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Welcome to the March eNewsletter.

BNF 71 is now published! Read on for more details. Remember, NICE no longer supply a March print edition to eligible health professionals, so see below for details of how to order your copy and the preferential pricing for bulk orders and members of various professional associations.

Elsewhere in this month's eNews you'll find new advice issued by the MHRA to prescribe and dispense levonorgestrel-releasing intra-uterine devices by brand name; updated information about the dosage and side-effects of nicorandil; new information about the licensed indication of prucalopride; updated guidance on the management of irritable bowel syndrome, and guidance on diverticular disease and diverticulitis.
BNF 71 available to order now More >
Significant changes More >
News More >
Monthly price update reminder More >
Drug Safety Update More >
Feedback on our eNewsletter More >
Finally, we're introducing a brand new function on MedicinesComplete, which allows the evidence grading of selected content to be displayed - see more.

Kind regards,
BNF Team
BNF 69 now published
BNF 71 (March 2016) has been revised and revalidated to reflect changes in product availability, emerging safety concerns and shifts in clinical practice. Out now, BNF 71 will help you prescribe the most effective drugs and minimise the risks, improve your patient care and comply with best practice. Its improved and redeveloped structure gives you quick and easy access to the information you need, helping you make better choices.

Some of the significant content updates for BNF 71 include:

New safety information including
very low risk of subacute cutaneous lupus erythematosus with proton pump inhibitors
risk of severe bradycardia and heart block when hepatitis C drugs taken with amiodarone hydrochloride
risk of diabetic ketoacidosis with sodium glucose co-transporter 2 (SGLT2) inhibitors
increased reports of eye irritation since reformulation of latanoprost (Xalatan®)
BNF 71
Updated advice for further measures to minimise risk of osteonecrosis of the jaw associated with use of denosumab and intravenous bisphosphonates
Updated safety information on risk factors for uterine perforation associated with the use of intra-uterine contraception (intra-uterine contraceptive devices (copper) and levonorgestrel)
Inclusion of monitoring recommendations for risks of cardiac failure with crizotinib
Updates to immunisation schedule (Summer 2015): meningococcal group B vaccine, meningococcal groups A, C, W135 and Y vaccine, and influenza vaccine added
Addition of new preparations including Otezla® (apremilast), Kengrexal® (cangrelor), Velphoro® (sucroferric oxyhydroxide), and more
Significant dose changes including avanafil, colistimethate sodium (Promixin®), oseltamivir, and more
Order now - see the box below for details.

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Outside the UK, content is available via a subscription to MedicinesComplete. For more information contact
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BNF is also available as an eBook. Find out more here.
We offer preferential pricing for bulk orders and for members of various professional associations. So if you are buying on behalf of a CCG, Health Board, NHS Trust or other organisation, contact us here. GPs should contact their CCG direct, who can obtain discount when placing a centralised bulk order.
Significant changes
This month's changes to the clinical content of BNF publications are described in three parts:

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

Evidence grading: displayed on MedicinesComplete for selected, revalidated content
Recommendations made in selected, revalidated content of BNF Publications have been evidence graded to reflect the strength of the recommendation. The text to which the evidence grading applies is highlighted followed by a five-level grading symbol, from A to E. Clicking on the symbol will redirect to How BNF Publications are constructed, which includes an explanation of the grading system. The green evidence grading icon at the top of the page allows this display to be toggled ON and OFF. For further information, see the ipratropium bromide and caffeine citrate drug monographs. For more details about newly, revalidated treatment summaries which also display evidence grading, see BNF update below.

Levonorgestrel-releasing intra-uterine devices: prescribing and dispensing by brand name
The MHRA has advised that as levonorgestrel-releasing intra-uterine devices vary in licensed indication, duration of use and insertion technique, they should be prescribed and dispensed by brand name in order to avoid inadvertent switching. For further information, see levonorgestrel.

BNF update

Nicorandil: updated dosage
The monograph for nicorandil has been updated with new indication and dose information. Nicorandil is now indicated as second-line prophylaxis and treatment of stable angina in adult patients and can be increased if tolerated to 40 mg twice daily. For further information, see nicorandil.

Nicorandil: risk of ulcer complications
The MHRA has advised that nicorandil can cause serious skin, mucosal, and eye ulceration; this includes gastrointestinal ulcers, which may progress to perforation, haemorrhage, fistula or abscess. If ulceration occurs, treatment with nicorandil should be stopped and alternative treatment options considered. For further information, see nicorandil.

Prucalopride: licensed for use in men and women
The monograph for prucalopride has been updated. Prucalopride is now licensed for the treatment of chronic constipation in both men and women (previously women-only) when other laxatives fail to provide an adequate response. For further information, see prucalopride.

Irritable bowel syndrome: updated guidance on management
This treatment summary discusses the drug and non-drug treatment options of irritable bowel syndrome, including diet and lifestyle, antispasmodic drugs, laxatives and anti-motility drugs. The evidence grading for recommendations in this content is displayed on MedicinesComplete. For further information, see irritable bowel syndrome.

Diverticular disease and diverticulitis: updated guidance on management
Diverticular disease is a condition where sac-like protrusions of mucosa through the muscular colonic wall cause intermittent lower abdominal pain. Diverticulitis occurs when this is associated with inflammation or infection. This treatment summary discusses the treatment options for the symptomatic relief of diverticular disease and the prevention and treatment of complicated and uncomplicated diverticulitis. The evidence grading for recommendations in this content is displayed on MedicinesComplete. For further information, see diverticular disease and diverticulitis.

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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BNF eNews
Thank you to everyone who replied to our survey about this eNewsletter. We are collating your replies, and will draw upon your suggestions to provide you with a better and more useful newsletter in the months to come.

Corrections and Clarifications
Reminder - you can keep up to date with clarifications, corrections and updates to BNF Publications here.

How to use the new BNF CPPE
Reminder - you can find an interactive PDF from CPPE explaining how to use the restructured BNF here.
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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Drug Safety Update
Drug Safety UpdateDrug Safety Update is a monthly newsletter from the MHRA and Commission on Human Medicine. Please follow this link to review this month's Drug Safety Update.

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Feedback on our eNewsletter
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Subscribe to this eNewsletter here.

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