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Dear Colleague,

Welcome to the August 2014 BNF e-newsletter.

This month we discuss concomitant use of drugs affecting the renin-angiotensin system, and increased cardiovascular risk with ivabradine use.

Kind regards,
BNF Team
Significant changes More >
Changes to Appendix 3 More >
News More >
Monthly price update reminder More >
How to purchase BNF More >
Drug Safety Update More >
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Feedback on our e-newsletter More >
Significant changes
This month's changes to the clinical content of BNF publications are described in two parts:

• BNF update should be read by all users of the BNF
• BNFC update should be read by all users of the BNF for Children

BNF 67
BNF update

Concomitant use of drugs affecting the renin-angiotensin system
The MHRA has issued new guidance that combination therapy with two drugs that affect the renin-angiotensin system (ACE inhibitors, angiotensin-II receptor antagonists, and aliskiren) is not recommended due to an increased risk of hyperkalaemia, hypotension, and renal impairment, compared to use of a single drug. There is some evidence that the benefits of combination use of an ACE inhibitor with candesartan or valsartan may outweigh the risks in selected patients with heart failure for whom other treatments are unsuitable, however, the concomitant use of this combination, together with an aldosterone antagonist or a potassium-sparing diuretic is not recommended. For patients currently taking combination therapy, the need for continued combined therapy should be reviewed. For further details see BNF section

Increased cardiovascular risk with ivabradine
Preliminary results from a subgroup analysis of the SIGNIFY trial have shown a small increased risk of cardiovascular events with ivabradine, which may be associated with a heart rate below 60 beats per minute. A European Medicines Agency review is ongoing. The BNF cautions for ivabradine have been updated to include the need to monitor for bradycardia during use. For further details, see ivabradine.

Delamanid is licensed for the treatment of multiple-drug resistant pulmonary tuberculosis, in combination with other drugs. For more information see delamanid.

Simeprevir is a protease inhibitor that is licensed for use in combination with ribavirin and peginterferon alfa for the treatment of chronic hepatitis C infection of genotype 1 or 4. Regimens containing peginterferon alfa-2b are less effective than those containing peginterferon alfa-2a. Simeprevir may also be used in combination with sofosbuvir, with or without ribavirin, for the urgent treatment of chronic hepatitis C infection of genotypes 1 or 4 only when peginterferon alfa cannot be used because of intolerance or contra-indications. Simeprevir monotherapy is not recommended. For more information see simeprevir.

Other changes
To review other changes in the BNF, click on changes.

BNFC update

To review changes in BNFC, click on changes.

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Changes to Appendix 3: Cautionary and advisory labels
The following products from BNF and BNFC in the Appendix 3 list of products and their labels have been updated: :

Anoro Ellipta - Budenoside nebs - Delamanid - Deltyba - Olodaterol - Olysio - Simeprevir - Striverdi Respimat

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BNF 67
Remember - BNFC 2014-2015 is now published.
Packed with significant content updates, it reflects the latest changes in product availability, emerging safety concerns and shifts in clinical practice.

Order your new print copy now, or find out more about BNFC on MedicinesComplete.

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Monthly price update reminder
Prices of all branded medicinal products in the BNF and BNFC are now updated monthly. Prices of generic preparations of medicinal products are updated every 2-4 months, to coincide with print editions of BNF and BNF for Children. The BNF team keep price information up to date using data sourced from the NHS dictionary of medicines and devices (dm+d).

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How to purchase BNF
Purchase a print copy Purchase print copies
To buy the March 2014 edition, visit the Pharmaceutical Press website.
Purchase a print subscription Purchase a print subscription - and save up to 31%
A print subscription is the best way to ensure access to the latest copy of BNF as soon as it publishes. To order bulk subscriptions contact
BNF online BNF online
Outside the UK, content is available via a subscription to MedicinesComplete. For more information contact
BNF online BNF e-book
BNF is also available as an e-book on the iBookstore. Find out more here.
Drug Safety Update
Drug Safety UpdateDrug Safety Update is a monthly newsletter from the MHRA and Commission on Human Medicine. Review this month's Drug Safety Update.

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Twitter Latest Tweets @BNFormulary
Pharmaceutical Press Pharmaceutical Press @PharmPress
Do you have any questions about Martindale? We're interviewing the editors. Find out more in our eAlert
07:30 -01 Aug 2014
BNF BNF Publications @BNFormulary
Of course, we hope nobody needs any medical attention and ne'er a BNF spine needs to be cracked. But when and if they do, we'll be there.
01:10 - 23 Jul 2014
BNF BNF Publications @BNFormulary
The @Glasgow2014 Commonweath Games kicks off today, and BNF67 has the pleasure of being the official drug reference for the games.
01:08 - 23 Jul 2014

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