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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Publication Updates

10 Nov

British National Formulary November 2020 Update

This update contains 29 significant changes, 4 dose changes, 7 new monographs and 2 new preparations.

See details

Significant Changes:

Andexanet alfa for adults treated with apixaban or rivaroxaban when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding [SMC guidance].
Avelumab with axitinib for untreated advanced renal cell carcinoma [NICE guidance].
Bedaquiline in combination regimen for multiple-drug resistant pulmonary tuberculosis [AWMSG guidance].
Brolucizumab for the treatment of adults with neovascular (wet) age-related macular degeneration [SMC guidance].
Cannabidiol with clobazam for therapy of seizures associated with Dravet syndrome [SMC guidance].
Cannabidiol with clobazam for therapy of seizures associated with Lennox-Gastaut syndrome [SMC guidance].
Caplacizumab for the treatment of adults with acquired thrombotic thrombocytopenic purpura [SMC guidance].
Doravirine in combination with other antiretroviral drugs for the treatment of adults infected with HIV-1 [AWMSG guidance].
Esketamine for adults with treatment-resistant major depressive disorder [SMC guidance].
Fentanyl transdermal patches for non-cancer pain: do not use in opioid-naive patients [MHRA/CHM advice].
Fluocinolone acetonide for prevention of relapse in recurrent non-infectious uveitis affecting the posterior segment of the eye [SMC guidance].
Gilteritinib for the treatment of adults who have relapsed or refractory acute myeloid leukaemia with a FLT3 mutation [SMC guidance].
Immunoglobulins: updated guidance on the use of varicella-zoster immunoglobulin in-line with Public Health England recommendations.
Insulins (all types): risk of cutaneous amyloidosis at injection site [MHRA/CHM advice] (advice in biphasic insulin aspart, biphasic insulin lispro, biphasic isophane insulin, insulin, insulin aspart, insulin degludec, insulin detemir, insulin glargine, insulin glulisine, insulin lispro, isophane insulin; see example in insulin).
Lamivudine with tenofovir disoproxil and doravirine for the treatment of adults infected with HIV-1 [AWMSG guidance].
Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing [MHRA/CHM advice].
Naldemedine for treating opioid-induced constipation [NICE guidance].
Opioids: risk of dependence and addiction [MHRA/CHM advice] (advice in alfentanil, buprenorphine, co-codamol, codeine phosphate, co-phenotrope, diamorphine hydrochloride, dihydrocodeine tartrate, fentanyl, hydromorphone hydrochloride, kaolin with morphine, meptazinol, methadone hydrochloride, morphine, oxycodone hydrochloride, pentazocine, pethidine hydrochloride, remifentanil, tapentadol, tramadol hydrochloride; see example in morphine).
Osteoporosis: updated guidance on management.
Pembrolizumab for the treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma [SMC guidance].
Pembrolizumab with axitinib for first-line treatment of advanced renal cell carcinoma [SMC guidance].
Pembrolizumab with axitinib for untreated advanced renal cell carcinoma [NICE guidance].
Pertuzumab in combination with trastuzumab and chemotherapy for the treatment of adults with HER2-positive early breast cancer [SMC guidance].
Poisoning, emergency treatment: updated guidance on the management of paracetamol poisoning in-line with TOXBASE recommendations.
Polatuzumab vedotin with rituximab and bendamustine for the treatment of relapsed or refractory diffuse large B-cell lymphoma [NICE and SMC guidance].
Semaglutide (Rybelsus®▼) for the treatment of adults with insufficiently controlled type 2 diabetes mellitus [SMC guidance].
Sodium zirconium cyclosilicate for the treatment of adults with hyperkalaemia [SMC guidance].
Steroid Emergency Card to support early recognition and treatment of adrenal crisis in adults [NHS Improvement Patient Safety Alert] (advice in alclometasone dipropionate, beclometasone dipropionate, benzyl benzoate with bismuth oxide, bismuth subgallate, hydrocortisone acetate, peru balsam and zinc oxide, betamethasone, budesonide, ciclesonide, cinchocaine hydrochloride with fluocortolone caproate and fluocortolone pivalate, cinchocaine with prednisolone, ciprofloxacin with fluocinolone acetonide, clobetasol propionate, clobetasone butyrate, deflazacort, dexamethasone, diflucortolone valerate, fludrocortisone acetate, fludroxycortide, flumetasone pivalate with cliquinol, fluocinolone acetonide, fluocinonide, fluorometholone, fluticasone, gentamicin with hydrocortisone, hydrocortisone, hydrocortisone butyrate, hydrocortisone with lidocaine, hydrocortisone with pramocaine, loteprednol etabonate, methylprednisolone, mometasone furoate, prednisolone, triamcinolone acetonide, triamcinolone hexacetonide; see example in dexamethasone).
Varicella-zoster vaccine: updated guidance in-line with Public Health England recommendations.

