British National Formulary
The frequently asked questions relating to BNF content have been moved and can now be found here.
How should I reference the BNF?
The Uniform Requirements for Manuscripts Submitted to Biomedical Journals (www.icmje.org), formerly referred to as the Vancouver convention, is preferred by many medical journals.
The style for referencing the printed version of the BNF using the Uniform Requirements for Manuscripts is as follows:
Joint Formulary Committee. British National Formulary. [edition number] ed. London: BMJ Group and Pharmaceutical Press; [year of publication]
The style for referencing the online versions of the BNF is as follows:
MedicinesComplete
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press <http://www.medicinescomplete.com> [Accessed on [date]]
BNF.org
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press <http://www.bnf.org> [Accessed on [date]]
Why is the printed BNF available before the electronic versions?
Our primary focus is to publish the printed BNF since it is this version that is used most extensively. The electronic versions of the BNF are derived from the same database as the one we use for the paper copy. However, a number of tasks are required to adapt the database output for the electronic verisons. These tasks are undertaken once the paper version has been sent away for printing. Unfortunately, this results in the electronic versions appearing shortly after the printed book.
Why do digital versions of the BNF expire but I can go on using a printed copy of the same edition as long as I want?
The information in the printed version of the BNF does actually expire. Under 'Significant changes' the BNF says,
'The BNF is revised twice yearly and numerous changes are made between issues. All copies of BNF No. … should therefore be withdrawn and replaced by BNF No. ….'
The BNF believes that there is now too much new information available for practitioners to keep abreast of it all. This was highlighted to us by a GP who was not aware of the change to recommendations regarding the dose of amoxicillin in pneumonia—he had not read the 'Changes for this edition' section at the front of his latest BNF.
The BNF is a point-of-care tool and as such it is important that it provides practitioners with the most up-to-date information on prescribing and dispensing medicines effectively and safely.
How often is BNF data updated?
Whilst the central BNF data is updated twice a year, the other pages on the website are updated on a more regular basis. The BNF text is compiled with the help of a network of expert clinical advisers under the authority of the Joint Formulary Committee. This allows the publication to provide impartial, authoritative, and practical advice and ensures that the BNF remains reliable. BNF's clinical advisers, the Joint Formulary Committee, and the editorial team work together to:
The rigour and consultative nature of this process limit the frequency with which the BNF text can be updated and certainly preclude a monthly production cycle. However, the BNF has a good record of anticipating future recommendations even though it is a biannual rather than monthly publication. And, as indicated above, the BNF website is able to provide any vital information that comes to light between editions.
How is the BNF funded?
The BNF is entirely funded from sales made by the joint publishers, the BMJ Group and Pharmaceutical Press. The great bulk of sales are of the printed version and made to the National Institute for Health and Clinical Excellence for distribution within the NHS in England and to the Departments of Health for distribution within the NHS in Northern Ireland, Scotland, and Wales. The publishers also sell the publication in both printed and electronic formats in the UK and the rest of the world.
Why does the BNF not include a disclaimer covering liability for its clinical content?
The BNF has often thought about adding a disclaimer. But we've come to the view that it really doesn't make any practical difference.
We take great care to ensure that our editorial processes are as robust as we can make them. So, we check that we have interpreted new data correctly and that the presentation of information is accurate and unambiguous. To this end we use expert clinical advisers to verify our data and, within the editorial team, subject the text to several layers of checking. Changes to clinical advice are also reviewed by the Joint Formulary Committee. Therefore, should the BNF be challenged, an important argument in our defence would be the rigour of our editorial processes; this strength comes not just from the mechanical processes but also from the experience, training, and expertise of the personnel who contribute to the construction of the text.
The following summary points from an article by Brian Hurwitz (BMJ 1999; 318: 661-4) might also be relevant:
The publishers of the BNF and staff are insured against damage that might possibly result from the BNF's advice.
How do I get permission to reproduce information from the BNF?
