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For November, 47 new medicines have been added, and numerous medicines have been amended.

This update contains 8 significant changes and 16 minor changes.

Significant Changes:

• Chronic obstructive pulmonary disease — reviewed. A literature search was conducted in August 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone minor restructuring. No major changes to the recommendations have been made.
• Epistaxis (nosebleeds) — A literature search was conducted in September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. A recommendation was added to consider tranexamic acid for people presenting after a major haemorrhage supported by a UK guideline and expert opinion in a review article. A section was added to highlight potential differential diagnoses. There have been minor structural changes to the topic updating the basis for recommendation sections in line with the updated literature.
• Halitosis — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.
• Hepatitis B — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.
• Premenstrual syndrome — reviewed. A literature search was conducted in August – September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The diagnostic criteria for premenstrual dysphoric disorder have been added. There have been no major changes to the recommendations; minor changes and detail have been added in line with recent Cochrane reviews and the 2023 American College of Obstetricians and Gynecologists guideline. The management section structure has been moved away from tiers of severity and towards individual tailored management focusing on individual symptoms and goals based on shared decision making.
• Teething — reviewed. A literature search was conducted in October 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The information on lidocaine-containing teething products has been updated to reflect the latest recommendations and manufacturers’ information. No other significant changes to the recommendations have been made.
• Varicose veins — reviewed. A literature search was conducted in August 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Based on expert opinion in a review article, three new recommendations were added regarding the assessment of people with varicose veins. These included asking about red flag symptoms which may be indicative of rare but severe causes of varicose veins, examining the varicose veins for the presence of superficial vein thrombosis, and performing an abdominal examination to assess for an abdominal or pelvic mass. There have also been minor structural changes to the topic, updating the basis for recommendation sections in line with the updated literature.
• Warts and verrucae — reviewed. A literature search was conducted in September to October 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to recommendations have been made.

Minor Changes:

• Attention deficit hyperactivity disorder — minor update. Risk of serotonin syndrome has been added to adverse effects of Atomoxetine in line with manufacturer’s SPC.
• Anticoagulation – oral— minor update. Monitoring guidance for NOACs has been updated from 6 monthly to 4 monthly for people 75 years or older or those who are frail. This aligns with recommendations from the European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation (2021).
• Atrial fibrilation— minor update. Additional information added regarding referral to cardiology for patients who are contraindicated for both DOACs and warfarin for consideration of other risk reducing procedures including left atrial appendage closure.
• Back pain – low (without radiculopathy) — minor update. Added spinal cord stimulation as a possible specialist treatment for people with chronic neuropathic low back pain.
• Coronavirus – COVID-19 — minor update. Available vaccines updated in line with autumn 2024 vaccination campaign.
• Diabetes – type 1 — minor update. A typographical error has been corrected.
• Diabetes – type 2 — minor update. Information that HbA1c should not be used to diagnose diabetes mellitus in people with HIV has been removed from this topic in line with the BHIVA guidelines for the routine investigation and monitoring of adult HIV 1 positive individuals (2019 interim update). Cutaneous amyloidosis added as an adverse effect of liraglutide.
• Erectile dysfunction— minor update. Central Serous Chorioretinopathy (CSCR) added as an adverse effect ofavanafil.
• Hypothyroidism — minor update. Initiation dosing of levothyroxine information has been updated to delete the BNF information, as this is now in line with NICE guidance.
• Insulin therapy in type 1 diabetes —minor update. Information about hybrid closed loop systems has been incorporated into this topic in line with the NICE technology appraisal Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes.
• Leg ulcer – venous — minor update.  The section on interpretation of ABPI has been removed from this topic and a link added to the topic on Peripheral arterial disease.
• Peripheral arterial disease — minor update. A recommendation to refer all people with an ABPI of 0.9 or less for specialist vascular assessment has been removed from the assessment section of this topic.
• Sepsis — minor update. Links to the Sepsis Trust clinical tools have been updated.
• Sore throat – acute — minor update. Drug interactions for phenoxymethylpenicillin updated and aligned with the prescribing section of sinusitis
• Urinary tract infection (lower) – women — minor update. Added information on MSU screening at booking appointments in intermediate and high-risk pregnancies to align with the NHS England document Saving babies’ lives: version 3 A care bundle for reducing perinatal mortality.
• Whooping cough — minor update. The preferred antibiotic choices for children aged 1 month or over have been clarified.

This update contains 9 new monographs and 38 revised monographs.

New monographs: Axatilimab-csfr; Benzgalantamine Gluconate; Lazertinib Mesylate; Levamlodipine Maleate; Nemolizumab-ilto; Omidubicel-onlv; Palopegteriparatide; Seladelpar Lysine; Vorasidenib.

Revised monographs: Alpelisib; Alteplase; Atorvastatin Calcium; Belimumab; Bictegravir Sodium, Emtricitabine, and Tenofovir Alafenamide Fumarate; Brexanolone; Brincidofovir; Capecitabine; Capivasertib; Cidofovir; COVID-19 Vaccine, Adjuvanted (Novavax)(2024-2025 Formula); COVID-19 Vaccine, mRNA (Moderna) (2024-2025 Formula); COVID-19 Vaccine, mRNA (Pfizer-BioNTech); DULoxetine Hydrochloride; Efavirenz; Emtricitabine and Tenofovir Alafenamide Fumarate; Eplontersen Sodium; Influenza Vaccine Live Intranasal; Influenza Vaccine Recombinant; Insulin Human; Ponesimod; Remifentanil Hydrochloride; Ritonavir; Rosuvastatin Calcium; Simvastatin; Siponimod Fumarate; Smallpox (Vaccinia) Vaccine Live; Smallpox and Mpox Vaccine Live; Talazoparib Tosylate; Teclistamab-cqyv; Tecovirimat; Temozolomide; Tenapanor Hydrochloride (Phosphate-Removing Agent); Teriflunomide; Vaccinia Immune Globulin IV (Human); Vamorolone; Vandetanib; Zuranolone.