British National Formulary - MedicinesComplete

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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Publication Updates

11 Dec

BNF December 2018 update

This update contains 7 significant changes, 13 dose changes and 3 new preparations.

See details

Significant Changes: 

Cabozantinib for untreated advanced renal cell carcinoma [NICE guidance]
Dabrafenib with trametinib for adjuvant treatment of resected BRAF V600 mutation-positive melanoma [NICE guidance].
Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura [NICE guidance].
Lyme disease: updated guidance on management.
Rheumatoid arthritis: updated guidance on management.
Romiplostim for the treatment of chronic immune (idiopathic) thrombocytopenic purpura [NICE guidance].
Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs [NICE guidance].

Dose Changes:

Amoxicillin [update to indications and doses for Lyme Disease].
Azithromycin [update to indication and doses for Lyme Disease].
Ceftriaxone [update to indications and doses for Lyme Disease].
Chloral hydrate [dose for insomnia using Chloral Mixture, BP 2000 deleted as preparation no longer available].
Clarithromycin [dosing recommendation for Lyme Disease deleted in line with updated guidance].
Dabigatran etexilate [update to duration for prophylaxis of venous thromboembolism following hip or knee surgery].
Dabigatran etexilate [update to initial dose for prophylaxis of venous thromboembolism following hip or knee surgery in patients receiving concomitant treatment with amiodarone or verapamil].
Doxycycline [update to indications and doses for Lyme Disease].
Erythromycin [dosing recommendation for Lyme Disease deleted in line with updated guidance].
Gabapentin [clarification of dosing in renal impairment].
Influenza vaccine [update to indication of annual immunisation against seasonal influenza (for children in clinical risk groups who have not received seasonal influenza vaccine previously)].
Roflumilast [initial dosing recommendation].
Tapentadol [update to dose adjustments in hepatic impairment].

New Preparations: Aimovig® [erenumab]; Rubraca® [rucaparib]; Vyxeos® [daunorubicin with cytarabine].

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

13 Nov

BNF November 2018 update

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

See details

Significant Changes: 

Dementia: updated guidance on management.
Inotuzumabozogamicin for treating relapsed or refractory B-cell acute lymphoblastic leukaemia [NICE guidance].
Pembrolizumab for treating relapsed or refractory classical Hodgkin lymphoma [NICE guidance].
Ponatinib (Iclusig®): reports of posterior reversible encephalopathy syndrome [MHRA/CHM advice].
Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure, particularly in children [MHRA/CHM advice].

Dose Changes:

Levonorgestrel [update to timings of administration of intra-uterine devices and advice on additional contraceptive precautions].
Tolvaptan (Jinarc®) [update to indication and addition of dosing recommendations for use with potent and moderate CYP3A4 inhibitors].
Tolvaptan (Samsca®) [option of reduced starting dose for patients at risk of overly rapid correction of serum-sodium concentration].

New Preparations: Senshio® [ospemifene]; Xonvea® [doxylamine with pyridoxine]; Zanosar® [streptozocin].

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

08 Oct

BNF October 2018 update

This update contains 9 significant changes, 2 dose changes and 4 new preparations.

See details

Significant Changes:

Side-effects and their further information sections have been reviewed against the current product literature and terms used to define these have been standardised across all drug monographs for this update.
Alectinib for untreated ALK-positive advanced non-small-cell lung cancer [NICE guidance] (BNF only).
Dinutuximab beta for treating neuroblastoma [NICE guidance].
Dupilumab for treating moderate to severe atopic dermatitis [NICE guidance] (BNF only).
Ear, Ear infections, antibacterial therapy: updated guidance on management of otitis media.
Heavy menstrual bleeding: updated guidance on management.
Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs [NICE guidance] (BNF only).
Lenvatinib and sorafenib for treating differentiated thyroid cancer after radioactive iodine [NICE guidance] (BNF only).
Nusinersen (Spinraza®): reports of communicating hydrocephalus not related to meningitis or bleeding [MHRA/CHM advice].

Dose Changes:

Golimumab [maintenance dose for patients with ulcerative colitis and body-weight less than 80␣kg] (BNF only).
Rufinamide [update to age range for use in children and dosing information for use with valproate].

New Preparations: Biktarvy® [bictegravir with emtricitabine and tenofovir alafenamide] (BNF only); Diclofenac mouthwash [diclofenac] (BNF only); Elmiron® [pentosane polysulfate sodium] (BNF only); Qarziba® [dinutuximab beta].

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

14 Sep

BNF September 2018 update

This update contains 16 significant changes and 6 dose changes.

See details

Significant Changes:

Atezolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable [NICE guidance].
Cenegermin for treating neurotrophic keratitis [NICE guidance].
Crizotinib for treating ROS1-positive advanced non-small-cell lung cancer [NICE guidance].
Darunavir boosted with cobicistat (darunavir with cobicistat): avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1 [MHRA/CHM advice].
Darunavir boosted with cobicistat (darunavir with cobicistat, emtricitabine and tenofovir alafenamide): avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1 [MHRA/CHM advice].
Eltrombopag (Revolade®): reports of interference with bilirubin and creatinine test results [MHRA/CHM advice].
Interferon beta and glatiramer acetate for treating multiple sclerosis [NICE guidance].
Niraparib for maintenance treatment of relapsed, platinum-sensitive ovarian, fallopian tube and peritoneal cancer [NICE guidance].
Nivolumab for treating locally advanced unresectable or metastatic urothelial cancer after platinum-containing chemotherapy [NICE guidance].
Ocrelizumab for treating relapsing–remitting multiple sclerosis [NICE guidance].
Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused [MHRA/CHM advice].
Pembrolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable [NICE guidance].
Pembrolizumab for untreated PD-L1-positive metastatic non-small-cell lung cancer [NICE guidance].
Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects [MHRA/CHM advice], see Respiratory system, drug delivery.
Stable angina: updated guidance on management.
Ulipristal acetate (Esmya®) for symptoms of uterine fibroids: restrictions to use and requirement to check liver function before, during and after treatment [MHRA/CHM advice].
Venous thromboembolism: updated guidance on prophylaxis.Dose Changes:
Anakinra [dosing in severe renal impairment].
Dasatinib [addition of information on dose adjustment due to side-effects].
Esmya® (ulipristal acetate) [dosing information for pre-operative treatment of moderate to severe symptoms of uterine fibroids].
Hexetidine [update to age-range for use in children].
Hydroxocobalamin [frequency of maintenance dosing for macrocytic anaemia without neurological involvement].
Hydroxocobalamin [frequency of maintenance dosing for pernicious anaemia without neurological involvement].

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

14 Aug

BNF August 2018 update

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

See details

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 Preparations: Juluca® [dolutegravir with rilpivirine], Kelhale® [beclometasone dipropionate], Lynparza® tablets [olaparib].

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

10 Jul

BNF July 2018 update

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

See details

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 http://www.medicinescomplete.com/mc/bnf/current/PHP107699-changes.htm

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