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Publication Updates

14 Aug
British National Formulary logo
BNF August 2018 update

This update contains 18 significant changes, 3 new preparations and 9 dose changes. 

Significant Changes:  

  • Age-related macular degeneration: updated guidance on management.
  • Arsenic trioxidefor treating acute promyelocytic leukaemia [NICE guidance]. 
  • Atezolizumabfor treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy [NICE guidance]. 
  • Brentuximab vedotinfor treating CD30-positive Hodgkin lymphoma [NICE guidance]. 
  • Cardiovascular disease risk assessment and prevention: updated guidance.
  • Denosumab(Xgeva®) for advanced malignancies involving bone: study data show new primary malignancies reported more frequently compared to zoledronate [MHRA/CHM advice]. 
  • Denosumab(Xgeva®) for giant cell tumour of bone: risk of clinically significant hypercalcaemia following discontinuation [MHRA/CHM advice]. 
  • Diabetic complications: updated guidance.
  • Dolutegravir(Tivicay®, Triumeq®, Juluca®): signal of increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception [MHRA/CHM advice]. 
  • Donepezil hydrochloride, galantamine, rivastigmine, and memantine hydrochloridefor the treatment of Alzheimer’s disease [NICE guidance]. 
  • Dyslipidaemias: updated guidance on familial hypercholesterolaemia.
  • Glaucoma and ocular hypertension: updated guidance on management.
  • Guselkumabfor treating moderate to severe plaque psoriasis [NICE guidance]. 
  • Lynparza® (olaparib): risk of medication errors with new pharmaceutical form [MHRA/CHM advice].
  • Midostaurinfor untreated acute myeloid leukaemia [NICE guidance]. 
  • Oropharyngeal infections, antibacterial therapy: updated guidance on sore throat (acute).
  • Pembrolizumabfor untreated locally advanced or metastatic urothelial cancer when cisplatin is unsuitable [NICE guidance]. 
  • Vaccines: updated guidance for Meningococcal group B vaccines.

Dose Changes: 

  • Canakinumab.
  • Ceritinib[dose and directions for administration]. 
  • Ciclosporin[rheumatoid arthritis indication and dose]. 
  • Collagenase[dosing statement for Dupuytren’s contracture]. 
  • Ferric maltol[indication]. 
  • Haloperidol.
  • Haloperidol decanoate.
  • Mometasone furoate[prophylaxis and treatment of seasonal allergic or perennial rhinitis— age range extended in children]. 
  • Vancomycin[deletion of the statement recommending the use of ideal body-weight to calculate intravenous doses in obese patients]. 

New PreparationsJuluca® [dolutegravir with rilpivirine], Kelhale® [beclometasone dipropionate], Lynparza® tablets [olaparib]. 

For further details on changes in the BNF click on 

10 Jul
British National Formulary logo
BNF July 2018 update

This update contains 7 significant changes, 2 new preparations and 7 dose changes. 

Significant Changes: 

  • Atezolizumab for treating locally advanced or metastatic non-small-cell lung cancer after chemotherapy [NICE guidance].
  • Avelumab for treating metastatic Merkel cell carcinoma [NICE guidance].
  • Braltus® (tiotropium): risk of inhalation of capsule if placed in the mouthpiece of the inhaler [MHRA/CHM advice].
  • Daclizumab (Zinbryta®) — marketing authorisation withdrawn for safety reasons.
  • Pembrolizumab for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy [NICE guidance].
  • Tivicay® (dolutegravir), Triumeq® (dolutegravir, abacavir, lamivudine), Juluca® (dolutegravir, rilpivirine): neural tube defects reported in infants born to women exposed to dolutegravir at the time of conception [MHRA/CHM advice].
  • Tocilizumab for treating giant cell arteritis [NICE guidance].

Dose Changes:

  • Amitriptyline hydrochloride [doses for depression, neuropathic pain and migraine prophylaxis].
  • Ganciclovir.
  • Ivabradine.
  • Macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride.
  • Sildenafil Digital ulcers associated with systemic sclerosis [unlicensed].
  • Tadalafil [clarification of dosing for intermittent use in erectile dysfunction and dosing in hepatic and renal impairment].
  • Vancomycin.

