British National Formulary (BNF) 89

Practical and evidence-based, BNF is an integral part of the UK’s healthcare infrastructure and relied on by health professionals who prescribe, dispense, and administer medicines globally.  Containing guidance on best practice in prescribing, as well as legal and ethical considerations, BNF supports safe and effective decision-making at the point of care.

Extensive content updates in the BNF 89 edition include:

New monographs for:

• Dzuveo ® [sufentanil] for acute moderate to severe pain
• Eladynos ® [abaloparatide] for osteoporosis in postmenopausal women at increased risk of fractures
• Emblaveo ® [aztreonam with avibactam] for complicated urinary-tract and intra-abdominal infection, hospital-acquired pneumonia, and aerobic Gram-negative infections in patients with limited treatment options
• Emollient creams and ointments, hydrogenated castor oil containing for dry skin conditions, eczema, and psoriasis
• Exblifep ® [cefepime with enmetazobactam] for complicated urinary-tract infection and hospital-acquired pneumonia
• Isoprenaline hydrochloride for emergency treatment of life-threatening bradycardia
• Obgemsa ® [vibegron] for symptomatic treatment of overactive bladder syndrome
• Produodopa ® [foslevodopa with foscarbidopa] for severe Parkinson's disease inadequately controlled by other preparations
• Pylera ® [bismuth potassium with metronidazole and tetracycline hydrochloride] for Helicobacter pylori eradication and prevention of relapse of associated peptic ulcers

MHRA advice on:

• Carbamazepine (Tegretol ® 100 mg/5 mL Liquid): temporary stock-out and reduction of maximum daily dose
• Epimax ® ointment and Epimax ® paraffin-free ointment: reports of ocular surface toxicity and ocular chemical injury
• Finasteride: reminder of the risk of psychiatric side effects and of sexual side effects which may persist after discontinuation of treatment
• Glatiramer acetate: anaphylactic reactions may occur months to years after treatment initiation
• GLP-1 receptor agonists: reminder of the potential side effects and to be aware of the potential for misuse
• Medroxyprogesterone acetate: risk of meningioma
• Montelukast: reminder of the risk of neuropsychiatric reactions
• Sodium valproate and Valproic acid: new precautionary advice for male patients
• Topical corticosteroids: introduction of new labelling and a reminder of the possibility of severe side effects, including Topical Steroid Withdrawal Reactions
• Topiramate (Topamax ®): introduction of new safety measures, including a Pregnancy Prevention Programme
• Warfarin: be alert to the risk of drug interactions with tramadol

Other significant changes include updated guidance on:

• Antibacterials, principles of therapy: update to notifiable diseases reporting
• Antibacterials, use for prophylaxis for secondary prevention of meningococcal disease and secondary prevention of pertussis
• Ceftriaxone for pre-hospital treatment of suspected bacterial meningitis and meningococcal disease
• Management of central nervous system infections, antibacterial therapy
• Cholera vaccines
• Combined hormonal contraceptives: update to breastfeeding advice
• Dexamethasone: adjunctive treatment of suspected bacterial meningitis
• Diabetic foot infections, antibacterial therapy: fluoroquinolones
• Ear: updated guidance for the removal of ear wax
• Gastro-intestinal system infections, antibacterial therapy: fluoroquinolone
• Human papillomavirus vaccine
• Management of hyperkalaemia
• Influenza vaccine
• Lower urinary tract symptoms in males
• Medical emergencies in the community: update to antibacterials for suspected bacterial meningitis and meningococcal disease; update to guidance on the use of salbutamol in the management of acute asthma
• Methenamine hippurate: updated prescribing information
• Migraine: to include atogepant for migraine prophylaxis
• Nutritional Borderline Substances re-arranged to align with changes made to the categorisation and coding of these products by the Advisory Committee on Borderline Substances and NHS Business Services Authority
• Oxytocin: risk of overdose during labour and childbirth [National Patient Safety Alert advice]
• Pertussis vaccine
• Posaconazole: important safety information added to highlight that tablets and oral suspension are not directly interchangeable
• Respiratory system infections, antibacterial therapy: fluoroquinolones
• Salbutamol: moderate to severe hyperkalaemia
• Management of status epilepticus
• Urinary-tract infections: fluoroquinolones, treatment of lower urinary-tract infections, and the prophylaxis of recurrent urinary tract infections

BNF is published jointly by BMJ Group and Pharmaceutical Press, the Royal Pharmaceutical Society's knowledge business.