British National Formulary (BNF)

12th November 2024

British National Formulary

This update contains 10 significant changes, 4 dose changes, 5 new monographs, and 5 new preparations.

Significant Changes:

• Antibacterials, principles of therapy: update to notifiable diseases reporting.
• Antibacterials, use for prophylaxis: updated guidance on secondary prevention of meningococcal disease and secondary prevention of pertussis.
• Borderline substances: oral nutritional supplements have been re-organised in a new section called Oral nutrition.
• Co-amoxiclav: update to structure of indications and dose section; tablet dose expression changed to co-amoxiclav (total of amoxicillin and clavulanic acid).
• Faricimab: new indication and dose for macular oedema secondary to retinal vein occlusion.
• Immunisation schedule: updated guidance for immunisation against influenza, and for pertussis in pregnancy.
• Lower urinary tract symptoms in males: new guidance.
• Oxytocin: risk of overdose during labour and childbirth [NPSA advice].
• Pertussis vaccine: updated guidance for immunisation.
• Topical corticosteroids: update to the list of topical corticosteroid potencies.

Dose Changes:

• Ciprofloxacin [indication changed from prevention of secondary case of meningococcal meningitis to prevention of secondary case of meningococcal disease].
• Lithium carbonate [update to dosing].
• Lithium citrate [update to dosing].
• Risankizumab [update to dosing].

New Monographs:

• Fabhalta® [iptacopan].
• Isoprenaline hydrochloride.
• Mepsevii® [vestronidase alfa].
• Obgemsa® [vibegron].
• Yselty® [linzagolix].

New Preparations: Ceyxa® [olanzapine]; Co-amoxiclav 1 g (875/125 mg) tablet; Co-amoxiclav 2.2 g (2000/200 mg) infusion; Metalyse® 5000 units (25 mg) [tenecteplase]; Xyquila® [olanzapine].

8th October 2024

British National Formulary

This update contains 11 significant changes, 2 dose changes and 3 new monographs.

Significant Changes:

• Borderline substances: enteral (tube) feeds have been re-organised in a new section called Enteral nutrition.
• Cholera vaccines: updated guidance for immunisation.
• Epimax® ointment and Epimax® paraffin-free ointment: reports of ocular surface toxicity and ocular chemical injury [MHRA/CHM advice] (advice in emollient creams and ointments, paraffin-containing and emollient creams and ointments, hydrogenated castor oil-containing).
• Human papillomavirus vaccine: updated guidance for immunisation.
• Immunisation schedule: updated guidance.
• Poisoning, emergency treatment: updated guidance for paracetamol overdose.
• Posaconazole: important safety information added to highlight that tablets and oral suspension are not directly interchangeable.
• Sacubitril with valsartan: update to dose expression.
• Sodium valproate: new precautionary advice for male patients [MHRA/CHM advice].
• Status epilepticus: updated guidance for management.
• Valproic acid: new precautionary advice for male patients [MHRA/CHM advice].

Dose Changes:

• Human papillomavirus vaccine [update to dosing].
• Levonorgestrel [update to indications and dose for intra-uterine devices].

New Monographs:

• Eladynos® [abaloparatide].
• Emollient creams and ointments, hydrogenated castor oil-containing.
• Pylera® [bismuth potassium with metronidazole and tetracycline hydrochloride].

10th September 2024

British National Formulary

This update contains 7 significant changes, 2 dose changes, 1 new preparation, 2 deleted monographs and 2 deleted preparations.

Significant Changes:

• Cabergoline: updated important safety information.
• Carbamazepine (Tegretol® 100 mg/5 mL Liquid): temporary stock-out and update to posology (reduction of maximum daily dose) [MHRA/CHM advice].
• Drugs that cause sedation and drugs with CNS depressant effects: pharmacodynamic effects drug groups combined and renamed as drugs with CNS effects; see Interactions.
• Hyperkalaemia: updated guidance on management.
• Salbutamol: new indication and dose for moderate to severe hyperkalaemia.
• Topiramate (Topamax®): introduction of new safety measures, including a Pregnancy Prevention Programme [MHRA/CHM advice].
• Warfarin: be alert to the risk of drug interactions with tramadol [MHRA/CHM advice] (advice in warfarin sodium and acenocoumarol; see example in warfarin sodium).

Dose Changes:

• Lebrikizumab [update to dosing].
• Rosuvastatin [update to dose adjustments due to interactions with belumosudil].

New Preparations: Ivermectin.

Deleted Monographs: Colecalciferol with calcium phosphate; Porfimer sodium.

