British National Formulary
2010-06-28: NICE technology appraisals
NICE technology appraisals have been published on:
2010-05-28: MHRA - Information sent to healthcare professionals in May
The MHRA sent letters to healthcare professionals in May 2010 to inform of new safety information and advice.
2010-04-28: MHRA - Information sent to healthcare professionals in April
The MHRA sent letters to healthcare professionals in April 2010 to inform of new safety information and advice.
2010-04-14: MHRA - Information sent to healthcare professionals in March
The MHRA sent letters to healthcare professionals in March 2010 to inform of new safety information and advice.
2010-04-14: New BNF e-learning modules for pharmacists and technicians
The BNF and the Centre for Pharmacy postgraduate Education (CPPE) announce the launch of the e-learning programmes related to the latest changes in the new BNF (BNF 59). There are two programmes; one targeted at pharmacists and registered pharmacy technicians in hospital, and one for pharmacists and technicians working in primary care and in the community. Both contain ten case studies, each with two parts, related to the most important changes introduced in the latest edition of the BNF.
The BNF59 community e-update includes case studies on topics as diverse as recognising and managing withdrawal reactions with antidepressants, monitoring requirements for patients taking long-term lithium, determining whether dental examination is necessary before bisphosphonate therapy, calculating opioid doses for breakthrough pain in terminally ill patients, and converting from oral to subcutaneous doses of opioids.
The BNF59 hospital e-update includes case studies on topics such as managing patients with haemorrhage and raised INR while taking warfarin, advising on the use of intravenous esomeprazole in patients with severe peptic ulcer bleeding and hepatic impairment, and recommending adjuvant therapy for oestrogen-receptor-positive early breast cancer.
Chris Cutts, director of CPPE, says: “Pharmacists and technicians really enjoy this bite-sized but vital learning programme. Not only does it give them the essential learning update for each new edition of the BNF; it also gives them several potential CPD entries!”
Duncan Enright, BNF Publishing Director, says: “The concise format of these modules allows pharmacists to rapidly understand how the major changes in the latest BNF will affect their practice so that they continue to make the best decisions for their patients.”
You can access the BNF 59 e-updates on the CPPE website at www.cppe.ac.uk: Log in as normal, select a sector, then go to learning programmes, e-learning, and e-learning portfolio. Click on the ‘e’ icon at the end of the row listing the programme you want to access.
2010-03-22: BNF Publications need your feedback
BNF Publications has set up ‘Virtual User Group’s’ that enable healthcare professionals to provide feedback on using the BNF and BNF for Children. Brief questionnaires will be available via the BNF/BNF for Children e-newsletters. Practising professionals who would like to contribute can simply follow the link below. Thank you in advance and we look forward to receiving your comments and contributions. The survey will close on 31.3.10.
Click here to take part.
2010-03-17: BNF contains vital new guidance
BNF contains vital new guidance on community-acquired pneumonia, the safe use of cytotoxic medicines, the withdrawal of sibutramine and a revised layout for prescribing information relating to hepatic and renal impairment, pregnancy and breast-feeding.
The BNF is the ‘drugs bible’ for health professionals. It is used three million times a week by doctors, nurses, pharmacists and dentists throughout the UK to help them keep up to date on the best treatment options for their patients.
BNF 59 provides updated guidance on the antibacterial treatment of community-acquired pneumonia. Advice is provided on the empirical treatment of low-severity, moderate-severity, and high-severity community-acquired pneumonia in order to reflect the severity classification used to assess the infection.
Advice on the safe use of cytotoxic medicines has been revised following recommendations made by the National Patient Safety Agency (NPSA) working in collaboration with a multidisciplinary group of specialists. Additional information is now available, particularly for non-cancer specialists in primary care.
To reflect the advice of the European Medicines Agency on the withdrawal of the marketing authorisation of sibutramine (Reductil®), BNF 59 notes that General Practitioners must not issue prescriptions for sibutramine and pharmacists must not dispense prescriptions for sibutramine. A large clinical study designed to investigate the cardiovascular safety of sibutramine (Sibutramine Cardiovascular OUTcomes (SCOUT) study) in obese and overweight patients with cardiovascular risk factors has shown a significant increase in cardiovascular events. Therefore patients who are taking sibutramine must have their treatment reviewed.
