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23 February 2024

BNF Newsletter

Read the BNF newsletter for the latest guidance and content updates to the BNF and BNF for Children. Sign up to the BNF monthly newsletter.

February 2024

Previous newsletters:
January 2024, December 2023, November 2023, October 2023, September 2023, August 2023July 2023June 2023May 2023April 2023March 2023February 2023,

23 February 2024

Nutritional Borderline Substances in BNF Publications

Throughout 2024 we are undertaking a project to re-arrange Nutritional Borderline Substances content in the BNF and BNF for Children to align with changes made to the categorisation and coding of these products by the Advisory Committee on Borderline Substances (ACBS) and NHS Business Services Authority (NHSBSA). The aim of these changes is to improve navigation and facilitate comparison of nutritional products to support prescribing.

9 January 2024

Pharmacodynamic effects tables now in digital formats

Pharmacodynamic effects of particular clinical significance are included in BNF and BNF for Children interactions content to draw users’ attention to the theoretical risks of the concurrent use of two or more drugs with the potential for the same additive effect; please note that this content is not exhaustive. In digital formats, these effects are included as interaction messages between drug pairs. However in print, where there are space constraints, tables are used to present this information.

Due to the popularity of the pharmacodynamic effects table format these have now been included in digital formats of the BNF and BNF for Children. Digital formats will also continue to include pharmacodynamic effects as interaction messages for quicker and easier searching and so that users can immediately see the full picture of both pharmacokinetic and pharmacodynamic interactions for a drug pair. The tables of pharmacodynamic effects are updated every six months, in line with the print editions of BNF Publications.

For more information, see Interactions, Pharmacodynamic effects in Frequently asked questions—clinical.

Changes will be seen in the January 2024 digital update and BNF + BNFC app, and will continue to appear in the print editions of BNF and BNF for Children.

How to find the tables of pharmacodynamic effects in digital formats

Online: To find the tables of pharmacodynamic effects in BNF or BNF for Children Online, search ‘interactions’ in the publication search bar at the top of the page. The tables of pharmacodynamic effects can be found by clicking on ‘Appendix 1 Interactions’ in the list of search results.

For the tables of pharmacodynamic effects on MedicinesComplete, see Appendix 1 Interactions.

BNF + BNFC app: To find the tables of pharmacodynamic effects in BNF + BNFC app, click on the ‘Interactions Checker’ icon at the bottom of the screen. The tables of pharmacodynamic effects can be found by clicking on ‘About interactions’.

12 December 2023

Errors involving different forms of benzylpenicillin

Errors describing confusion between the different salt formulations of benzylpenicillin (benzylpenicillin sodium and benzathine benzylpenicillin) have been reported to NHS England’s National Patient Safety Team. A statement has been added to the Important safety information section of these monographs in the BNF and BNF for Children to highlight the importance of ensuring that the correct formulation is ordered, prescribed, dispensed, and administered.

6 October 2023

Vaccines in BNF Publications

Vaccine monographs in the BNF and BNF for Children have been updated to more clearly identify whether a vaccine is live or not.

For each vaccine monograph, the Drug action section includes a short summary of the vaccine type. Detailed information on the vaccine’s mechanism of action can be found in the corresponding Treatment summaries. The classifications, which are used to group similar vaccines, have also been updated.

For some vaccines, such as the influenza vaccines, live and inactivated preparations are available, so information has been separated into two monographs. Users should ensure they are referring to the correct monograph when looking for information; to navigate between related monographs, use the cross-reference in the Drug action section.

The vaccines class monograph has also been reviewed and updated. Information that is common to all vaccines can be found in the Vaccines, general class monograph. A new class monograph Vaccines, live contains information that is only relevant to live vaccines. Some monographs may have additional information that is specific to the individual vaccine. In such cases, information from the class monograph(s) and the individual monograph need to be considered together.

Changes will be seen in the October 2023 digital update and BNF app, and will appear in the 2024 print editions of BNF and BNF for Children.

7 June 2023

NICE and UKHSE antimicrobial summary guidance

The Summary of antimicrobial prescribing guidance – managing common infections is now hosted on the Antibiotic and diagnostic quick reference tools of the Royal College of General Practitioners eLearning website and, as such, is no longer hosted by BNF Publications.

23 May 2023

Specialist drug monographs within BNF Publications

From June 2023, BNF Publications will be more clearly and consistently identifying specialist drug monographs within content, by including the words “Specialist drug” alongside the monograph title. This feature will be applied to existing monographs, and to monographs moving forward, that are used within specialist settings (such as drugs used for malignancy, and those given via intravitreal injection). These “specialist drug” monographs will contain less detail than a regular monograph within BNF Publications. A “specialist drug” monograph will continue to include information to support patient safety and non-specialist patient care (such as important safety information, interactions, side-effects, and contra-indications), but it will not contain information which is within the remit of specialist care (such as doses, and directions for administration).

Why are these changes being made?

Based on the primary use case of BNF Publications, supporting non-specialist clinical practice, the preface of the BNF sets out that less detail is given for specialist areas such as malignant disease. However, there has been no consistent style used within BNF monographs to highlight to users that a drug is used in these specialist areas.

Over the last year, we have undertaken research to understand how we could ensure that specialist drug content in BNF Publications is aligned with the stated scope within the preface, and with the primary use case of the BNF. Analytics around the use of BNF Publications’ content confirmed that specialist drug content is accessed much less frequently than drug content for non-specialist use. User research supported the analytics, and showed that those users who did access specialist content were most commonly looking at safety information, such as contra-indications, interactions, and side-effects.

