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.

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.

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).

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.

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.

BNF Publications will now host the Summary of antimicrobial prescribing guidance – managing common infections on behalf of the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE). The hosting on BNF.org is an interim measure, whilst a long-term solution for the governance and hosting is established.

The Summary is a rapid reference containing recommendations around antimicrobial prescribing from NICE and PHE. The Summary will be updated at least quarterly and is available as a PDF and Word Document (updated February 2023).

The current version was updated February 2023, with changes made to recommendations for Acute sore throat and Scarlet fever (GAS).

From June 2023, NICE will resume responsibility for hosting this resource and, as such, it will no longer be hosted on www.bnf.org. Please email nice@nice.org.uk for further information.

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.

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.

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.

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.