BNF 59 now includes information on prescribing for patients with hepatic or renal impairment, or who are pregnant or breast-feeding, within the relevant chapters instead of as separate appendices. This means that the information can now be read in the context of other prescribing information, with the messages adjacent to bold headings so they can be found easily.
Duncan Enright, Publishing Director of BNF Publications said: "The latest edition of the BNF provides clear, practical guidance on all aspects of drug therapy. BNF Publications quality management system has recently achieved ISO 9001:2008 certification which demonstrates that the procedures underpinning the production of BNF products are carried out to the highest of standards and that we are committed to ongoing innovation to meet the needs of healthcare professionals in the future.”
Details about all these changes can be found under What’s new in BNF 59 .
2010-03-04: NPSA urges neonatal services to follow new gentamicin safety guidance
New guidance, produced by the National Patient Safety Agency (NPSA) and NHS organisations across England and Wales, has been issued aimed at ensuring safer systems are in place to care for newborn babies needing treatment with gentamicin.
2010-03-04: The MHRA sent letters to healthcare professionals in February 2010 to inform of new safety information and advice.
The MHRA sent letters to healthcare professionals in February 2010 to inform of new safety information and advice.
2010-03-04: NICE technology appraisals have been published
NICE technology appraisals have been published on:
2010-01-26: NPSA issue new guidance to improve the safety of lithium therapy
The NPSA has published new guidance for NHS and independent healthcare organisations to improve the safety of lithium therapy.
2010-01-26: UK Anti-Doping (UKAD)
The new organisation, UK Anti-Doping (UKAD), assumes responsibility from UK Sport as the National Anti-Doping Organisation for the UK.The UKAD website contains links to the current World Anti-Doping Agency (WADA) Prohibited List and to the Global Drug Reference Online, which provides athletes and support personnel with information about the prohibited status of specific substances based on the current WADA Prohibited List.
2010-01-26: MHRA- suspension of sibutramine (Reductil) licence
The European-wide review of the anti-obesity drug sibutramine (Reductil) has concluded and an opinion reached recommending the suspension of the licence for the medicine across Europe.
2009-12-01: A NICE technology appraisal has been published
A NICE technology appraisal has been published on:
2009-11-04: The BNF quality management system achieves ISO9001:2008 certification
BNF Publications are delighted to announce that SGS, one of the world leaders in quality management assessment, has confirmed that the BNF quality management system (QMS) has achieved ISO9001:2008 certification.
Through formalisation of working processes, ISO9001:2008 QMS provides assurance about the ability to satisfy quality requirements and to enhance customer satisfaction.
Duncan Enright, Publishing Director at the BNF, said:
"This certification will allow us to use the ISO9001:2008 as a mark of quality. It demonstrates to others our robust processes and controls, it allows us to meet other compliance challenges more easily as they emerge, and most importantly, it lets us develop and seek efficiencies most effectively."
2009-11-03: NICE technology appraisals have been published
NICE technology appraisals have been published on:
2009-11-03: NPSA issue rapid response report
The NPSA has issued a rapid response report on oxygen safety in hospitals
2009-10-26: New Nurse Prescribers' Formulary published
The Nurse Prescribers' Formulary for Community Practitioners (NPF) 2009–2011 has been published, in a 64-page booklet format, to help nurses make the best treatment decisions for their patients.
The NPF is designed for community practitioner nurse prescribers, who are trained to prescribe from a limited list of preparations. The list is reviewed constantly in the light of comments from nurse prescribers and applications from manufacturers. The NPF provides an overview of some common conditions, together with details of the medicines that may be prescribed by community practitioner nurse prescribers.
As well as containing the latest nurse prescribers’ list and updated details of the medicines, there are 2 significant dose changes, made in the light of recent safety concerns; the minimum ages for Choline Salicylate Dental Gel and for Miconazole Oromucosal Gel have been increased.
The new edition contains the newly reorganised Appendix 8 Wound Management Products and Elasticated Garments from BNF 58 (September 2009). This includes a new table of wound contact materials, intended to aid selection of the appropriate type of dressing based on the appearance and condition of the wound. Advanced wound dressings have been reorganised in order of increasing absorbency, and dressings with antimicrobial properties have been moved to a separate section.
This new edition also contains Yellow Cards to assist nurses in reporting suspected adverse drug reactions directly to the MHRA.
