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March 2020

Welcome to the March BNF Newsletter.

• One new drug monograph has been added to both the BNF and BNF for Children in the last month: dienogest. Two new drug monographs have been added to the BNF in the last month: strontium ranelate and upadacitinib.
• MHRA advice on mecasermin (Increlex®), ondansetron, sodium valproate, valproic acid.

Kind regards,
BNF Team

Other topics:

Significant changes   |   Drug Safety Update   |   BNF 79 new edition available

Significant changes

BNF BNF only

New monograph: Aritso® [strontium ranelate] for severe osteoporosis in men and postmenopausal women at increased risk of fractures [when other treatments are contra-indicated or not tolerated].

New monograph: Rinvoq® [upadacitinib] for rheumatoid arthritis (specialist use only)

Olaparib for maintenance treatment of relapsed platinum-sensitive ovarian, fallopian tube or peritoneal cancer [NICE guidance].

Osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer [NICE guidance].

Pain, chronic: new guidance on management.

Palbociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer [NICE guidance].

BNF for Children BNF for Children Only

Mecasermin (Increlex®): risk of benign and malignant neoplasia [MHRA/CHM advice].

Newborn life support algorithm updated.

BNF BNF for Children Both BNF and BNF for Children

New monograph: Zalkya® [dienogest] for endometriosis.

Cannabidiol with clobazam for treating seizures associated with Dravet syndrome and treating seizures associated with Lennox–Gastaut syndrome [NICE guidance].

Diabetic foot infections, antibacterial therapy: new guidance on management.

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.

Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy [MHRA/CHM advice].

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

Sodium valproate: Updated Valproate Pregnancy Prevention Programme [MHRA/CHM advice].

Valproic acid: Updated Valproate Pregnancy Prevention Programme [MHRA/CHM advice].

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.

Ingenol mebutate gel (Picato): suspension of the licence due to risk of skin malignancy.

Lemtrada (alemtuzumab): updated restrictions and strengthened monitoring requirements following review of serious cardiovascular and immune-mediated reactions.

Valproate (Epilim, Depakote) pregnancy prevention programme: updated educational materials.

Nexplanon (etonogestrel) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration.



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

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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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