The results of this research have enabled us to critically review the information that should be included within specialist drug monographs. “Specialist drug” monographs will contain less detail than a regular monograph within BNF Publications, in a consistent format. A “specialist” monograph will continue to include information to support patient safety and non-specialist patient care (such as important safety information, interactions, side-effects, and contra-indications), but it will not contain information which is within the remit of specialist care (such as doses, and directions for administration). The current level of additional prescribing information has been retained for drug monographs that have a mix of specialist and non-specialist uses (such as methotrexate that is used for both malignancy and rheumatological conditions).

This new feature will appear within the June 2023 monthly digital update and the BNF app, and will be present within the September 2023 print editions of BNF and BNF for Children.

24 February 2023

Remember to check the information for all components of combination drugs

In drug monographs that contain two or more drugs, the BNF includes cross references to the single ingredient monographs to help the user locate all information about the drugs contained in the combination product.

Currently the cross references from combination monographs to constituent drugs are not appearing on the Android app in a small number of cases. We are working to reinstate these signposting statements.

Note: This issue is now resolved.

16 September 2022

BNF 84 and BNF for Children 2022-23: Yellow Cards and Quick Reference Guides

In the upcoming print editions, BNF 84 and BNF for Children 2022–23, you will notice that the pages inserted after the index have been updated as follows:

  • Yellow Card inserts have been removed — information on when and how to submit Yellow Cards and links to online reporting sites remain available in the Adverse reactions to drugs section; signposting to this section and a link to the MHRA’s Yellow Card website is included on the back cover of print editions
  • Quick reference guides are now printed on standard paper stock instead of glossy paper — all content that was previously on these pages remains present (e.g. life support algorithms and key drug doses in medical emergencies)
  • Quick reference guides have been re-ordered to facilitate rapid reference — the advanced life support algorithm is now easily accessible on the inside back cover and listed in the Contents page

25 July 2022

BNF app login brings new Favourites functionality

With the latest update, you now have access to the new features on the BNF app, providing you with an improved experience.

Favourite records
Our research has shown many users want quick access to BNF records they visit frequently. By introducing registration, we are now able to give you a more personalised experience with the new ‘Favourites’ feature. Favourites will allow you to bookmark drug monographs, treatment summaries, and other records you refer to frequently or need to find quickly and access them across multiple devices.

Registration
To enable the Favourites functionality, and to support future app development, you will now be asked to register for access to the BNF app. It is quick and easy to do — just enter your email address and job role, then choose a password. Once you log in to the BNF app, you will remain logged in on your device.

All users are now required to register and log in to access the BNF app. The BNF app remains fully functional both online and offline, providing access to the latest drug information quickly, and on-the-go.

Why register for an account?

  • Quick and easy registration process, at no cost to you
  • Access your favourite records quickly, across multiple devices
  • Help us improve the app based on usage and needs

The BNF app remains fully functional both online and offline, providing access to the latest drug information quickly, and on-the-go.

30 June 2022

Correction of side-effect content in BNF monographs for cetuximab, lenvatinib and regorafenib

Omissions of side-effects within three BNF monographs have been identified, as follows:

  • Cetuximab — hypersensitivity (severe, sometimes fatal and may be delayed)
  • Regorafenib — haemorrhage (sometimes fatal)
  • Lenvatinib — haemorrhage (sometimes fatal)

These omissions have been corrected and the side-effects will be present in digital versions of BNF for the July 2022 monthly update and the forthcoming print edition, BNF 84 (September 2022).

10 September 2021

NHS registered user access extended

NHS registered user access to BNF content through MedicinesComplete has been automatically extended. If you have received an email asking you to re-register as an NHS user, you can safely ignore it and your access will not be affected.

If you have re-registered as an NHS user, thank you, your access to BNF content through MedicinesComplete is also confirmed.

If you have any questions, please get in touch.

6 August 2021

Correction of valganciclovir information in BNF for Children

The valganciclovir drug monograph in BNF for Children has incorrectly included the following equivalence statement since the monograph was added for the July 2018 monthly digital update and the print edition BNF for Children 2018-2019.

Dose equivalence and conversion
Oral valganciclovir 900 mg twice daily is equivalent to intravenous ganciclovir 5 mg/kg twice daily.

This statement applies to dosing in adults only.

It will be removed from digital versions of BNF for Children for the August 2021 monthly update and the forthcoming print edition BNF for Children 2021-2022.

30 July 2021

Interactions for combination drugs: check interactions for the individual component drugs

On MedicinesComplete, the interactions checker is currently not displaying interactions for co-drugs (e.g. co-codamol, co-trimoxazole) correctly. The results state that there are no interaction results for co-drugs, when this is not the case. Users are reminded to always check the interactions of all individual components of co-drugs to get the complete clinical information.

This issue applies to the interactions checkers for BNF and BNF for Children and the Stockley’s Interactions Checker on MedicinesComplete. In BNF and BNF for Children on MedicinesComplete, when using the navigation panel to filter search results of co-drugs by Interactions, the same issue also occurs.

The interactions are displaying correctly when the interactions information is accessed directly via links from the Interactions section of the co-drug monographs in BNF and BNF for Children.

This issue only affects interactions content on MedicinesComplete.

Please contact editor@bnf.org with any questions.

Note: This issue is now resolved.

30 May 2019

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.

26 July 2018

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.