New Preparations: Mylotarg® [gemtuzumab ozogamicin], Synagis® [palivizumab]

For further details on changes in the BNF click on

11 Jun
British National Formulary logo
BNF June 2018 update

This update contains 11 significant changes, 5 new preparations and 6 dose changes. 

Significant Changes:

Asthma, chronic: updated guidance on management.
Brodalumab for treating moderate to severe plaque psoriasis [NICE guidance]
Cabozantinib for treating medullary thyroid cancer [NICE guidance].
Eribulin for treating locally advanced or metastatic breast cancer after 1 chemotherapy regimen [NICE guidance].
Immunoglobulins: updated guidance for Varicella-zoster immunoglobulin.
Obeticholic acid (Ocaliva®): risk of serious liver injury in patients with pre-existing moderate or severe hepatic impairment; reminder to adjust dosing according to liver function monitoring [MHRA/CHM advice].
Obinutuzumab for untreated advanced follicular lymphoma [NICE guidance].
Quinine: clarification of parenteral dose for the treatment of malaria [dose reduction necessary if parenteral treatment is required for more than 48 hours].
Regorafenib for previously treated advanced hepatocellular carcinoma [NICE guidance].
Vaccines: updated guidance for Hepatitis A Vaccine.
Vaccines for travel: updated guidance on Hepatitis A.

Dose changes:

Bosutinib [update to dose in renal impairment].
Candesartan cilexetil [clarification of maximum daily dose in heart failure].
Haloperidol [clarification of continuous subcutaneous dose for nausea and vomiting in palliative care].
Nivolumab [doses for monotherapy].

New Preparations:

AirFluSal® preparations [fluticasone with salmeterol], Fasenra® [benralizumab], Hemlibra® preparations [tocilizumab], Rydapt® [midostaurin].

For further details on changes in the BNF click on changes.

14 May
British National Formulary logo
BNF May 2018 update

This update contains 15 significant changes, 7 new preparations and 6 dose changes

Significant Changes:

  • Alendronic acid, ibandronic acid, risedronate sodium and zoledronic acid for treating osteoporosis [updated NICE guidance].
  • Cystic fibrosis: updated guidance.
  • Daratumumab monotherapy for treating relapsed and refractory multiple myeloma [NICE guidance].
  • Esmya® (ulipristal acetate) for uterine fibroids: do not initiate or re-start treatment; monitor liver function in current and recent users [MHRA/CHM advice].
  • Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma [NICE guidance].
  • Noradrenaline/norepinephrine 0.08 mg/mL (4 mg in 50 mL) solution for infusion association with potential risk of medication errors.
  • Osteoporosis: updated guidance.
  • Pertuzumab with trastuzumab and docetaxel for treating HER2-positive breast cancer [NICE guidance].
  • Pirfenidone for treating idiopathic pulmonary fibrosis [NICE guidance].
  • Raloxifene hydrochloride and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women [updated NICE guidance].
  • Raloxifene hydrochloride for the primary prevention of osteoporotic fragility fractures in postmenopausal women [updated NICE guidance].
  • Skin infections: head lice eradication products: risk of serious burns if treated hair is exposed to open flames or other sources of ignition [MHRA/CHM advice].
  • Sofosbuvir with velpatasvir and voxilaprevir for treating chronic hepatitis C [NICE guidance].
  • Terbinafine: clarification of hepatic monitoring advice.
  • Valproic acid and sodium valproate: valproate medicines contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met [MHRA/CHM advice].

Dose Changes:

  • Abatacept [update to dosing advice].
  • Daptomycin [update to dosing advice].
  • Levonorgestrel [update to effective duration for Levosert® intra-uterine device].
  • Levonorgestrel [update to timing for emergency contraception].
  • Nilotinib [update to dosing advice].
  • Sodium thiosulfate.