The NPF is currently issued every two years and is designed for use with the full BNF (British National Formulary).
2009-10-01: New BNF e-learning module for hospital pharmacists
In an extension to the new BNF58 e-update, the British National Formulary (BNF) and the Centre for Pharmacy postgraduate Education (CPPE) today revealed an e-learning module for hospital pharmacists.
BNF58 Hospital e-update will enable hospital pharmacists to identify and assess how significant changes in the BNF affect their clinical practice.
Each BNF e-update includes ten clinical case studies, each with two-part questions and answers. Pharmacists can use their print BNF or the seamless hyperlinks to relevant sections of the online BNF to help them answer these questions. From there, they can check their answer with the model version provided. The module takes about 30-60 minutes to complete.
The CPPE’s Director, Dr Christopher Cutts, said: “This collaboration between the BNF and CPPE brings together the therapeutic expertise and educational skills of both organisations. Pharmacists working in the community and other primary care settings have enjoyed the BNF57 Community e-update since April 2009. Now, for the first time, hospital pharmacists have a BNF e-update that is designed especially for them.
“Feedback shows that pharmacists find these modules interesting, informative and relevant to their clinical practice, and that the modules provide ammunition for many continuing professional development entries.”
Dr John Martin, Managing Editor of BNF publications, said: “The BNF e-update brings into focus many important clinical changes that the BNF undergoes from one edition to the next. Hospital pharmacists can now assess the impact of these changes on their clinical practice at a time and place that is convenient for them.”
The BNF58 Hospital e-update includes case studies on topics as diverse as chronic kidney disease, diabetes, asthma, COPD, arrhythmias, wound dressings, hospital-acquired pneumonia, Clostridium difficile infection, and antibiotic prophylaxis for surgery. It can be accessed free of charge by all pharmacists and preregistration pharmacists in England alongside the BNF58 Community e-update at http://www.cppe.ac.uk. New versions of these modules will be released every six months to complement publication of each new edition of the BNF.
2009-09-25: NICE technology appraisals
NICE technology appraisals have been published on:
2009-09-16: BNF 58 (September 2009) is published
Information about changes made for this edition is available here.
2009-09-16: BNF 58 (The British National Formulary) contains vital new information on conditions such as influenza in pregnant women; management of acute and chronic asthma, wound management, nutrition and adjustment of drug dosages in renal impairment.
The BNF is the ‘drugs bible’ for health professionals. It is used three million times a week by doctors, nurses, pharmacists and dentists throughout the UK to help them keep up to date on the best treatment options for their patients.
BNF 58 provides advice on the choice of antiviral drug to be used for influenza in women who are pregnant or breast-feeding.
The new edition also includes the latest information on the management of acute and chronic asthma, updated guidance on the antibacterial treatment of Clostridium difficile infection and the treatment of hospital-acquired pneumonia.
Advice on the adjustment of drug doses in renal impairment have also been revised and updated. Following a wide-ranging consultation, including discussions with the Department of Health, the regulatory authorities, and experts in the field, BNF will now express information on dosage adjustment in renal impairment in terms of estimated glomerular filtration rate (eGFR—derived from the Modification of Diet in Renal Disease (MDRD) formula) rather than creatinine clearance in the majority of cases. Information on the limitations of eGFR and when creatinine clearance or plasma-drug concentration should still be used is also included.
BNF 58 has a new table of wound contact materials, intended to aid selection of the appropriate type of dressing based on the appearance and condition of the wound. There is also more information on the composition of ACBS-approved enteral feeds and nutritional supplements.
John Martin, Managing Editor of BNF publications said: "Just as health professionals will not give their patients out of date medicines, neither should they rely on out of date information for prescribing medicines. Instead they should turn to the latest edition of BNF for clear, practical guidance on all aspects of drug therapy.
The BNF has been a trusted source of prescribing information for decades, and BNF 58 is no exception. Health professionals at all levels can continue to rely on the BNF to keep them up to date and help them to maintain sensible and safe use of medicines. This new edition has been extensively revised and updated, validated by national experts and improved in response to constructive comments from GPs, hospital doctors, nurses, pharmacists, dentists and dieticians."
Details about all these changes can be found under What’s new in BNF 58 .
