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May 2019


Welcome to the May BNF eNewsletter.

• Two new drug monographs have been added to the BNF in the last month: apalutamide and inotersen. One new drug monograph has been added to the BNFC in the last month: glecaprevir with pibrentasvir. One new drug monograph has been added to both BNF and BNFC in the last month: tezacaftor with ivacaftor.
• We have also included dose changes for alirocumab to the BNF and glycerol phenylbutyrate to the BNFC.
• We have included MHRA advice on fluoroquinolone antibiotics, irinotecan hydrochloride (liposomal formulations) and prescribing in pregnancy.

Also check out our new BNF case study booklet. This edition covers malaria, heavy menstrual bleeding and glaucoma.

Kind regards,
BNF Team

Other topics:

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

Significant changes

BNF BNF for Children Both BNF and BNFC

New monograph: Symkevi® [tezacaftor with ivacaftor] for cystic fibrosis (specialist use only).

Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin): new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects [MHRA/CHM advice].

Prescribing in pregnancy: Medicines with teratogenic potential, what is effective contraception and how often is pregnancy testing needed? [MHRA/CHM advice].

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

Respiratory system infections, antibacterial therapy: new guidance for acute exacerbations of Bronchiectasis (non-cystic fibrosis).

BNF for Children BNFC Only

New monograph: Maviret® [glecaprevir with pibrentasvir] for chronic hepatitis C (specialist use only).

Dose Changes for BNFC only
Glycerol phenylbutyrate [dose rounding recommendation for children under 2 years].

BNF BNF only

New monograph: Erleada® [apalutamide] for prostate cancer (specialist use only).

New monograph: Tegsedi® inotersen for stage 1 or stage 2 polyneuropathy in patients with hereditary transthyretin amyloidosis (hATTR) (initiated by a specialist).

New preparation: Buvidal® buprenorphine for adjunctive therapy in the treatment of opioid dependence.

New preparation: Fortacin® lidocaine with prilocaine for primary premature ejaculation.

Benralizumab for treating severe eosinophilic asthma [NICE guidance].

Brigatinib for treating ALK-positive advanced non-small-cell lung cancer after crizotinib [NICE guidance].

Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes [NICE guidance].

Irinotecan hydrochloride, liposomal formulations (Onivyde®): reports of serious and fatal thromboembolic events [MHRA/CHM advice].

Pertuzumab for adjuvant treatment of HER2-positive early stage breast cancer [NICE guidance].

Respiratory system infections, antibacterial therapy: updated guidance for acute exacerbations of chronic obstructive pulmonary disease.

Dose Changes for BNF only
Alirocumab [dosing options for primary hypercholesterolaemia or mixed dyslipidaemia].

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.

Yellow fever vaccine (Stamaril) and fatal adverse reactions: extreme caution needed in people who may be immunosuppressed and those 60 years and older.

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.

Belimumab (Benlysta): increased risk of serious psychiatric events seen in clinical trials.

Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April 2019.

Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1.


Royal Pharmaceutical Society Museum

The British National Formulary, your day-to-day handbook for using medicines safely and effectively, is published by the publishing division of the Royal Pharmaceutical Society. Within the office building there is the Royal Pharmaceutical Society Museum. Established in 1842, the museum is a unique resource for all those interested in the history of British pharmacy. The museum also recently welcomed historians Lucy Worsley and Helen Rappaport to record an episode of the BBC Radio 4 series Encounters with Victoria.

If you are a researcher, student, teacher, or simply interested in pharmacy history, we have online exhibitions and learning resources to provide you with ways to find out more about the history of British pharmacy. The museum displays are open to all visitors. It is FREE admission and donations are welcome. Please contact us for more details via telephone on 020 7572 2210 (museum enquiries only) or via email at

BNF Case studies Volume 3 available now

Volume 3 of our digital BNF case study booklet is now available to download, based on the content from the BNF 77. Get your copy today and get access to our latest case studies on malaria, heavy menstrual bleeding and glaucoma.

If you're an online BNF user, access the additional content on MedicinesComplete by clicking the interactive links in the case study, which link through to the relevant content pages.

Sign up here to download your copy

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

To order the March 2018 edition, visit the Pharmaceutical Press website

Purchase a print subscription, ensure access to the latest copy of BNF and save money
Outside the UK, content is available via a subscription to MedicinesComplete

Access the latest copy of BNF on your mobile device, which is available as a PDF eBook

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