BNF: British National Formulary No. 86: September 2023 - March 2024

An integral part of the UK’s healthcare infrastructure and relied on by health professionals who prescribe, dispense, and administer medicines globally. Containing guidance on best practice in prescribing, as well as legal and ethical considerations, BNF supports safe and effective decision-making at the point of care.

Extensive content updates in the BNF 86 edition include:

New monographs for:

• Livtencity® [maribavir] for cytomegalovirus disease in recipients of haematopoietic stem cell transplant or solid organ transplant
• Lupkynis® [voclosporin] for lupus nephritis
• Mounjaro® [tirzepatide] for type 2 diabetes mellitus
• Orgovyx® [relugolix] for prostate cancer
• Rezurock® [belumosudil] for chronic graft-versus-host disease
• Tezspire® [tezepelumab] for severe asthma

MHRA advice on:

• Dupilumab (Dupixent®): risk of ocular adverse reactions and need for prompt management
• Ibrutinib (Imbruvica®): new risk minimisation measures, including dose modification recommendations, due to the increased risk for serious cardiac events
• Metolazone (Xaqua®): exercise caution when switching patients between metolazone preparations
• Pholcodine-containing cough and cold medicines: withdrawal from UK market as a precautionary measure
• Terlipressin acetate: new recommendations to reduce risks of respiratory failure and septic shock in patients with type 1 hepatorenal syndrome
• Testosterone (Testogel®): risk of harm to children following accidental exposure

Other significant changes include updated guidance on:

Specialist drug monographs: inclusion of the words “Specialist drug” alongside the monograph title to identify drugs used within specialist settings (such as drugs used for malignancy, and those given via intravitreal injection). These monographs continue to include information to support patient safety and non-specialist patient care (such as important safety information, interactions, side-effects, and contra-indications) but no longer include information which is within the remit of specialist care (such as doses, and directions for administration).

• Adrenaline/epinephrine: recall of Emerade® 500 micrograms and Emerade® 300 micrograms auto-injectors, due to the potential for device failure [National Patient Safety Alert advice]
• Pre-treatment screening advice on genetic testing for aminoglycoside exposure posing risk to hearing
• Management of iron deficiency anaemia, including update to oral iron dosing and monitoring based on British Society of Gastroenterology guidelines
• COVID-19 vaccines
• Management of uncomplicated genital chlamydia and non-gonococcal urethritis
• National genomic testing directory
• Ibuprofen: breast-feeding advice
• Management of metabolic disorders
• Management of obesity
• Management of osteoarthritis
• Prescribing in palliative care
• Respiratory system, inhaled drug delivery
• Smallpox and mpox vaccine