2009-09-07: MHRA - New advice on over the counter analgesics containing codeine and dihydrocodeine
The MHRA has announced new advice on over-the-counter (OTC) medicines containing codeine and dihydrocodeine (DHC) to minimise the risk of overuse and addiction
2009-09-07: NICE technology appraisals
NICE technology appraisal are available for cetuximab for the first line treatment of metastatic colorectal cancer and for alitretinoin for the treatment of severe chronic hand eczema.
2009-08-10: MHRA - Information sent to healthcare professionals in July
The MHRA sent letters to healthcare professionals about Plavix® (clopidogrel) in July 2009, to inform of new safety information and advice.
2009-08-10: NICE technology appraisals
NICE technology appraisals are available for tenofovir disoproxil fumarate for the treatment of hepatitis B, and for rituximab for first line treatment of chronic lymphocytic leukaemia.
2009-07-10: The fifth edition of BNF for Children (BNFC 2009) has been published
The fifth edition of BNF for Children (BNFC 2009) has been published. To review the changes made for this new edition please see What's new in BNF for Children 20092009-06-30: NICE technology appraisals
NICE technology appraisals are available for cetuximab for the treatment of metastatic and/or recurrent squamous cell carcinoma of the head and neck and for lenalidomide for the treatment of multiple myeloma in people who have received at least one prior therapy.
2009-06-02: Medicines for Children information leaflets
http://www.medicinesforchildren.org.uk/The Medicines for Children website was launched in April 2009. It provides information leaflets specifically about the use of medicines in children. They have been written for parents and carers but are also suitable for older children.
The leaflets have been developed under a joint initiative by the Royal College of Paediatrics and Child Health (RCPCH), Neonatal and Paediatric Pharmacists group (NPPG) and WellChild.
2009-06-02: Rivaroxaban NICE technology appraisal
A NICE technology appraisal is available for rivaroxaban for the prevention of venous thromboembolism.
2009-05-19: New functionality added to give online users an index in a familiar form
The BNF online is now available with a browseable index. This has been developed in response to feedback from users and is intended to give access to the content via an additional route that will be familiar to the many readers who have traditionally used print versions of BNF publications.
The index can be accessed via a link in the ‘top bar’ displayed at the top of each screen. Users who are unsure of the precise spelling of a particular drug name or condition may feel more comfortable browsing the index, rather than relying on the misspelling algorithm that is part of the BNF’s search function.
The index complements the existing search functionality by providing links to entries in the main body of the BNF text and to information in Appendices 6, 7 and 8 (Intravenous Additives, Borderline Substances, and Wound management products, respectively). Details in Appendix 1 (Interactions) and Appendices 2–5 (dealing with the use of medicines in liver disease, renal impairment, pregnancy and breast-feeding) are not indexed. These sections of the publication not covered by the index are easily accessed by browsing the main hierarchy or by using the full text search. In this respect the new index will also be useful for confirming the correct spelling of a term that can then be typed into the main search field.
The index has been added to online versions of BNF 57 and will be included in the Intranet version from BNF 58 (September 2009). A similar index will be added to BNF for Children online for the July 2009 edition.
2009-04-22: NICE technology appraisals
A NICE technology appraisal is available for sunitinib for the first-line treatment of advanced and/or metastatic renal cell carcinoma.
2009-04-02: Pharmacists working in the community and other primary care settings will be able to access changes to the British National Formulary more easily than ever, thanks to a leading-edge e-learning tool.
BNF Update, unveiled by the Centre for Pharmacy Postgraduate Education (CPPE) and the British National Formulary (BNF), gives pharmacists the ability to quickly identify and assess how significant changes to the BNF affect their clinical practice.
Beginning with BNF 57, each BNF Update includes 10 clinical case studies with short-answer questions. Pharmacists can use their print BNF or the hyperlinks to relevant sections of the online BNF to help them answer these questions. From there, they can check their answer with the model version provided by the tutors. The module takes about 30-60 minutes to complete.
The Centre for Pharmacy Postgraduate Education’s Director, Dr Christopher Cutts said: "In this collaboration between the BNF and CPPE, both organisations have brought together the right expertise and resources to produce a valuable learning tool that is available free to all pharmacists and pre-registration pharmacists in England.
"Feedback from a pilot study shows pharmacists, be they generalists or specialists, find this module interesting, informative and relevant to clinical practice. We plan to develop more e-learning modules like this, and are encouraged by the numerous requests we have received to produce a BNF Update for secondary care."
