British National Formulary (BNF)

14th January 2025

British National Formulary

This update contains 15 significant changes, 4 dose changes, 4 new monographs, 3 new preparations and 3 deleted monographs.

Significant Changes:

Cefotaxime: removal of indication and dose for emergency treatment of suspected bacterial meningitis or meningococcal disease, before urgent transfer to hospital, in patients who cannot be given benzylpenicillin.

Ceftriaxone: update to indications and dosing for pre-hospital treatment of suspected bacterial meningitis and meningococcal disease.

Central nervous system infections, antibacterial therapy: updated guidance on management.

Chloramphenicol: updated monitoring advice.

Dexamethasone: update to dose advice for adjunctive treatment of suspected bacterial meningitis.

Diabetic foot infections, antibacterial therapy: updated guidance on fluoroquinolones.

Gastro-intestinal system infections, antibacterial therapy: updated guidance on fluoroquinolones.

Glatiramer acetate: anaphylactic reactions may occur months to years after treatment initiation [MHRA/CHM advice].

GLP-1 receptor agonists: reminder of the potential side effects and to be aware of the potential for misuse [MHRA/CHM advice] (advice in dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide and tirzepatide; see example in liraglutide).

Mavacamten: pre-treatment screening advice on genetic testing for treating symptomatic obstructive hypertrophic cardiomyopathy.

Medical emergencies in the community: update to antibacterials for suspected bacterial meningitis and meningococcal disease.

Medroxyprogesterone acetate: risk of meningioma and measures to minimise this risk [MHRA/CHM advice].

Respiratory system infections, antibacterial therapy: updated guidance on fluoroquinolones.

Urinary-tract infections: updated guidance on fluoroquinolones.

Urinary-tract infections: updated guidance on treatment of lower urinary-tract infections.

Dose Changes:

Cefotaxime [removal of intramuscular route for severe susceptible infections due to sensitive Gram-positive and Gram-negative bacteria, and meningitis].

Ceftriaxone [removal of intramuscular route for meningitis].

Ceftriaxone [update to indications and dosing for meningitis and meningococcal disease].

Fluconazole [update to indications and dosing].

New Monographs:

Iqirvo® [elafibranor].

Piasky® [crovalimab].

Sogroya® [somapacitan].

Voydeya® [danicopan].

New Preparations: Alutard SQ Bee® [bee venom extract]; Alutard SQ Wasp® [wasp venom extract]; Itulazax 12 SQ-Bet® [tree pollen extract].

Deleted Monographs: Belantamab mafodotin; Crizanlizumab; Voxelotor.

10th December 2024

British National Formulary

This update contains 3 significant changes, 4 dose changes, 5 new monographs, 2 new preparations, and 2 deleted preparations.

Significant Changes:

• Bromocriptine: monitor blood pressure when prescribing bromocriptine for prevention or inhibition of post-partum physiological lactation [MHRA/CHM advice].
• Methenamine hippurate: updated prescribing information.
• Urinary-tract infections: updated guidance for the prophylaxis of recurrent urinary tract infections.

Dose Changes:

• Epipen® auto-injector 0.3 mg (adrenaline/epinephrine) [update to body-weight ranges].
• Epipen® Jr auto-injector 0.15 mg (adrenaline/epinephrine) [update to body-weight ranges].
• Jext® 150 micrograms (adrenaline/epinephrine) [update to body-weight ranges].
• Jext® 300 micrograms (adrenaline/epinephrine) [update to body-weight ranges].

New Monographs:

• Emblaveo® [aztreonam with avibactam].
• Korserdu® [elacestrant].
• Leqembi® [lecanemab].
• Truqap® [capivasertib].
• Vyloy® [zolbetuximab].

New Preparations:

• Lecigon® [levodopa with carbidopa and entacapone].
• Velariq® [oxybutynin hydrochloride].

Deleted Preparations:

• Emerade® 300 micrograms [adrenaline/epinephrine].
• Emerade® 500 micrograms [adrenaline/epinephrine].

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].