British National Formulary (BNF)

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Publication Updates

09 Feb

British National Formulary February 2021 Update

This update contains 20 significant changes and 2 new monographs.

See details

Significant Changes:
• Andexanet alfa (Ondexxya®): avoid use of andexanet prior to heparinisation [MHRA/CHM advice].

• Atezolizumab with bevacizumab for treating advanced or unresectable hepatocellular carcinoma [NICE guidance].

• Avatrombopag (Doptelet®) for the treatment of severe thrombocytopenia in adult patients with chronic liver disease who are scheduled to undergo an invasive procedure [SMC guidance].

• Bempedoic acid (Nilemdo®) in adults with primary hypercholesterolaemia or mixed dyslipidaemia, as an adjunct to diet: in combination with a statin or statin with other lipid-lowering therapies; or alone or in combination with other lipid-lowering therapies in patients who are statin-intolerant, or for whom a statin is contra-indicated [SMC guidance].

• Caplacizumab with plasma exchange and immunosuppression for treating acute acquired thrombotic thrombocytopenic purpura [NICE guidance].

• COVID-19: updated guidance.

• COVID-19 vaccine: new guidance in-line with Public Health England recommendations.

• Dimethyl fumarate (Tecfidera®): updated advice on the risk of progressive multifocal leukoencephalopathy (PML) associated with mild lymphopenia [MHRA/CHM advice].

• Erythromycin: caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban [MHRA/CHM advice].

• Fingolimod (Gilenya®): updated advice about the risks of serious liver injury and herpes meningoencephalitis [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.

• Liraglutide for managing overweight and obesity [NICE guidance].

• Methylprednisolone as sodium succinate (Solu-Medrone®) 40 mg powder and solvent for solution for injection: change from lactose-containing to a lactose-free formulation; risk of serious allergic reactions if formulations are confused [MHRA/CHM advice].

• Mexiletine (Namuscla®) for the symptomatic treatment of myotonia in adult patients with non-dystrophic myotonic disorders [SMC guidance].

• Quinolones (systemic and inhaled fluoroquinolones): small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk [MHRA/CHM advice] (advice in ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin; see example in ciprofloxacin).

• Rheumatoid arthritis: updated guidance on management.

• Upadacitinib for treating severe rheumatoid arthritis [NICE guidance].

• Venetoclax (Venclyxto®) in combination with obinutuzumab for the treatment of adult patients with previously untreated chronic lymphocytic leukaemia (CLL) [SMC guidance].

• Venetoclax with obinutuzumab for untreated chronic lymphocytic leukaemia [NICE guidance].

New Monographs:

• COVID-19 vaccine.

• Treprostinil.

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

12 Jan

British National Formulary January 2021 Update

This update contains 25 significant changes, 9 dose changes, 5 new monographs, 3 new preparations, 3 deleted monographs and 3 deleted preparations.

See details

Significant Changes: 
• Antibacterials, use for prophylaxis: updated guidance for the prevention of secondary Haemophilus influenzae type b disease.

• Atezolizumab (Tecentriq®) in combination with carboplatin and etoposide, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer [SMC guidance].

• Atezolizumab (Tecentriq®) in combination with nab-paclitaxel for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer whose tumours have PD-L1 expression at a level of 1 % or more and who have not received prior chemotherapy for metastatic disease [SMC guidance].

• Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure [NICE guidance].

• Bupropion hydrochloride (Zyban®): risk of serotonin syndrome with use with other serotonergic drugs [MHRA/CHM advice].

• Carfilzomib for previously treated multiple myeloma [NICE guidance].

• Darolutamide (Nubeqa®) for the treatment of adult men with non-metastatic castration-resistant prostate cancer who are at high risk of developing metastatic disease [SMC guidance].

• Darolutamide with androgen deprivation therapy for treating hormone-relapsed non-metastatic prostate cancer [NICE guidance].

• Darunavir with cobicistat (Rezolsta®) in combination with other antiretroviral medicinal products for the treatment of human immunodeficiency virus-1 (HIV-1) infection in adults and adolescents (aged 12 years and older with body weight at least 40 kg) [AWMSG guidance].

• Eye: updated guidance for expiration of eye preparations.

