BNF: British National Formulary No. 85: March - September 2023

The British National Formulary (BNF) is the first choice for concise medicines information. Trusted by healthcare professionals across the world to support confident decision-making at the point of care. The new edition (BNF 85) provides up-to-date guidance on prescribing, dispensing, and administering medicines, plus legal and professional guidelines.

Extensive content updates in the BNF 85 edition include:

New monographs for:

• Aklief® [trifarotene] for acne vulgaris
• Drovelis® [drospirenone with estetrol] for hormonal contraception
• Ducressa® [dexamethasone with levofloxacin] for prophylaxis or treatment of postoperative inflammation, or prevention of infection, following cataract surgery
• Kerendia® [finerenone] for chronic kidney disease associated with type 2 diabetes
• Magnesium citrate for treatment and prevention of magnesium deficiency
• Netildex® [dexamethasone with netilmicin] for local treatment of eye inflammation and bacterial infection
• Nettacin® [netilmicin] for local treatment of eye infection
• Sibnayal® [potassium citrate with potassium bicarbonate] for distal renal tubular acidosis
• Tenkasi® [oritavancin] for acute bacterial skin and skin structure infections
• Vydura® [rimegepant] for treatment or prophylaxis of migraine
• Xerava® [eravacycline] for complicated intra-abdominal infections

MHRA advice on:,/u>

• Anagrelide: risk of thrombosis, including cerebral infarction, if treatment discontinued abruptly
• Denosumab (Prolia®): should not be used in patients under 18 years due to the risk of serious hypercalcaemia
• Dexmedetomidine: clinical trial finds increased risk of mortality in intensive care unit patients aged 65 years or younger
• Metformin hydrochloride: reduced vitamin B12 levels and new advice for monitoring patients at risk
• Methylphenidate hydrochloride long-acting (modified-release) preparations: caution if switching between products due to differences in formulations
• Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists
• Rucaparib (Rubraca®): withdrawal of third-line treatment indication
• Topiramate (Topamax®): start of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities in children with prenatal exposure

Other significant changes include updated guidance on:

• Antibacterials for the prevention of secondary cases of diphtheria, and addition of guidance for the prevention of intra-uterine infection in preterm prelabour rupture of membranes
• Contraceptive interactions
• Prescribing of drugs associated with dependence and withdrawal
• COVID-19 vaccines
• Management of depression
• Diphtheria vaccine
• Management of epilepsy
• Management of gout
• Post-exposure prophylaxis of herpesvirus infections
• Hydrocortisone: addition of children’s dosing for adrenal crisis
• Management of hypertension in patients with type 1 diabetes
• Management of multiple sclerosis
• Obstetrics: preterm labour
• Tacrolimus: updated pregnancy, breast-feeding and monitoring advice
• Type 1 diabetes: inclusion of continuous glucose monitoring in aims of treatment
• Type 2 diabetes: use of non-insulin antidiabetic drugs
• Valaciclovir: update to indication and doses in line with UK Health Security Agency recommendations on post-exposure prophylaxis for chickenpox and shingles

BNF 85 is an essential publication, it provides you with:

• Up-to-date information on prescribing, dispensing, and administering medicines
• Authoritative, independent guidance on best practice enabling you to select safe and effective medicines
• Information you know you can trust for quality, reliability, and independence
• Everything you need at your fingertips, all in one book