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April 2019


Welcome to the April BNF eNewsletter.

• Five new drug monographs have been added to the BNF in the last month: mexiletine, cidofovir, insulin glargine with lixisenatide, stiripentol and letermovir. One new drug monograph has been added to the BNFC in the last month: tigecycline.
• We have also included a dose change for rivaroxaban.
• We have included MHRA advice on carbimazole, olaratumab and SGLT2 inhibitors.

Other topics:

Significant updates   |   Drug safety update  |   News  |   How to purchase BNF   |   Feedback

Significant updates

Clarification for Anthrax vaccine dosing schedule update. This content appears in BNF only.

BNF BNF for Children Both BNF and BNFC

Carbimazole: risk of acute pancreatitis [MHRA/CHM advice].

Carbimazole: increased risk of congenital malformations; strengthened advice on contraception [MHRA/CHM advice].

Yellow fever vaccine: updated guidance in-line with Public Health England recommendations.

Controlled drugs and drug dependence: reclassification of gabapentin and pregabalin as Class C and Schedule 3 Controlled Drugs. Note: Preparation records containing pregabalin or gabapentin may not display a CD3 symbol for the April 2019 monthly update but will be amended in due course.

BNF for Children BNFC Only

New monograph: Tygacil® [tigecycline] for complicated skin and soft tissue infections and complicated intra-abdominal infections (when other antibiotics are not suitable).

Stiripentol [updated dosing information].

BNF BNF only

New monograph: Namuscla® [mexiletine] for myotonia in non-dystrophic myotonic disorders.

New monograph: Cidofovir for cytomegalovirus retinitis in patients with AIDS (in combination with probenecid) (specialist use only).

New monograph: Suliqua® [insulin glargine with lixisenatide] for type 2 diabetes mellitus [in combination with metformin].

New monograph: Diacomit® [stiripentol] for adjunctive therapy of refractory generalised tonic-clonic seizures in patients with severe myoclonic epilepsy in infancy (Dravet syndrome) in combination with clobazam and valproate (under expert supervision).

New monograph: Prevymis® [letermovir] for prevention of cytomegalovirus reactivation and disease [in recipients of an allogenic haematopoietic stem cell transplant who are seropositive for the human cytomegalovirus] (initiated by a specialist).

Venetoclax with rituximab for previously treated chronic lymphocytic leukaemia [NICE guidance].

Encorafenib and binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma [NICE guidance].

Abemaciclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer [NICE guidance].

Olaratumab (Lartruvo®): no new patients to be prescribed due to study showing no clinical benefit [MHRA/CHM advice].

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin): reports of Fournier's gangrene (necrotising fasciitis of the genitalia or perineum) [MHRA/CHM advice].

Epilepsy inclusion of guidance for the management of Dravet syndrome and Lennox-Gastaut syndrome.

Dose Changes for BNF only
Rivaroxaban [clarification of dosing options for prophylaxis of recurrent deep-vein thrombosis and pulmonary embolism].

Drug Safety Update
Drug Safety Update is a monthly newsletter from the MHRA and Commission on Human Medicine. Please follow this link to review the latest Drug Safety Update.

Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects.

Onivyde (irinotecan, liposomal formulations): reports of serious and fatal thromboembolic events.

Medicines with teratogenic potential: what is effective contraception and how often is pregnancy testing needed?


Please donate old copies of the BNF
Old BNF copies can be donated to certain Commonwealth countries via the Pharmaid scheme of the Commonwealth Pharmacists Association. For more information on this scheme see If you would like to donate your copy email:

Tips for using the BNF and BNFC

In the BNF and BNFC drug monographs, information is placed under the most relevant heading. We do not duplicate the content in all relevant sections. This means you need to look at the monograph holistically, considering all content that could be relevant.

Examples of why this is important:
• If a medicine is contraindicated in pregnancy, you should expect to find this information under the PREGNANCY heading, rather than under the CONTRA-INDICATIONS heading. • A significant safety warning which needs passing on to patients may be highlighted in the IMPORTANT SAFETY INFORMATION box rather than sections such as PATIENT AND CARER ADVICE.

To safely and effectively use the BNF it is important to be familiar with the About and Guidance sections; the drug monographs should not be read in isolation.

Examples of why this is important:
• Before looking up a side effect in the drug monograph, you should read Adverse reactions to drugs in the Guidance section. This section explains why we don't routinely include some side effects.
• It is noted in both Prescribing in Pregnancy and Prescribing in Breast Feeding in the Guidance section that 'Absence of information does not imply safety'

See the How to use BNF publications in print (page xii of BNF 77) and the How to use BNF publications online sections for an overview on structure and navigation of the BNF.

How to purchase BNF

To order the March 2018 edition, visit the Pharmaceutical Press website

Purchase a print subscription, ensure access to the latest copy of BNF and save money
Outside the UK, content is available via a subscription to MedicinesComplete

Access the latest copy of BNF on your mobile device, which is available as a PDF eBook

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