• Ferric carboxymaltose (Ferinject®▼): risk of symptomatic hypophosphataemia leading to osteomalacia and fractures [MHRA/CHM advice].

• Frequently asked questions—clinical: updated guidance for expiration of eye preparations.

• Galcanezumab for preventing migraine [NICE guidance].

• Interactions: drugs that cause myelosuppression: pharmacodynamic effects drug group revalidated and updated.

• Isatuximab with pomalidomide and dexamethasone for treating relapsed and refractory multiple myeloma [NICE guidance].

• Modafinil (Provigil®): increased risk of congenital malformations if used during pregnancy [MHRA/CHM advice].

• National funding decisions: advice from NICE, SMC, and AWMSG now briefly referenced in relevant monographs—funding body website should be accessed for full details; see Guidance on prescribing.

• Patiromer calcium (Veltassa®) for the treatment of hyperkalaemia in adults [SMC guidance].

• Pembrolizumab for untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma [NICE guidance].

• Pirfenidone (Esbriet®): risk of serious liver injury; updated advice on liver function testing [MHRA/CHM advice].

• Romosozumab (Evenity®) for the treatment of severe osteoporosis in postmenopausal women at high risk of fracture [SMC guidance].

• Siponimod for treating secondary progressive multiple sclerosis [NICE guidance].

• Trabectedin (Yondelis®) for the treatment of adult patients with advanced soft tissue sarcoma, after failure of anthracyclines and ifosfamide, or who are unsuited to receive these agents [SMC guidance].

• Trastuzumab emtansine (Kadcyla®) as a single agent, for the adjuvant treatment of adult patients with HER2-positive early breast cancer who have residual invasive disease, in the breast and/or lymph nodes, after neoadjuvant taxane-based and HER2-targeted therapy [SMC guidance].

• Vaccination, general principles: updated guidance.

Dose Changes:

• Clinorette® (estradiol with norethisterone) [update to dosing].

• Elleste-Duet® Conti (estradiol with norethisterone) [update to dosing].

• Evorel® Conti (estradiol with norethisterone) [update to dosing].

• Evorel® Sequi (estradiol with norethisterone) [update to dosing].

• Kliofem® (estradiol with norethisterone) [update to dosing].

• Kliovance® (estradiol with norethisterone) [update to dosing].

• Novofem® (estradiol with norethisterone) [update to dosing].

• Sumatriptan [update to dosing for treatment of acute migraine].

• Trisequens® (estradiol with norethisterone) [update to dosing].

New Monographs:

• Calquence®▼ [acalabrutinib].

• Doptelet® [avatrombopag].

• Enerzair Breezhaler® [mometasone furoate with glycopyrronium bromide and indacaterol].

• Otigo® [phenazone with lidocaine].

• Zeposia® [ozanimod].

New Preparations: Lecicarbon A® [sodium acid phosphate with sodium bicarbonate]; Lecicarbon C® [sodium acid phosphate with sodium bicarbonate]; Symbicort® 100 micrograms/3 micrograms per actuation pressurised inhalation [budesonide with formoterol].

Deleted Monographs: Sodium stibogluconate; Telbivudine; Ticarcillin with clavulanic acid.

Deleted Preparations: Climagest® 1 mg [estradiol with norethisterone]; Climagest® 2 mg [estradiol with norethisterone]; Climesse® [estradiol with norethisterone].

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

08 Dec

British National Formulary December 2020 Update

This update contains 25 significant changes, 2 dose changes, 4 new monographs, 4 deleted monographs and 1 deleted preparation.

