British National Formulary - BNF 88 - Sept 24

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 88 edition include:

New monographs for:

• Adacel ® [diphtheria with tetanus and pertussis vaccine] for immunisation against diphtheria, tetanus, and pertussis, and passive immunisation against pertussis in pregnant women
• Cytisine ® [cytisinicline] to aid smoking cessation
• Domnisol ® [calcifediol monohydrate] for primary prevention and treatment of vitamin D deficiency
• Ebglyss ® [lebrikizumab] for moderate to severe atopic eczema
• Evkeeza ® [evinacumab] for homozygous familial hypercholesterolaemia
• Litfulo ® [ritlecitinib] for alopecia areata
• Rezzayo ® [rezafungin] for invasive candidiasis
• SimAlvia ® [alverine with simeticone] for abdominal pain in irritable bowel syndrome
• Slynd ® [drospirenone] for contraception
• Velsipity ® [etrasimod] for ulcerative colitis
• Veoza ® [fezolinetant] for moderate to severe vasomotor symptoms associated with menopause

MHRA advice on:

• Aripiprazole: risk of pathological gambling
• Codeine phosphate linctus (codeine oral solutions): reclassification to prescription-only medicine
• Nirmatrelvir with ritonavir (Paxlovid ®): be alert to the risk of drug interactions with ritonavir
• Omega-3-acid ethyl esters (Omacor ® / Teromeg ® 1000mg capsules): dose-dependent increased risk of atrial fibrillation in patients with established cardiovascular diseases or cardiovascular risk factors
• Pseudoephedrine hydrochloride: very rare risk of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS)
• Quinolones: must now only be prescribed when other commonly recommended antibiotics are inappropriate
• Semaglutide (Ozempic ®), Liraglutide (Saxenda ®): vigilance required due to potentially harmful falsified products
• Valproate: new safety and educational materials to support regulatory measures in men and women under 55 years of age
• Vitamin B12: advise patients with known cobalt allergy to be vigilant for sensitivity reaction

Other significant changes include updated guidance on:

• Bromocriptine: update to important safety information
• Budesonide dosing for modified-release capsules
• Controlled drugs and drug dependence: control of nitrous oxide
• Management of diabetic hyperglycaemic emergencies in individuals aged 16-18 years
• Empagliflozin use in renal impairment and new indication for chronic kidney disease
• Ezetimibe for prevention of cardiovascular events
• Hyoscine butylbromide: update to important safety information
• Insulin degludec (Tresiba ®): potential for inappropriate dosing of insulin when switching (Tresiba ®) products [National Patient Safety Alert advice]
• Malaria prophylaxis
• Meningococcal vaccines
• Metformin hydrochloride for type 1 diabetes mellitus
• Pneumococcal vaccine
• Prescribing in renal impairment: removal of race from CKD-EPI equation
• Management of type 2 diabetes
• Vaccination, general principles: for individuals with asplenia, splenic dysfunction, or complement disorders
• Valproate: organisations to prepare for new regulatory measures for oversight of prescribing to new patients and existing female patients [National Patient Safety Alert advice]
• Varicella-zoster vaccines: immunisation against herpes zoster (shingles)

British National Formulary is published jointly by BMJ and Pharmaceutical Press, the publishing division of Royal Pharmaceutical Society.