanz®): restriction of 10 mg twice daily dose in patients at high risk of pulmonary embolism while safety review is ongoing [MHRA/CHM advice].

Dose Changes:

Emicizumab [alternative dosing for existing indications added].
Pembrolizumab [alternative dosing for monotherapy indications added].

New Preparations: Cuprior® [trientine dihydrochloride], Jorveza® [budesonide], Lokelma® [sodium zirconium cyclosilicate], Renapime® [cefepime], Skyrizi® [risankizumab].

For further details on changes in the BNF click on http://www.medicinescomplete.com/mc/bnf/current/PHP107699-changes.htm

11 Jun

BNF June 2019 Update

This update contains 21 significant changes, 1 dose changes and 4 new preparations.

See details

Significant Changes: 

Alemtuzumab (Lemtrada®): restriction of use due to serious safety concerns [MHRA/CHM advice].
Belimumab (Benlysta®): increased risk of serious psychiatric events seen in clinical trials [MHRA/CHM advice].
Brentuximab vedotin for treating CD30-positive cutaneous T-cell lymphoma [NICE guidance].
Certolizumab pegol for treating moderate to severe plaque psoriasis [NICE guidance].
Daratumumab with bortezomib and dexamethasone for previously treated multiple myeloma [NICE guidance].
Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1 [MHRA/CHM advice] (see elvitegravir with cobicistat, emtricitabine and tenofovir alafenamide).
Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1 [MHRA/CHM advice] (see elvitegravir with cobicistat, emtricitabine and tenofovir disoproxil).
Gabapentin (Neurontin®) and risk of abuse and dependence: new scheduling requirements from 1 April [MHRA/CHM advice].
Immunisation schedule: updated National flu immunisation programme in-line with Public Health England recommendations.
Influenza vaccine: updated guidance in-line with Public Health England recommendations.
Malaria, prophylaxis: updated country recommendations in the Recommended regimens for prophylaxis against malaria in-line with Public Health England.
Malaria, prophylaxis: updated guidance in-line with Public Health England recommendations.
Pregabalin (Lyrica®) and risk of abuse and dependence: new scheduling requirements from 1 April [MHRA/CHM advice].
Quinolones: new MHRA/CHM advice on restrictions and precautions for use of fluoroquinolone antibiotics.
Renal and ureteric stones: new guidance on management.
Respiratory system infections, antibacterial therapy: new guidance on management of Cough, acute.
Tildrakizumab for treating moderate to severe plaque psoriasis [NICE guidance].
Tofacitinib (Xeljanz®): increased risk of pulmonary embolism and mortality in rheumatoid arthritis patients receiving 10 mg twice daily in a clinical trial [MHRA/CHM advice].
Valproate medicines and serious harms in pregnancy: new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme [MHRA/CHM advice] (see sodium valproate and valproic acid).
Yellow fever vaccine, live (Stamaril®) and fatal adverse reactions: extreme caution needed in people who may be immunosuppressed [MHRA/CHM advice].
Yellow fever vaccine, live (Stamaril®) and fatal adverse reactions: extreme caution needed in those aged 60 years and older [MHRA/CHM advice].

Dose Changes:

Malarone® (atovaquone with proguanil hydrochloride) [update to weight range for prophylaxis of falciparum malaria].

New Preparations: Delstrigo® [lamivudine with tenofovir disoproxil and doravirine], Intrarosa® [prasterone], Pifeltro® [doravirine], Testavan® [testosterone].

For further details on changes in the BNF click on http://www.medicinescomplete.com/mc/bnf/current/PHP107699-changes.htm

14 May

BNF May 2019 Update

This update contains 11 significant changes, 1 dose changes and 5 new preparations.

See details

Significant Changes: 

Benralizumab for treating severe eosinophilic asthma [NICE guidance].
Brigatinib for treating ALK-positive advanced non-small-cell lung cancer after crizotinib [NICE guidance].
Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes [NICE guidance].
Fluoroquinolone antibiotics (ciprofloxacin): new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects [MHRA/CHM advice].
Fluoroquinolone antibiotics (levofloxacin, moxifloxacin, ofloxacin): new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects [MHRA/CHM advice].
Irinotecan hydrochloride, liposomal formulations (Onivyde®): reports of serious and fatal thromboembolic events [MHRA/CHM advice].
Pertuzumab for adjuvant treatment of HER2-positive early stage breast cancer [NICE guidance].
Pneumococcal vaccine: updated guidance in-line with Public Health England recommendations.
Prescribing in pregnancy: medicines with teratogenic potential: what is effective contraception and how often is pregnancy testing needed? [MHRA/CHM advice].
Respiratory system infections, antibacterial therapy: new guidance for acute exacerbations of Bronchiectasis (non-cystic fibrosis
Respiratory system infections, antibacterial therapy: updated guidance for acute exacerbations of Chronic obstructive pulmonary disease.