The BNF’s Managing Editor: Knowledge Creation, Dr John Martin said: "Assessing the clinical impact of significant changes in the latest BNF is an essential part of every pharmacist’s Continuing Professional Development. BNF Update will help pharmacists achieve this at a time and place that is convenient for them."
The BNF 57 Update includes case studies on topics as diverse as irritable bowel syndrome, Crohn’s disease, diabetes, osteoporosis, contraception, infections and adverse drug reactions. The module is available free to registered pharmacists and pre-registration pharmacists in England by logging into the CPPE website at http://www.cppe.ac.uk/.
2009-03-12: Leading charities have today welcomed new guidance for healthcare professionals in the latest edition of the BNF (British National Formulary)
BNF 57 contains vital new information on conditions such as irritable bowel syndrome, respiratory failure and HIV infection.
The BNF is the ‘drugs bible’ for health professionals. It is used three million times a week by doctors, nurses, pharmacists and dentists throughout the UK to help them keep up to date on the best treatment options for their patients.
BNF 57 advises that fibre intake of patients with irritable bowel syndrome (IBS) should be reviewed, and if an increase in dietary fibre is required, soluble fibre is recommended but bran should be avoided. It also advises on treatment with antidepressants for abdominal pain or discomfort.
Welcoming this new guidance, Dr Nick Read, Medical Advisor at the Gut Trust, the national charity for people with IBS in the UK, said: “We believe that the advice on fibre consumption is long overdue and we are delighted that this guidance is now included in the BNF. The advice on drug treatment is also a welcome step forward for the many millions who live with the pain and discomfort of IBS on a daily basis.”
The new edition also includes the latest information on the emergency use of oxygen. It follows a British Thoracic Society (BTS) recommendation that patients who have had an episode of hypercapnic respiratory failure should be given an oxygen alert card including the oxygen saturations required during previous exacerbations.
Dame Helena Shovelton, Chief Executive of the British Lung Foundation, the only UK charity for people with lung disease, said: “Getting the right level of emergency oxygen treatment is vital. Oxygen alert cards are a great way for patients, ambulance crew and healthcare professionals to avoid making mistakes. We are delighted that this guidance has now been incorporated in the BNF where health professionals can refer to it quickly and whenever they need it.”
Guidance on the treatment of HIV infection has been updated in BNF 57 to take account of the recommendations of the British HIV Association. Advice on reducing the cardiovascular risk of patients receiving antiretrovirals has also been expanded to include information on monitoring plasma lipids and blood glucose.
Lisa Power, Head of Policy at HIV and sexual health charity Terrence Higgins Trust said: “With the right treatment, people with HIV can live relatively healthy lives. We welcome this new guidance in the BNF as it will help to ensure consistent high standards of care for everyone entitled to free HIV treatment in the UK.”
BNF 57 also includes the latest advice on preventing osteoporotic fractures in postmenopausal women and updated guidance on the use of oral antidiabetic drugs during pregnancy and breast feeding.
Commenting on the new edition, Martin Kendall OBE, Emeritus Professor of Clinical Pharmacology from the University of Birmingham Medical school says: “The BNF has been a trusted source of prescribing information for decades, and BNF 57 is no exception. Health professionals at all levels can continue to rely on the BNF to keep them up to date and help them to maintain sensible, cost-effective and safe use of medicines.”
Details about all these changes can be found under What's new in BNF 57.
2009-03-11: The MHRA sent letters to healthcare professionals about Fareston® (toremifene), Avastin® (bevacizumab) and Raptiva® (efalizumab) in February 2009, to inform of new safety information and advice
2009-03-11: A NICE technology appraisal is available for amantadine, oseltamivir and zanamivir for the treatment of influenza (review of existing guidance No. 58)
2009-03-11: The NPSA has issued a rapid response report on reducing risk of harm from oral bowel cleansing solutions (NPSA/2009/RRR012)
2009-03-11: The MHRA has issued advice on over-the-counter cough and cold medicines for children
2009-03-02: BNF 57 (March 2009) is published
Information about changes made for this edition is available here.
2009-02-24: The European Medicines Agency has completed a review of efalizumab (Raptiva®) after concerns about its safety. The Agency’s Committee for Medicinal Products for Human Use (CHMP) has concluded that the benefits of efalizumab do not outweigh its risks, and that the marketing authorisation should be suspended across the EU.