Dose Changes:

Avelumab [dosing information updated].
Escitalopram [elderly dosing for panic disorder updated].
Mercaptamine [update to dosing for nephropathic cystinosis].
Pembrolizumab [dosing information updated].

New Monographs:

Daurismo® [glasdegib].
Fetcroja® [cefiderocol].
Kaftrio® [tezacaftor with ivacaftor and elexacaftor].
Nilemdo® [bempedoic acid].
Nustendi® [bempedoic acid with ezetimibe].
Piqray® [alpelisib].
Sunosi® [solriamfetol].

New Preparations: Remsima® solution for injection in pre-filled pens or syringes [infliximab]; Rybelsus®▼ [semaglutide].

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

13 Oct

British National Formulary October 2020 Update

This update contains 29 significant changes, 5 dose changes, 2 new monographs and 1 new preparation.

See details

Significant Changes:

Amisulpride: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity [MHRA/CHM advice].
Aripiprazole: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity [MHRA/CHM advice].
Baricitinib (Olumiant®▼): increased risk of diverticulitis, particularly in patients with risk factors [MHRA/CHM advice].
Bisacodyl: Stimulant laxatives (bisacodyl, senna and sennosides, sodium picosulfate) available over-the-counter: new measures to support safe use [MHRA/CHM advice].
Brentuximab vedotin in combination for untreated systemic anaplastic large cell lymphoma [NICE guidance].
Cariprazine for the treatment of schizophrenia [AWMSG guidance].
Clozapine: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity [MHRA/CHM advice].
Denosumab 60 mg (Prolia®): increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment [MHRA/CHM advice].
Entrectinib for treating NTRK fusion-positive solid tumours [NICE guidance].
Entrectinib for treating ROS1-positive advanced non-small-cell lung cancer [NICE guidance].
Gilteritinib for treating relapsed or refractory acute myeloid leukaemia [NICE guidance].
Hydroxycarbamide for the prevention of vaso-occlusive complications of sickle-cell disease in patients over 2 years of age [AWMSG guidance].
Hydroxycarbamide for the prevention of vaso-occlusive complications of sickle-cell disease in patients over 2 years of age [SMC guidance].
Immunisation schedule: updated National flu immunisation programme in-line with Public Health England recommendations.
Influenza: updated guidance on management.
Influenza vaccine: updated guidance in-line with Public Health England recommendations.
Isotretinoin (Roaccutane®▼): reminder of important risks and precautions [MHRA/CHM advice].
Neratinib for the extended adjuvant treatment of adult patients with early-stage hormone receptor positive HER2-overexpressed/amplified breast cancer [SMC guidance].
Olanzapine: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity [MHRA/CHM advice].
Olanzapine embonate: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity [MHRA/CHM advice].
Quetiapine: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity [MHRA/CHM advice].
Risperidone: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity [MHRA/CHM advice].
Senna: Stimulant laxatives (bisacodyl, senna and sennosides, sodium picosulfate) available over-the-counter: new measures to support safe use [MHRA/CHM advice].
Sodium picosulfate: Stimulant laxatives (bisacodyl, senna and sennosides, sodium picosulfate) available over-the-counter: new measures to support safe use [MHRA/CHM advice].
Sulpiride: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity [MHRA/CHM advice].
Tick-borne encephalitis vaccine: updated guidance in-line with Public Health England recommendations.
Treosulfan with fludarabine for malignant disease before allogeneic stem cell transplant [NICE guidance].
Vedolizumab for the treatment of adults with moderately to severely active Crohn’s disease [SMC guidance].
Vedolizumab for the treatment of adults with moderately to severely active ulcerative colitis [SMC guidance].

Dose Changes:

Gaviscon infant® (alginic acid) [update to dosing for management of gastro-oesophageal reflux disease].
Influenza vaccine [update to dosing for immunisation].
Isotretinoin [indication updated].
Oseltamivir [update to dosing for treatment and prevention of influenza].
Zanamivir [update to dosing for treatment of influenza].

New Monographs:

Recarbrio® [imipenem with cilastatin and relebactam].
Rozlytrek® [entrectinib].

New Preparation: Trecondi® [treosulfan].