Dose Changes:

Alirocumab [Dosing options for Primary hypercholesterolaemia or mixed dyslipidaemia].

New Preparations: Buvidal® [buprenorphine], Erleada® [apalutamide], Fortacin® [lidocaine with prilocaine], Symkevi® [tezacaftor with ivacaftor], Tegsedi® [inotersen].

For further details on changes in the BNF click on http://www.medicinescomplete.com/mc/bnf/current/PHP107699-changes.htm

09 Apr

BNF April 2019 Update

This update contains 10 significant changes, 1 dose change and 5 new preparations.

See details

Significant Changes: 

Abemaciclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer [NICE guidance].
Carbimazole: increased risk of congenital malformations; strengthened advice on contraception [MHRA/CHM advice].
Carbimazole: risk of acute pancreatitis [MHRA/CHM advice].
Controlled drugs and drug dependence: reclassification of gabapentin and pregabalin as Class C and Schedule 3 Controlled Drugs. Note: Preparation records containing pregabalin (BNF only) or gabapentin may not display a CD3 symbol for the April 2019 monthly update but will be amended in due course.
Encorafenib and binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma [NICE guidance].
Epilepsy inclusion of guidance for the management of Dravet syndrome and Lennox-Gastaut syndrome.
Olaratumab (Lartruvo®): no new patients to be prescribed due to study showing no clinical benefit [MHRA/CHM advice].
SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin): reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) [MHRA/CHM advice].
Venetoclax with rituximab for previously treated chronic lymphocytic leukaemia [NICE guidance].
Yellow fever vaccine: updated guidance in-line with Public Health England recommendations.

Dose Changes:

Rivaroxaban [clarification of dosing options for prophylaxis of recurrent deep-vein thrombosis and pulmonary embolism].

New Preparations: Cidofovir, Diacomit® [stiripentol], Namuscla® [mexiletine], Prevymis® [letermovir], Suliqua® [insulin glargine with lixisenatide].

For further details on changes in the BNF click on: http://www.medicinescomplete.com/mc/bnf/current/PHP107699-changes.htm

12 Mar

BNF March 2019 update

This update contains 16 significant changes, 5 dose changes and 3 new preparations.

See details

Significant Changes:  

Anthrax vaccine: updated guidance in-line with Public Health England recommendations.
Attention deficit hyperactivity disorder: updated guidance on management.
Breast cancer: updated guidance on management.
Cholera vaccine: updated guidance in-line with Public Health England recommendations.
Chronic heart failure: updated guidance on management.
Heavy menstrual bleeding: updated recommendations for the use of ulipristal acetate.
Ipilimumab (Yervoy®): reports of cytomegalovirus (CMV) gastrointestinal infection or reactivation [MHRA/CHM advice].
Japanese encephalitis vaccine: updated guidance in-line with Public Health England recommendations.
Lenvatinib for untreated advanced hepatocellular carcinoma [NICE guidance].
Methotrexate: updated recommendations for conception and contraception.
Nivolumab for adjuvant treatment of completely resected melanoma with lymph node involvement or metastatic disease [NICE guidance].
Pembrolizumab for adjuvant treatment of resected melanoma with high risk of recurrence [NICE guidance].
Pembrolizumab with pemetrexed and platinum chemotherapy for untreated, metastatic, non-squamous non-small-cell lung cancer [NICE guidance].
Regorafenib for previously treated advanced hepatocellular carcinoma [NICE guidance].
Tapentadol (Palexia®): risk of seizures and reports of serotonin syndrome when co-administered with other medicines [MHRA/CHM advice].
Typhoid vaccine: updated guidance in-line with Public Health England recommendations.

Dose Changes:

Adalimumab [maintenance dosing updated].
Anthrax vaccine [dosing schedule updated].
Imipenem with cilastatin [dosing recommendation in renal impairment updated].
Japanese encephalitis vaccine [dosing schedule updated].
Pembrolizumab [dose for non-small cell lung cancer (following prior chemotherapy) and melanoma].

New Preparations: Alunbrig® [brigatinib], Ozempic® [semaglutide], Steglatro® [ertugliflozin].

For further details on changes in the BNF click on http://www.medicinescomplete.com/mc/bnf/current/PHP107699-changes.htm

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