Permission to reproduce material from the BNF is granted in certain circumstances and should be sought from
Pharmaceutical Press,Please note that the publishers do not permit the reproduction of any part of the BNF for promotional purposes.
Many websites provide information on medicines. What's special about BNF.org?
BNF.org includes the entire content of the British National Formulary, which is widely regarded by doctors, pharmacists and other healthcare professionals as an up to date and highly authoritative information resource on medicines prescribed in the UK. BNF.org also includes supplementary information of relevance to those with an interest in the effective use of medicines.
A Joint Formulary Committee (comprising representatives of the two publishers and the Department of Health) is responsible for the content of the BNF—this allows the publication to provide impartial, authoritative, and practical advice.
Find out about how the BNF is constructed.
Can the BNF office offer advice about the treatment of my specific condition?
We regret that we are unable to comment on individual cases and cannot enter into correspondence with patients (or their relatives). These matters are best dealt with by properly qualified professionals who are familiar with all the circumstances surrounding the case.
Whereas the BNF tries to give the best possible advice on treatment, there are sometimes special circumstances when the doctor may want to deviate from this advice.
Corresponding with the BNF
The BNF receives a great many comments and it is not always possible to acknowledge each one or to specify what action the BNF will take in response. However, we are very grateful for the comments and we will consider each comment carefully. The comments which the BNF is most likely to respond to are those received from the intended audience of the BNF (healthcare professionals dealing with medicines), especially when there is definite concern about the correct use of medicines. Before making an enquiry to the editorial department, the BNF also expects healthcare professionals to have checked other sources of information, including a medicines information centre. More advice about this is available on our Contact Us page.
Readers of the BNF should note that the BNF is an aide memoire (for use by practitioners with a high level of background knowledge about medicines) and the BNF cannot be exhaustive in its coverage. Supplementary information is available from the summaries of product characteristics of individual products and from works such as Martindale: the complete drug reference as well as from medicines information centres.
Why does the BNF no longer list preparations on sale to the public?
Owing to the large number of frequently changing products that are available for purchase, it has become difficult to maintain the lists accurately and the Joint Formulary Committee considers that incomplete or out of date information is potentially dangerous. To identify the active ingredients in preparations on sale to the public, it is safer to consult the product literature or the manufacturer.
Why are herbal and homeopathic remedies not included in the BNF?
We appreciate that such an expansion of the BNF would enable practitioners to access various options from a single volume. However, to expand the BNF in this way is unlikely to be practicable currently.
The infrastructure of the BNF (the Joint Formulary Committee, the clinical advisers, and the editorial staff) has been set up to possess special expertise and knowledge on the use of conventional medicines. Such a structure enables the BNF to provide authoritative information. In order to provide reliable and authoritative information on homeopathic or herbal medicines, it would be necessary to set up a parallel structure with specific expertise in complementary medicine. It would be very difficult to achieve this and to include all the information in one volume which provides advice on the selection of both types of medicines would add a further level of complexity. In short, we feel that it is best for the BNF to focus on what it does best! To expand its scope could risk devaluing the product.
A particular difficulty with complementary medicines is that there are no nationally recognised standards to govern the quality (or even identity) of the products. Therefore, it is not possible to describe the clinical effects of these products reliably.
Nevertheless, we are sympathetic to healthcare professionals' needs and we are looking into ways of providing information on complementary medicines without compromising the core content of the BNF.
Why has the BNF changed the names of some drugs? Why does the BNF use adrenaline and not epinephrine?
European law requires the use of the Recommended International Non-proprietary Name (rINN) for medicinal substances. In most cases the familiar British Approved Name (BAN) and the rINN are identical. Where they were different the BANs have been amended to conform to the rINNs. The only exception to this is adrenaline and noradrenaline.