2009-02-18: The MHRA sent letters to healthcare professionals about Sustiva® and Stocrin® (efavirenz) and Torisel® (temsirolimus) in January 2009, to inform of new safety information and advice
2008-12-12: A NICE technology appraisal is available for erlotinib for the treatment of non-small cell lung cancer
2008-12-12: The MHRA sent letters to healthcare professionals about Raptiva® (efalizumab) and Mabthera® (rituximab) in November 2008, to inform of new safety information and advice
2008-11-19: Due to internal promotions and the expansion of the editorial team, BNF publications are currently recruiting Clinical Pharmacists to work as staff editors for BNF and BNF for Children.
If you feel you would to take up this challenging but rewarding opportunity, further details and how to apply can be found at bnf.org/jobs.2008-11-11: The MHRA sent letters to healthcare professionals about Arcoxia® (etoricoxib) and Acomplia® (rimonabant) in October 2008, to inform of new safety information and advice.
2008-11-11: NICE technology appraisals are available for primary osteoporosis prevention and secondary osteoporosis prevention.
2008-10-07: NICE technology appraisals are available for Influenza prophylaxis and for dabigatran etexilate and the prevention of venous thromboembolism after hip or knee replacement surgery in adults
2008-09-11: The new edition of the BNF (British National Formulary) published—delivering the latest prescribing advice
The new edition of the BNF (British National Formulary) published today reflects the latest changes in guidance and emerging safety concerns, including:
BNF 56 recommends that a statin remains the drug of choice for the primary and secondary prevention of cardiovascular events. Target cholesterol concentrations are given for the secondary prevention of cardiovascular events together with advice on adjusting drug treatment if these concentrations are not achieved.
BNF 56 provides valuable advice on which cephalosporins to use in patients with a history of serious penicillin allergy when other suitable antibacterials are not available.
The revised guidance on atrial fibrillation in BNF 56 is an essential read. More detail is provided on controlling the ventricular rate, restoring sinus rhythm, and assessing patients for their risk of stroke and need for thromboprophylaxis.
BNF 56 highlights the risk of suicidal thoughts and behaviour with antiepileptic drugs and recommends that patients should seek medical advice if they develop mood changes or suicidal thoughts.
As part of an ongoing commitment to making BNF knowledge more accessible, a new online revision aid, BNF Prescribing Practice for Medical Students, will help students assess and diagnose common clinical conditions, and improve their knowledge of safe prescribing while using the latest BNF. Designed to support best practice, the resource covers topics as diverse as asthma, cardiology, diabetes, infections, medical emergencies, drug interactions, adverse drug reactions, and pregnancy.
Martin Kendall OBE, Emeritus Professor of Clinical Pharmacology from the University of Birmingham Medical school comments: “BNF 56 contains a huge amount of new information on many important clinical problems. Health professionals can rely on the latest BNF to keep themselves up to date on the best treatment options for their patients. Those training for these professions are increasingly recognising that the BNF is a valuable learning tool for the health professionals of tomorrow.”
2008-08-11: The NPSA has issued a rapid response report on new guidance for injecting adults and adolescent patients with intravenous cancer drug (NPSA/2008/RRR004).
2008-08-11: The Chief Medical Officer has issued a Health Service Circular (2008/001) which covers the updated National Guidance on the Safe Administration of Intrathecal Chemotherapy. The updated guidance replaces HSC 2003/010.
The guidance cross-refers to the National Patient Safety Agency (NPSA) rapid response report (NPSA/2008/RRR004) on the use of vinca alkaloid minibags that should be read in conjunction with this document.2008-08-07: The Department of Health is making extra vaccine and more funds available to help local health trusts start a campaign to vaccinate every child up to the age of 18 against measles. For further details visit Department of Health, News.
2008-07-14: NICE technology appraisals are available for adalimumab in the treatment of psoriasis, rimonabant for the treatment of overweight and obese patients, and on cetuximab for the treatment of head and neck cancer. For further details visit NICE guidance, June 2008
2008-07-14: The NPSA has issued a rapid response report on Reducing Dosing Errors with Opioid Medicines
2008-06-05: New online revision resource will help medical students assess and diagnose common clinical conditions and improve their knowledge of safe prescribing while using the British National Formulary (BNF)
Many medical students are unprepared for practical prescribing, yet drug treatment is a major part of the management of most patients.