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

08 Sep

British National Formulary September 2020 Update

This update contains 29 significant changes, 5 dose changes and 4 new monographs.

See details

Significant Changes:
• Aflibercept: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Amphotericin: name change to amphotericin B.
• Amphotericin B: Liposomal and lipid-complex formulations: name change to reduce medication errors [MHRA/CHM advice].
• Andexanet alfa (Ondexxya®): Commercial anti-FXa activity assays are unsuitable for measuring anti-FXa activity following administration of andexanet alfa [MHRA/CHM advice].
• Atezolizumab (Tecentriq®) with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer [NICE guidance].
• Atezolizumab (Tecentriq®) with nab-paclitaxel for untreated PD-L1-positive, locally advanced or metastatic, triple-negative breast cancer [NICE guidance].
• Axitinib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Bevacizumab: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• BNF updates for Community Practitioner Nurse Prescribers: For BNF app and online versions of the BNF – list of medicinal preparations (renamed as Approved list for prescribing by Community Practitioner Nurse Prescribers (NPF)) updated with indications for use by Community Practitioner Nurse Prescribers and links to BNF monographs; general guidance and treatment summaries for use by Community Practitioner Nurse Prescribers have also been added. For BNF print editions – list of medicinal preparations (Nurse Prescribers’ Formulary (NPF)) updated with indications for use by Community Practitioner Nurse Prescribers and cross-references to BNF monographs. For further information, see How to use the NPF above the list of medicinal preparations.
• Cabozantinib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Capecitabine: Fluorouracil (i.v.), capecitabine and tegafur containing products: Pre-treatment testing to identify DPD-deficient patients at increased risk of severe and fatal toxicity [MHRA/CHM advice].
• Cytarabine: Liposomal and lipid-complex formulations: name change to reduce medication errors [MHRA/CHM advice].
• Daunorubicin: Liposomal and lipid-complex formulations: name change to reduce medication errors [MHRA/CHM advice].
• Daunorubicin with cytarabine: Liposomal and lipid-complex formulations: name change to reduce medication errors [MHRA/CHM advice].
• Doxorubicin hydrochloride: Liposomal and lipid-complex formulations: name change to reduce medication errors [MHRA/CHM advice].
• Flucytosine: Updated recommendations for the use in patients with dihydropyrimidine dehydrogenase (DPD) deficiency [MHRA/CHM advice].
• Fluorouracil: Fluorouracil (i.v.), capecitabine and tegafur containing products: Pre-treatment testing to identify DPD-deficient patients at increased risk of severe and fatal toxicity [MHRA/CHM advice].
• Irinotecan hydrochloride: Liposomal and lipid-complex formulations: name change to reduce medication errors [MHRA/CHM advice].
• Lenvatinib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Nintedanib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Pazopanib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Ponatinib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Ramucirumab: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Regorafenib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Sorafenib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Sunitinib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Tegafur with gimeracil and oteracil: Fluorouracil (i.v.), capecitabine and tegafur containing products: Pre-treatment testing to identify DPD-deficient patients at increased risk of severe and fatal toxicity [MHRA/CHM advice].
• Tivozanib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].
• Vandetanib: Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection [MHRA/CHM advice].

Dose Changes:
• Cefixime [update to dosing for uncomplicated gonorrhoea].
• Ofloxacin [update to dosing for complicated skin and soft-tissue infections].
• Ofloxacin [update to dosing for complicated urinary-tract infections].
• Ofloxacin [update to dosing for lower respiratory-tract infections].
• Ofloxacin [update to dosing for urinary-tract infections].

New Monographs:
• Cefazolin.
• Quofenix® [delafloxacin].
• Sarclisa® [isatuximab].
• Veklury® [remdesivir].

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

11 Aug

British National Formulary August 2020 Update

This update contains 13 significant changes, 8 dose changes, 1 new monograph, 2 new preparations, and 3 deleted monographs.

See details

Significant Changes:

Apixaban: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents [MHRA/CHM advice].
Cyproterone acetate: new advice to minimise risk of meningioma [MHRA/CHM advice].
Dabigatran etexilate: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents [MHRA/CHM advice].
Edoxaban: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents [MHRA/CHM advice].
Emtricitabine with tenofovir disoproxil for pre-exposure prophylaxis to reduce the risk of sexually acquired HIV-1 infection [AWMSG guidance].
Fremanezumab for preventing migraine [NICE guidance].
Genital system infections, antibacterial therapy: updated guidance for the management of uncomplicated gonorrhoea.
Ketotifen for the symptomatic treatment of seasonal allergic conjunctivitis [AWMSG guidance].
Rivaroxaban: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents [MHRA/CHM advice].
Smallpox vaccine: updated guidance in-line with Public Health England recommendations.
Trastuzumab emtansine for adjuvant treatment of HER2-positive early breast cancer [NICE guidance].
Ustekinumab for treating moderately to severely active ulcerative colitis [NICE guidance].
Venous thromboembolism: updated guidance for the treatment of venous thromboembolism.

