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April 2020

Welcome to the April BNF Newsletter.

• One new drug monograph has been added to both the BNF and BNF for Children in the last month: benzathine benzylpenicillin. One new drug monograph has been added to the BNF in the last month: siponimod. One new drug has been added to the BNF for Children in the last month: plerixafor.
• MHRA advice on adrenaline/epinephrine (Emerade®) pre-filled auto-injector, alemtuzumab (Lemtrada®), etonogestrel (Nexplanon®) contraceptive implants, ingenol mebutate gel (Picato®) and modafinil.

Kind regards,
BNF Team

Other topics:

Significant changes   |   Drug Safety Update   |   BNF 79   |   Critical Illness   |   COVID-19 resources

Significant changes

BNF BNF only

New monograph: Mayzent® [siponimod] for multiple sclerosis (secondary progressive, with active disease, initiated by a specialist).

Alemtuzumab (Lemtrada®): updated restrictions and strengthened monitoring requirements following review of serious cardiovascular and immune-mediated reactions [MHRA/CHM advice].

Cardiovascular disease risk assessment and prevention: updated guidance.

Dapagliflozin with insulin for treating type 1 diabetes [NICE guidance].

Diverticular disease and diverticulitis: updated guidance on management

Gastro-intestinal system infections, antibacterial therapy: updated guidance for acute diverticulitis

Ingenol mebutate gel (Picato®): suspension of the licence due to risk of skin malignancy [MHRA/CHM advice].

Modafinil: potential risk of congenital malformations during pregnancy [MHRA/CHM advice]

Patiromer calcium for treating hyperkalaemia [NICE guidance].

Peginterferon beta-1a for treating relapsing–remitting multiple sclerosis [NICE guidance].

Dose changes for BNF only
Ergotamine tartrate with caffeine hydrate and cyclizine hydrochloride [addition of max. courses per month].

BNF for Children BNF for Children Only

New monograph: Mozobil® [plerixafor] to mobilise haematopoietic stem cells to peripheral blood for collection and subsequent autologous transplantation in patients with lymphoma or solid malignant tumours (specialist use only)

Dose changes for BNF for Children only
Eucalyptus with menthol [updated child age range].

BNF BNF for Children Both BNF and BNF for Children

New monograph: benzathine benzylpenicillin for erysipelas, yaws, pinta, syphilis [primary and secondary stage and late-stage (latent seropositive)], prophylaxis of rheumatic fever [without cardiac involvement, transient cardiac involvement and persistent cardiac involvement], prophylaxis of poststreptococcal glomerulonephritis [without cardiac involvement, transient cardiac involvement and persistent cardiac involvement] and prophylaxis of erysipelas [without cardiac involvement, transient cardiac involvement and persistent cardiac involvement].

Adrenaline/epinephrine (Emerade®) pre-filled auto-injector: update on failure to activate [MHRA/CHM advice].

Antimicrobial stewardship: new guidance.

Etonogestrel (Nexplanon®) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration [MHRA/CHM advice].

Medicines optimisation: new guidance.

Dose changes for both BNF and BNF for Children
Benzoin tincture, compound [updated child age range].

Eucalyptus with menthol [frequency of dosing].

Fluocinolone acetonide with clioquinol [updated dosing frequency].

Paracetamol with buclizine hydrochloride and codeine phosphate [child age ranges].

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.

Esmya (ulipristal acetate): suspension of the licence due to risk of serious liver injury

Tofacitinib (Xeljanz): new measures to minimise risk of venous thromboembolism and of serious and fatal infections

Baricitinib (Olumiant): risk of venous thromboembolism

SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness

Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression



BNF 79 new edition available!

Compiled with the advice of clinical experts and continually updated to reflect the latest evidence from credible sources worldwide, the new edition of the British National Formulary 79 (BNF) provides up-to-date guidance on prescribing, dispensing, and administering medicines.

978 0 85711 365 8 | £59.95 | 1768 pages | March 2020

BNF 79

Extensive content updates in the BNF 79 edition include:

New Monographs added on
Renoxitin® [cefoxitin] for complicated urinary tract infections and pyelonephritis
Ledaga® gel [chlormethine] for mycosis fungoides
Ondexxya® [andexanet alfa] for reversal of apixaban or rivaroxaban in life-threatening or uncontrolled bleeding
Epidyolex® [cannabidiol] for seizures associated with Lennox-Gastaut syndrome and seizures associated with Dravet syndrome [adjunctive treatment with clobazam]
Rizmoic® [naldemedine] for opioid-induced constipation.
MHRA advice on
Febuxostat (Adenuric®): increased risk of cardiovascular death and all-cause mortality in clinical trial in patients with a history of major cardiovascular disease
Pentosan polysulfate sodium (Elmiron®): rare risk of pigmentary maculopathy
Hormone replacement therapy (HRT) (conjugated oestrogens (equine) and estradiol): further information on the known increased risk of breast cancer with HRT and its persistence after stopping.
Dose changes including magnesium sulfate: change to additional dose for seizure recurrence in pre-eclampsia and eclampsia.

Updated guidance on vaccines in-line with Public Health England recommendations.

Buy BNF 79

Critical Illness

Critical Illness

We are currently developing an essential resource focussed on supporting those working in critical care, due for release next year. Due to these exceptional circumstances we are releasing as much content as we can now and at no charge, to support the NHS and MedicinesComplete users through this crisis.

View Critical Illness

or click the icon under the search bar on the MedicinesComplete homepage.

Critical Illness provides evidence-based information to help guide the most effective treatment for adult patients in intensive care. This advance release will start with 6 drug monographs including dosage and prescribing guidance.

To be notified when a full set of guidance is published in 2021 or if you would like to be involved in the further development of Critical Illness please sign up here.

Useful COVID-19 Resources

Information around medicines use in COVID-19 is changing rapidly. Stay on top of the most recent information produced by the government and the RPS, using the links below:

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 If you would like to donate your copy email:


How to purchase BNF





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