The BNF Prescribing Practice resource begins to address a gap in the medical curriculum by teaching students how to prescribe using the BNF.
Evidence of poor prescribing in the UK is abundant—6.5% of hospital admissions are related to adverse drug reactions (ADRs) and this costs the NHS £466m a year. But most of these ADRs could be avoided.
Part of the problem is that the number of hours devoted to teaching medical students pharmacology and therapeutics has declined in recent years. In addition, many universities and medical schools no longer have courses on drug prescribing.
Martin Kendall OBE, Emeritus Professor of Clinical Pharmacology from the University of Birmingham Medical School, comments: "It is well known that most junior doctors are poorly trained in therapeutics, but good prescribing is very important. From day one student doctors have to prescribe with the potential to cause tremendous benefit if they get it right or tremendous harm if they get it wrong.”
The BNF Prescribing Practice resource provides students with a collection of case studies designed to stimulate problem solving and improve patient management using the BNF, with a focus on emergency medicine and prescribing in pressurised environments.
Designed to support best practice, the questions cover topics as diverse as asthma, cardiology, diabetes, infections, drug interactions, adverse drug reactions, prescribing in pregnancy and much more.
The BNF is no longer available free to medical students in England, but this comprehensive package includes a printed copy of the current BNF and unlimited access to the online version.
The revision resource provides:
2008-03-17: BNF 55 (March 2008) is published
Information about changes made for this edition is available here.
2007-11-16: As part of an ongoing digital development programme, the display of preparation records in the BNF has changed so that they now also show the corresponding drug monograph
With this change, the monograph information will be more readily available to users when they open a preparation record, thus increasing the likelihood that pertinent information and important warnings will be seen.
The preparation record itself will still be shown as a ‘Sub-section’ in the list of links at the end of the relevant monograph. This retains the access to preparations from the drug monograph and is now complemented by the display of the monograph-level information with the preparation details.
Users who access preparation records in the BNF via direct links from their prescribing or dispensing systems will now be able to review monograph-level information without any additional navigation within the BNF.
The display of preparation records that are not associated with a BNF drug monograph remains unchanged.
2007-11-14: The Nurse Prescribers' Formulary (NPF) 2007 has been published, in a brand new 60-page booklet format to help nurses make the best treatment decisions for their patients.
The Nurse Prescribers' Formulary (NPF) 2007 has been published, in a brand new 60-page booklet format to help nurses make the best treatment decisions for their patients.
The NPF is designed for community practitioner nurse prescribers, who are trained to prescribe from a limited list of preparations. It should also be of interest to nurse independent prescribers, who have received specific preparation and training and who are able to prescribe any licensed medicine for any medical condition, including some controlled drugs.
The current edition of the NPF provides an overview of some common conditions, together with a detailed list of the medicines that may be prescribed by community practitioner nurse prescribers, and the controlled drugs and the indications for which they may be prescribed by nurse independent prescribers.
The list is reviewed constantly in the light of comments from nurse prescribers and applications from manufacturers.
The NPF is currently issued every two years and is designed for use with the full BNF (British National Formulary). The Departments of Health in England, Scotland and Northern Ireland will therefore be making copies of the BNF 54 (just published) available to community nurses and are already supplying nurse independent prescribers with copies of the BNF every six months.
The new edition of the NPF has six additions, 12 deletions and three listed title changes.
Nicky Cullum, Chairman of the Nurse Prescribers’ Advisory Group (NPAG), which oversees the preparation of the NPF and advises the UK health ministers on the list of preparations that may be prescribed, welcomed the new edition as a vital tool for nurses.
“With the new format, nurses will now be able to use the new NPF in conjunction with the most recent BNF available. To prescribe safely, nurse prescribers must not only have the necessary training, but access to up to date information about the drug treatment of diseases and about the individual drugs, the preparations available, the doses that should be used, and precautions which should be noted or acted on,” she says. “The most accessible, up to date and respected source of information on drugs comes from the BNF and, as such, it ensures consistent standards of prescribing are maintained.”