Dose Changes:

Atovaquone with proguanil hydrochloride [update to dosing for prophylaxis of malaria].
Azithromycin [update to dosing for uncomplicated gonorrhoea].
Ceftriaxone [update to dosing for gonococcal infections].
Chloroquine [update to dosing for prophylaxis of malaria].
Ciprofloxacin [update to dosing for gonococcal infections].
Mefloquine [update to dosing for prophylaxis of malaria].
Omeprazole [update to dosing for acid reflux disease].
Proguanil hydrochloride [update to dosing for prophylaxis of malaria].

New Monograph: Tavlesse® [fostamatinib].

New Preparations: Lenzetto® [estradiol]; Spravato® [esketamine].

Deleted Monographs: Collagenase; Pergolide; Stavudine.

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

14 Jul

BNF July 2020 Update

This update contains 12 significant changes and 2 new preparations.

See details

Significant Changes:

Cyproterone acetate: Restrictions in use of cyproterone acetate due to risk of meningioma (letter) [MHRA/CHM advice].
Hyperthyroidism: updated guidance on management.
Hypothyroidism: updated guidance on management.
Larotrectinib for treating NTRK fusion-positive solid tumours [NICE guidance].
Lenalidomide: Immunomodulatory drugs and pregnancy prevention: temporary advice for management during coronavirus (COVID-19) [MHRA/CHM advice].
Lorlatinib for previously treated ALK-positive advanced non-small-cell lung cancer [NICE guidance].
Obinutuzumab with bendamustine for treating follicular lymphoma after rituximab [NICE guidance].
Pomalidomide: Immunomodulatory drugs and pregnancy prevention: temporary advice for management during coronavirus (COVID-19) [MHRA/CHM advice].
Rabies vaccine: updated guidance in-line with Public Health England recommendations.
Sodium valproate: Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19) [MHRA/CHM advice].
Thalidomide: Immunomodulatory drugs and pregnancy prevention: temporary advice for management during coronavirus (COVID-19) [MHRA/CHM advice].
Valproic acid: Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19) [MHRA/CHM advice].

New Preparations: Medabon® [mifepristone and misoprostol], Nubeqa® [darolutamide].

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

09 Jun

BNF June 2020 Update

This update contains 7 significant changes, 2 dose changes and 8 new preparations.

See details

Significant Changes:

Adrenaline/epinephrine auto-injectors (Emerade®): all strengths of auto-injector pens have been recalled from patients due to failure to activate. Healthcare professionals are advised to ensure that patients who have previously been prescribed an Emerade® 150, 300 or 500 microgram pen are supplied with a prescription for an alternative brand—see the MHRA website for full details [MHRA/CHM advice].
Hypoglycaemia: updated guidance on management.
Lenalidomide with rituximab for previously treated follicular lymphoma [NICE guidance].
Nurse Prescribers’ Formulary: list of medicinal preparations updated with indications for use by Community Practitioner Nurse Prescribers and links to BNF monographs. For further information, see How to use the NPF in the Nurse Prescribers’ Formulary (NPF).
Poisoning, emergency treatment: updated guidance on the management of beta-blockers poisoning in-line with TOXBASE recommendations.
Poisoning, emergency treatment: updated guidance on the management of paracetamol poisoning in-line with TOXBASE recommendations.
Skin infections, antibacterial therapy: updated guidance on management of impetigo.

Dose Changes:

Co-fluampicil [update to dosing information].
Fostair® NEXThaler 100/6 (beclometasone with formoterol) [dosing for maintenance and reliever therapy added].

New Preparations:

Ampres® [chloroprocaine hydrochloride].
Beovu® [brolucizumab].
Combisal® 25/50 [fluticasone with salmeterol].
Combisal® 25/125 [fluticasone with salmeterol].
Combisal® 25/250 [fluticasone with salmeterol].
Fusacomb 50/250 Easyhaler® [fluticasone with salmeterol].
Fusacomb 50/500 Easyhaler® [fluticasone with salmeterol].
Staladex® [leuprorelin acetate].

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

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