Adrenaline and noradrenaline are the terms used in the titles of monographs in the European Pharmacopoeia and are thus the official names in the member states. For these substances the British Pharmacopoeia shows the European Pharmacopoeia names and the rINNs (epinephrine and norepinephrine respectively) at the head of the monographs; the BNF uses a similar style.
The list of commonly used substances whose names have been affected by the name change is available from the Medicines and Healthcare products Regulatory Agency (MHRA) website.
How are the prices in the BNF calculated?
Prices are included in the BNF to allow comparison between products. They are not suitable for quoting to patients since they do not include elements such as container allowance and professional fees.
Prices in the BNF are generally calculated from the net cost used in pricing NHS prescriptions. The bulk of this information comes from NHSBS Prescription Services (via the Dictionary of Medicines and Devices service) and is updated each edition. The price for an extemporaneously prepared preparation has been omitted where the net cost of the ingredients used to make it would give a misleadingly low impression of the final price.
The BNF is currently changing its process for updating prices of non-proprietary and branded preparations in an effort to improve the accuracy of data presented.
In past editions, pricing data has been obtained from the NHSBS (formerly the PPD) via the DM+D service; this will remain the source of our data, however the work involved in automating this process is still ongoing. As a result, we are unable to update the prices in BNF 63 (March 2012). Prices in BNF 63 will therefore remain unchanged from those in BNF 62 (September 2011).
Where does the BNF get its information?
Find out how the BNF is constructed.
Why is there sometimes a discrepancy between a product SPC and the BNF monograph?
The most important source of information on drug entries is the manufacturer's product literature (including Summaries of Product Characteristics and Patient Information Leaflets). However, the BNF entries may not be entirely consistent with the manufacturers' literature because the entries are constructed according to internal editorial guidelines; the following examples illustrate how the BNF 'rules' are applied:
Information from other sources (such as
journal articles, Drug Safety Updates issued by the Medicines and Healthcare products Regulatory Agency, and expert advice) may also be
incorporated into the BNF drug entries.
For some drugs there is good reason to include indications or
doses that are inconsistent with those in the Summaries of Product
Characteristics. In such cases the BNF verifies its information
with clinical literature and with expert advisers.
Why does the BNF include information on some 'unlicensed' medicines?
Occasionally where a particular clinical need has been identified, the BNF gives information on the use of unlicensed medicines, or the use of licensed medicines in an unlicensed way ('off-label' use). Such information is included on the basis of robust evidence of safety and efficacy, and advice from clinical experts.
How does BNF.org choose links to other websites?
The inclusion of links to other websites is at the discretion of the BNF. Criteria for linking to other websites include:
What other digital versions of the BNF are available?
Who will receive a printed copy of the BNF?
The UK health departments distribute BNFs to NHS hospitals, doctors, dental surgeons, and community pharmacies.
In England, contact the DH Publications Orderline for extra copies or changes relating to mailed BNFs: Tel: 0300 123 1002
In Scotland, email: nss.psd-bnf@nhs.net
In Wales, contact the Business Services Centre: Tel: (01495) 332 000
In Northern Ireland, email: ni.bnf@hscni.net
What arrangements have been made for digital access to BNF content?
The official BNF website is at http://bnf.org. Access to some of the content on this site is restricted. Further information on the available options for access to BNF online and the corresponding access control arrangements are available on the Digital BNF page.
If I don't work for the NHS can I still have online access to BNF?
If you live in the UK, then the full content of BNF is available without charge at http://bnf.org. Online access to BNF is also available by subscription at www.medicinescomplete.com. Further information on the available options for access to BNF online and the corresponding access control arrangements are available on the Digital BNF page.
For details of organisational access please contact opsteam@rpharms.com.
Do digital versions of the BNF and BNF for Children interoperate?
Presently the BNF and BNF for Children digital products do not interoperate. The subscription service at www.medicinescomplete.com provides the facility to search both the BNF and the BNF for Children simultaneously. Where additional paediatric dosage information is available, a link is provided from bnf.org to bnfc.org. and vice-versa.