New Preparations:

Cetraxal ® [ciprofloxacin ear drops], Chenodeoxycholic acid [chenodeoxycholic acid capsules], Kyleena ® [levonorgestrel intrauterine device], NACSYS ® [acetylcysteine effervescent tablets], Skudexa ® [tramadol with dexketoprofen], Testogel ® 16.2 mg [testosterone gel], Xylonor ® [lidocaine with cetrimide].

For further details on changes in the BNF click on changes.

10 Apr
British National Formulary logo
BNF April 2018 update

This update contains 10 significant changes, 3 new preparations and 4 dose changes. 

Significant Changes:

  • Ceritinib for untreated ALK-positive non-small-cell lung cancer [NICE guidance].
  • Daclizumab (Zinbryta®) suspension and recall for safety reasons; review patients as soon as possible and start alternative therapy [MHRA/CHM advice].
  • Fulvestrant for untreated locally advanced or metastatic oestrogen-receptor positive breast cancer [NICE guidance].
  • Glecaprevir with pibrentasvir for treating chronic hepatitis C [NICE guidance].
  • Golimumab for treating non-radiographic axial spondyloarthritis [NICE guidance].
  • Ibrutinib for treating relapsed or refractory mantle cell lymphoma [NICE guidance].
  • Lenvatinib with everolimus for previously treated advanced renal cell carcinoma [NICE guidance].
  • Malaria, prophylaxis: update to country recommendations and guidance.
  • Mycophenolate mofetil, mycophenolic acid: updated contraception advice for male patients [MHRA/CHM advice].
  • Sinusitis (acute): updated guidance.

Dose Changes:

  • Alprostadil [Initial dose for erectile dysfunction and neurogenic erectile dysfunction for Viridal® Duo].
  • Hydroxycarbamide.
  • Lacosamide.
  • Papaveretum [clarification of dosing].

New Preparations: Fotivda® [tivozanib], Ocrevus ® [ocrelizumab], Plenvu® [Macrogol 3350 with anhydrous sodium sulfate, ascorbic acid, potassium chloride, sodium ascorbate and sodium chloride]

For further details on changes in the BNF click on changes

13 Mar
British National Formulary logo
BNF March 2018 update

This update contains 9 significant changes, 3 new preparations and 7 dose changes

Significant Changes:

  • Attention deficit hyperactivity disorder: updated guidance on management.
  • Cladribine tablets for treating relapsing-remitting multiple sclerosis [NICE guidance].
  • Daclizumab (Zinbryta®) and risk of severe liver injury: new restrictions to use and strengthened liver monitoring [MHRA/CHM advice].
  • Drug name confusion: reminder to be vigilant for potential errors between clobazam and clonazepam, atenolol and amlodipine, propranolol and prednisolone, risperidone and ropinirole, sulfadiazine and sulfasalazine, amlodipine and nimodipine, mercaptamine and mercaptopurine, zuclopentixol acetate and zuclopentixol decanoate [MHRA/CHM advice].
  • Emergency contraception: updated guidance on management.
  • Naltrexone with bupropion for managing overweight and obesity [NICE guidance].
  • Palbociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER-2 negative, locally advanced or metastatic breast cancer [NICE guidance].
  • Recombinant human erythropoietins (epoetin alfa, epoetin beta, epoetin zeta, darbepoetin alfa, methoxy polyethylene glycol-epoetin): very rare risk of severe cutaneous adverse reactions [MHRA/CHM advice].
  • Ribociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer [NICE guidance].

Dose Changes:

  • Budesonide [alternative dosing regimen for Crohn’s disease updated for Budenofalk® capsules].
  • Chloroquine [clarification of dose equivalence statement].
  • Chloroquine [clarification of dosing for rheumatoid arthritis, systemic and discoid lupus erythematosus].
  • Clomifene citrate [clarification of dosing].
  • Gentamicin [clarification of dosing for surgical prophylaxis, including joint replacement surgery].
  • Olaparib [dose in renal impairment].
  • Tramadol with paracetamol [clarification of dosing].

New Preparations: Tremfya® [guselkumab], Vemlidy® [tenofovir alafenamide], Zejula® [niraparib]

For further details on changes in the BNF click on changes

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