June 2019 eNewsletter

The June newsletter contains the latest guidance and content updates to the BNF and BNFC. This month features the BNF app, new dose changes, monographs and clinical news.

Previous eNewsletters can be found below:

May 2019

April 2019

March 2019

February 2019

January 2019

December 2018

November 2018

October 2018

September 2018

August 2018

July 2018

June 2018

May 2018

April 2018

March 2018

February 2018

January 2018

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BNF Interactions

In 2017 the BNF interactions were rewritten to be more consistently structured, allowing users to find interactions more easily, and giving more information about the severity and evidence of an interaction. All interactions are listed under individual drugs. When checking interactions for combination drugs or co-drugs, it is essential to refer to each drug in the combination. The interactions section of the drug monograph clearly states the drugs (or drug classes) that need to be referred to in the interactions (Appendix 1 in print).

Co-trimoxazole

Please note that co-trimoxazole currently has its own entry in print that does not include the interactions for trimethoprim. As stated above, it is essential to refer to both drugs (trimethoprim and sulfamethoxazole, under sulfonamides) to find all relevant interactions for this drug. This inconsistency will be corrected in the upcoming September editions, BNF 78 and BNF for Children 2019-2020. Digital products including MedicinesComplete and the BNF app have been corrected for the June monthly update.

For information on how to use the BNF, see How to use BNF publications. For more information on how to use the interactions content, see Appendix 1 Interactions.

Important notice to users of the iOS and Android BNF and BNFC Apps

Please ensure that you update your BNF app before you access the content. A fix has been made to correct a technical error that was resulting in some content not appearing. Online web versions of the BNF are unaffected.

The correct version to run for the December 2018 monthly update is 2.1.8 (iOS) and 2.1.11 (Android).

Please note that all digital platforms are updated every month. For the most up-to-date content and functionality, please ensure that you are using the latest version.

Clarification of the Doses at extremes of body-weight statement for vancomycin in BNF and BNF for Children

In July, BNF and BNF for Children digital products were updated in line with the SPC to recommend weight-based dosing of intravenous vancomycin. The ‘doses at extremes of body-weight’ section erroneously included a recommendation about dosing based on ideal body-weight. Note that the manufacturer recommends that intravenous weight-based doses for all patients should be based on total [actual] body-weight.

BNF and BNF for Children digital products will be updated to reflect this recommendation in both BNF and BNF for Children in the next scheduled update in mid-August.

Clarification of the parenteral dose of quinine for the treatment of malaria in BNF and BNF for Children

The maintenance dosing recommendations for parenteral quinine for the treatment of malaria have been updated in the BNF and BNF for Children digital publications. The requirement to reduce the maintenance dose to 5–7 mg/kg if parenteral treatment is needed for more than 48 hours has been added to all parenteral dose statements.

These updated recommendations will be present in the June monthly update for all digital products of BNF and BNF for Children; these changes will also be reflected in the print editions for BNF 76 and BNF for Children 2018-2019.

Clarification of dose of tramadol with paracetamol in BNF and BNF for Children

In light of a range of strengths now being available for combination tramadol-paracetamol preparations, the dose in BNF and BNF for Children has been updated in digital products.

The previous dose, expressed as tablets was not appropriate for the highest strength preparation (tramadol 75mg and paracetamol 650mg). The dosing has therefore been updated to express the dose in milligrams.

The new dosing has now been published in the tramadol with paracetamol monograph in digital versions of the BNF Publications.

Palliative care: tell us what you think

BNF Publications are always looking for ways to improve. Currently, we are particularly keen to understand what users think about the palliative care content within our publications.

With that in mind, below is a link to a short survey (approximately 10 minutes) that aims to help us understand how BNF Publications can further support palliative care practice. We thank you in advance for your participation.

BNF Palliative Care Survey

Correction of dose of Ironorm® Drops in BNF for Children

The dose of Ironorm® Drops for the treatment of iron deficiency anaemia has been updated in the BNF for Children digital products.

The dose incorrectly stated a maximum volume per dose of 8mL, instead of a maximum volume per day of 8mL.

The correct dose is as follows:

Iron-deficiency anaemia (therapeutic)

By mouth

Child 1 month–5 years
0.12–0.24 mL/kilogram daily in 2–3 divided doses; maximum 8 mL per day.

Child 6–11 years
0.12–0.24 mL/kilogram daily in 2–3 divided doses; maximum 8 mL per day.

Child 12–17 years
4 mL 1–2 times a day.

This updated dose will be present in the October monthly update for all digital products of BNF for Children.

Appointments to the BNF for Children’s Paediatric Formulary Committee

BNF Publications are pleased to announce the appointments of a Chair and Deputy Chair of the BNF for Children’s Paediatric Formulary Committee (PFC).

Dr David Tuthill has been appointed as the Chair of the BNF for Children’s PFC. David is a consultant general paediatrician at the Children’s Hospital for Wales and Llandough Hospital. His main clinical focus is children with allergic and general paediatric problems. He has been involved in work around medication and patient safety and also has expertise in quality improvement. He has been a member of the PFC since 2011. David is also a member of the Medicines Committee at the Royal College of Paedatrics and Child Health (RCPCH). He has been actively involved in development of the Medicines for Children website, a joint initiative between RCPCH, the Neonatal and Paediatric Pharmacists Group (NPPG) and Wellchild.

Neil Caldwell has been appointed as the Deputy Chair of the BNF for Children’s PFC. Neil is a consultant pharmacist for children’s services at Wirral University Teaching Hospital and honorary lecturer at Liverpool John Moores University and has been a member of the PFC since 2011. Neil is a lead reviewer of Medicines for Children leaflets and, since 2009, he has been member of the NPPG committee; he was also part of the NICE Guideline Development Group for Antibiotics for Early Onset Neonatal Infection from 2010­–2012. Neil was awarded a Faculty Fellow of Royal Pharmaceutical Society in 2014.

New BNF & BNFC App launches for UK NHS Professionals

A new BNF & BNFC App is available to download from App Store and Google Play.  Containing the latest content from both the BNF and BNF for Children (BNFC), the app provides access to practical, evidence-based medicines information whenever – and wherever – it is needed.

The App is aimed at prescribers, pharmacists, and other health and social care professionals working within the NHS in the UK who need accurate, up-to-date information about the use of medicines. It features the same content structure as the BNF print and web editions and has been purpose-built for iOS and Android platforms.

The App’s predictive searching is fast and intuitive, the BNF drug monographs make dosage and prescribing information immediately accessible, and the arrangement of information into sections on Drugs, Treatment summaries, Interactions, Medical devices, Borderline substances and Wound care makes it easy to navigate. The App includes a robust interactions checker that makes identifying potentially serious issues between combinations of drugs quick and simple.

The App lets users search and retrieve BNF content without a connection to the internet. Its clinical content is updated every month, so users can be sure they are basing their decisions on the latest information available.

BNF Director, Karen Baxter comments:

“The new BNF & BNFC App has been designed to be responsive, interactive and very easy to access, saving clinicians valuable time. We have had great initial feedback from our test group on its intuitive design and ease of use.  This new digital format adds to the range of ways health professionals can access BNF content and we are delighted to be able to share it with you.”

Commercial users of the BNF who wish to use the App should contact opsteam@rpharms.com to discuss licencing arrangements.