See details

Significant Changes:

Avelumab (Bavencio®) in combination with axitinib for the first-line treatment of adult patients with advanced renal cell carcinoma [SMC guidance].
Budesonide (Jorveza®) for the treatment of eosinophilic esophagitis in adults [SMC guidance].
Carfilzomib (Kyprolis®) in combination with lenalidomide and dexamethasone for the treatment of adult patients with multiple myeloma who have received at least one prior therapy [for patients who have received only one prior therapy] [SMC guidance].
Daratumumab (Darzalex®) subcutaneous injection as monotherapy, for the treatment of adult patients with relapsed and refractory multiple myeloma, whose prior therapy included a proteasome inhibitor and an immunomodulatory agent and have demonstrated disease progression on the last therapy [SMC guidance].
Daratumumab (Darzalex®) subcutaneous injection in combination with lenalidomide and dexamethasone, or bortezomib and dexamethasone, for the treatment of adult patients with multiple myeloma who have received at least one prior therapy [SMC guidance].
Dolutegravir (Tivicay®▼, Triumeq®▼, Juluca®▼): updated advice on increased risk of neural tube defects [MHRA/CHM advice].
Flucytosine (Ancotil®): new contraindication in patients with DPD deficiency [MHRA/CHM advice].
5-Fluorouracil (intravenous), capecitabine, tegafur: DPD testing recommended before initiation to identify patients at increased risk of severe and fatal toxicity [MHRA/CHM advice] (advice in fluorouracil, capecitabine and tegafur with gimeracil and oteracil; see example in fluorouracil).
Haemophilus influenzae type B conjugate vaccine: updated guidance in-line with Public Health England recommendations.
Hepatitis A vaccine: updated guidance in-line with Public Health England recommendations.
Ibrutinib (Imbruvica®) in combination with rituximab for the treatment of adult patients with Waldenström’s macroglobulinaemia [SMC guidance].
Immunoglobulins: updated guidance in-line with Public Health England recommendations for the use of normal immunoglobulin for protection against hepatitis A infection.
Introduction of a new symbol to indicate manufacturer information: the symbol M (manufacturer information) will be used within text to indicate when recommendations are based on summaries of product characteristics; see How BNF Publications are constructed.
Lenalidomide (Revlimid®) as monotherapy for the maintenance treatment of adult patients with newly diagnosed multiple myeloma who have undergone autologous stem cell transplantation [SMC guidance].
Lenalidomide (Revlimid®) in combination with rituximab (anti-CD20 antibody) for the treatment of adult patients with previously treated follicular lymphoma (Grade 1 to 3a) [SMC guidance].
Meropenem with vaborbactam (Vaborem®) for the treatment of: complicated urinary tract infection; complicated intra-abdominal infection; hospital-acquired pneumonia; bacteraemia that occurs in association with, or is suspected to be associated with, any of these infections; infections due to aerobic Gram-negative organisms in adults with limited treatment options [AWMSG and SMC guidance].
Niraparib (Zejula®▼): reports of severe hypertension and posterior reversible encephalopathy syndrome (PRES), particularly in early treatment [MHRA/CHM advice].
Nivolumab for advanced squamous non-small-cell lung cancer after chemotherapy [NICE guidance].
Osimertinib for treating EGFR T790M mutation-positive advanced non-small-cell lung cancer [NICE guidance].
Osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer [NICE guidance].
Peri-operative analgesia: updated guidance for the management of postoperative pain.
Siponimod (Mayzent®) for the treatment of adult patients with secondary progressive multiple sclerosis (SPMS) with active disease evidenced by relapses or imaging features of inflammatory activity [SMC guidance].
Skin infections, antibacterial therapy: new guidance for the management of insect bites and stings.
Volanesorsen for treating familial chylomicronaemia syndrome [NICE guidance].
Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic [MHRA/CHM advice] (advice in acenocoumarol, apixaban, dabigatran etexilate, edoxaban, phenindione, rivaroxaban, warfarin sodium; see example in warfarin sodium).

Dose Changes:

Hydrocortisone [dosing updated].
Subgam® (normal immunoglobulin) [update to dosing for hepatitis A prophylaxis].

New Monographs:

Atectura Breezhaler® [indacaterol with mometasone furoate].
Ayvakyt®▼ [avapritinib].
Jyseleca® [filgotinib].
Myopridin® [pridinol].

Deleted Monographs: Conjugated oestrogens with bazedoxifene acetate; Fenticonazole nitrate; Nedocromil sodium; Rolapitant.

Deleted Preparation: Esmya® [ulipristal acetate].

For further details on changes in the BNF click on https://www.medicinescomplete.com/#/content/bnf/PHP107699

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 https://www.medicinescomplete.com/#/content/bnf/PHP107699

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

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