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eNewsletter
June 2019

Welcome

Welcome to the June BNF eNewsletter.

• Two new drug monographs have been added to the BNF in the last month: prasterone and doravirine. One new drug monograph has been added to the BNFC in the last month: mepolizumab.
• We have also included dose changes for atovaquone with proguanil hydrochloride to both the BNF and BNFC and to caffeine citrate in the BNFC.
• We have included MHRA advice including restrictions and precautions for use of fluoroquinolone antibiotics and yellow fever vaccine fatal adverse reactions: extreme caution needed in those who are immunocompromised or aged 60 years and older.
• We have updated guidance in-line with Public Health England recommendations including influenza vaccine and malaria prophylaxis.

Kind regards,
BNF Team

Other topics:

Significant changes   |   Drug safety update  |   News  |   Clinical News  |   How to purchase BNF   |   Feedback

Significant changes

BNF BNF for Children Both BNF and BNFC

Valproate medicines and serious harms in pregnancy: new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme [MHRA/CHM advice] (see sodium valproate and valproic acid).

Gabapentin (Neurontin®) and risk of abuse and dependence: new scheduling requirements from 1 April [MHRA/CHM advice].

Respiratory system infections, antibacterial therapy: new guidance on management of Cough, acute.

Malaria, prophylaxis: updated country recommendations in the recommended regimens for prophylaxis against malaria in-line with Public Health England.

Malaria, prophylaxis: updated guidance in-line with Public Health England recommendations.

Immunisation schedule: updated National flu immunisation programme in-line with Public Health England recommendations.

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

Quinolones: new MHRA/CHM advice on restrictions and precautions for use of fluoroquinolone antibiotics.

Renal and ureteric stones: new guidance on management.

BNF for Children BNFC Only

New monograph: Nucala® [mepolizumab] as add on treatment for severe refractory eosinophilic asthma (under expert supervision).

New preparation: Slentyo® [melatonin] for insomnia with autism spectrum disorder [where sleep hygiene measures have been insufficient] or insomnia with Smith-Magenis syndrome [where sleep hygiene measures have been insufficient].

Yellow fever vaccine, live (Stamaril®) and fatal adverse reactions: extreme caution needed in people who may be immunosuppressed [MHRA/CHM advice].

Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1 [MHRA/CHM advice] (see elvitegravir with cobicistat, emtricitabine and tenofovir alafenamide).

Dose Changes for BNFC only
Caffeine citrate [maintenance dosing].

Malarone® Paediatric (atovaquone with proguanil hydrochloride) [update to weight ranges for prophylaxis of falciparum malaria].

BNF BNF only

New monograph: Intrarosa® [prasterone] for vulvar and vaginal atrophy [in postmenopausal women with moderate to severe symptoms].

New monograph: Pifeltro® [doravirine] for HIV-1 infection in combination with other antiretroviral drugs (initiated by a specialist)

New preparation: Delstrigo® [lamivudine with tenofovir disoproxil and doravirine] for HIV-1 infection (initiated by a specialist).

New preparation: Testavan® [testosterone] for hypogonadism due to androgen deficiency in men.

Daratumumab with bortezomib and dexamethasone for previously treated multiple myeloma [NICE guidance].

Tildrakizumab for treating moderate to severe plaque psoriasis [NICE guidance].

Certolizumab pegol for treating moderate to severe plaque psoriasis [NICE guidance].

Brentuximab vedotin for treating CD30-positive cutaneous T-cell lymphoma [NICE guidance].

Alemtuzumab (Lemtrada®): restriction of use due to serious safety concerns [MHRA/CHM advice].

Tofacitinib (Xeljanz®): increased risk of pulmonary embolism and mortality in rheumatoid arthritis patients receiving 10 mg twice daily in a clinical trial [MHRA/CHM advice].

Yellow fever vaccine, live (Stamaril®) and fatal adverse reactions: extreme caution needed in those aged 60 years and older [MHRA/CHM advice].

Belimumab (Benlysta®): increased risk of serious psychiatric events seen in clinical trials [MHRA/CHM advice].

Pregabalin (Lyrica®) and risk of abuse and dependence: new scheduling requirements from 1 April [MHRA/CHM advice].

Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1 [MHRA/CHM advice] (see elvitegravir with cobicistat, emtricitabine and tenofovir alafenamide and elvitegravir with cobicistat, emtricitabine and tenofovir disoproxil).

Dose Changes for BNF only
Malarone® (atovaquone with proguanil hydrochloride) [update to weight range for prophylaxis of falciparum malaria].

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.

Lemtrada (alemtuzumab) and serious cardiovascular and immune-mediated adverse reactions: new restrictions to use and strengthened monitoring requirements

Tofacitinib (Xeljanz): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing

Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy

Yellow Card: please help to reverse the decline in reporting of suspected adverse drug reactions

News

A successful year for the BNF app

The British National Formulary (BNF) app helps busy healthcare professionals access essential medicines information quickly, offline and on-the-go.

Its intuitive and user-friendly design has been recognised multiple times over the past 12 months, winning two British Interactive Media Association (BIMA) Awards, a London Design Award and a Business Association Design Effectiveness Award.

From the predictive search helping users to find information quickly, to the Interactions Checker tool enabling rapid identification of harmful drug interactions, the thoughtful design of the BNF app supports the selection of safe and effective medicines.

Used by more than 180,000 healthcare professionals every month, it continues to be an essential tool for those prescribing, dispensing and administering medicines.

Find out more about the BNF app.

Clinical News

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.

Please donate old copies of the BNF
The PharmAid Scheme is an initiative of the Commonwealth Pharmacists Association where recent versions of medicines information resources including the BNF are redistributed to low and middle income countries. You can make a difference in another commonwealth country by simply donating your old BNF copies to them.

For more information on this scheme see commonwealthpharmacy.org/what-we-do/pharmaid/. If you would like to donate your copy email: admin@commonwealthpharmacy.org.

How to purchase BNF

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To order the March 2019 edition, visit the Pharmaceutical Press website

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