Deleted Preparations: Creon 40000® [pancreatin]; Pancrease HL® [pancreatin].”

13th August 2024

British National Formulary

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

Significant Changes:
•Immunisation schedule: updated guidance for immunisation against influenza.
•Influenza vaccine: updated guidance for immunisation.
•Medical emergencies in the community: updated guidance on the use of salbutamol in the management of acute asthma.
•Migraine: updated guidance to include atogepant for migraine prophylaxis.
•Topical corticosteroids: introduction of new labelling and a reminder of the possibility of severe side effects, including Topical Steroid Withdrawal Reactions [MHRA/CHM advice] (advice in relevant monographs; see example in betamethasone).

Dose Changes:
•Levomepromazine [update to palliative care indications and dosing].
•Midazolam [update to palliative care indications and dosing].
•Salbutamol [update to dosing for asthma; prophylaxis of allergen-or-exercise-induced bronchospasm; other conditions associated with reversible airways obstruction (adults only); and exacerbation of reversible airways obstruction (children only)].

New Monographs:
•Dzuveo® [sufentanil].
•Exblifep® [cefepime with enmetazobactam].
•Rystiggo® [rozanolixizumab].

9th July 2024

British National Formulary

This update contains 8 significant changes, 2 new monographs and 1 deleted monograph.

Significant Changes:

• Borderline substances: products suitable for additional energy, protein, or fibre requirements have been moved to a new section called Energy, protein, and fibre fortifiers.
• Co-codamol: update to dose expression.
• Combined hormonal contraceptives: update to breast-feeding advice (see example in ethinylestradiol with norethisterone).
• Ear: updated guidance for the removal of ear wax.
• Finasteride: reminder of the risk of psychiatric side effects and of sexual side effects (which may persist after discontinuation of treatment) [MHRA/CHM advice].
• Intra-uterine contraceptive devices (copper): name change of Novaplus T 380® Ag to Eurogine T 380® Ag, and name change of Novaplus T 380® Cu to Eurogine T 380® Cu.
• Leuprorelin acetate: name change of Staladex® 10.72 mg to Staladex® 11.25 mg.
• Montelukast: reminder of the risk of neuropsychiatric reactions [MHRA/CHM advice].

New Monographs:

• Produodopa® [foslevodopa with foscarbidopa].
• Vanflyta® [quizartinib].

Deleted Monographs:

• Soybean oil.

11th June 2024

British National Formulary

This update contains 10 significant changes, 9 dose changes, 5 new monographs and 3 deleted monographs.

Significant Changes:

• Antibacterials, use for prophylaxis: addition of antibacterial prophylaxis guidance for assisted vaginal birth (ventouse or forceps).
• Borderline substances: products suitable for conditions requiring a ketogenic diet have been moved to a new section called Ketogenic diet.
• Diabetic hyperglycaemic emergencies: updated guidance for management of individuals aged 16-18 years.
• Immunisation schedule: updated guidance for herpes zoster (shingles) immunisation.
• Meningococcal vaccines: updated guidance for immunisation.
• Metformin hydrochloride: new indication and dose for type 1 diabetes mellitus.
• Obstetrics: updated guidance for the prevention and treatment of haemorrhage.
• Prescribing in renal impairment: update to CKD-EPI equation to remove race.
• Sacubitril with valsartan: update to dose expression.
• Varicella-zoster vaccines: updated guidance for immunisation against herpes zoster (shingles).

Dose Changes:

• Bexsero® (meningococcal group B vaccine (rDNA, component, adsorbed)) [update to dosing].
• Carbetocin [update to indication and dose].
• Cyanocobalamin [update to dosing].
• Ergometrine maleate [update to dosing for postpartum haemorrhage caused by uterine atony].
• Ergometrine with oxytocin [update to dosing for active management of the third stage of labour].
• Haemophilus influenzae type b with meningococcal group C vaccine [update to dosing].
• Herpes-zoster vaccine (recombinant, adjuvanted) [update to dosing].
• Meningococcal groups A with C and W135 and Y vaccine [update to dosing].
• Oxytocin [update to dosing for active management of the third stage of labour].

New Monographs:

• Adacel® [diphtheria with tetanus and pertussis vaccine].
• Elrexfio® [elranatamab].
• Omjjara® [momelotinib].
• Opdualag® [nivolumab with relatlimab].
• Velsipity® [etrasimod].

Deleted Monographs:

• Artenimol with piperaquine phosphate.
• Bambuterol hydrochloride.
• Herpes-zoster vaccine (live).