Her views are supported by a recent independent survey of 200 primary and secondary care nurses in the UK. Eighty-eight percent said the BNF was their single favourite source of information and refer to it several times a week or more. And almost three quarters (71%) find the considered advice and practical guidance given in the BNF a very valuable source of information.
“I trust its comprehensiveness and this was the preferred way I learnt to access drug information when completing my nurse prescribing course.” (Primary Care Nurse)
“It is comprehensive and trustworthy. It has all the medicines in one place and can be used by the entire multi-disciplinary team.” (Secondary Care Nurse)
2007-09-11: The new edition of the British National Formulary (BNF54) is published.
Who is most likely to suffer psychiatric reactions with prednisolone?
What restrictions have been introduced on the use of telithromycin and piroxicam?
Is there a fire-risk with paraffin-based emollients?
The new edition of the British National Formulary (BNF 54) published today, answers these questions and more.
BNF 54 enables health professionals to identify patients at risk of developing psychiatric reactions with systemic corticosteroids, and advises health professionals to alert patients to these potential side-effects, and to take appropriate action if they occur.
Safety concerns with telithromycin and piroxicam mean that the restrictions on the use of these drugs are a ‘must read’ in BNF 54.
Following a fatality involving smoking and the use of a paraffin-based emollient, BNF 54 provides advice on how to reduce the risk of fire when using these preparations.
For safety reasons, the BNF continues to recommend that isotretinoin should be prescribed only by, or under the supervision of, a consultant dermatologist.
The new edition also includes everything health professionals need to know about the Department of Health’s ‘catch-up’ programme for haemophilus influenzae type b vaccine.
Further advice is provided on appropriate measures of renal function when making drug dosage adjustments for patients with renal impairment.
“Alerting health professionals to drug safety issues and other significant changes to prescribing practice is a fundamental part of our role,” says John Martin, Acting Executive Editor, BNF publications. “In this way, we continue to ensure that consistent standards of prescribing are maintained.
Details about these changes can be found easily on the What's new in BNF54 page of BNF.org and in the Changes section of the BNF.”
2007-08-01: The Medicines and Healthcare products Regulatory Agency and the Commission on Human Medicines launch a new monthly drug safety bulletin
Drug Safety Update is a monthly bulletin produced by the Medicines and Healthcare products Regulatory Agency (MHRA) and the Commission on Human Medicines (CHM). It takes the place of Current Problems in Pharmacovigilance.
Drug Safety Update aims to provide the latest information and clinical advice from the MHRA about the safe use of medicines. It will also include regular updates on the Yellow Card scheme, a vital part of the Agency’s vigilance activities. It is intended for all healthcare professionals who work in the UK—doctors, pharmacists, nurses, dentists, allied health professionals and coroners.
The bulletin is available on the MHRA website at www.mhra.gov.uk/mhra/drugsafetyupdate.
2007-07-11: The online edition of the BNF for Children now incorporates an interface to the NHS Dictionary of Medicines and Devices
The online edition of the latest BNF for Children (BNFC 2007), published earlier this month, now incorporates an interface to the NHS Dictionary of Medicines and Devices. This provides healthcare professionals with seamless access to BNFC content on the Internet using NHS dm+d codes, helping them to make the best treatment decisions for their patients.
The move is a fundamental step towards more efficient and safer prescribing practices and provides a means of directly accessing BNFC information from within the healthcare professional’s workflow.
The new interface can be accessed by appending an NHS dm+d code to a programmatically generated BNFC web address (URL). Once clinical systems have been configured to generate these URLs, the links between the NHS dm+d and BNFC will provide health professionals with a new means of accessing concise, authoritative and up-to-date prescribing information to support their clinical decisions.
The interface allows users direct access to BNFC information about a selected medicinal product from within a clinical system. As clinicians are working, prescribing or dispensing a medicine during a clinical encounter, it is now possible with a single click to access the relevant BNFC information for that medicine. Similarly, library or local formulary systems can use the interface to provide links from their material directly to corresponding BNFC content.
“Providing clinicians with the tools to make the best decisions for their patients is a key objective of the NHS Connecting for Health programme and closely parallels BNFC’s mission to provide excellence at the point of care,” says Dominic Vaughan, BNFC publishing director.
“With the ever-increasing pressure on clinicians, this development is an important step towards ensuring BNFC knowledge is accessible whenever and wherever it is required from within the clinician’s workflow.”
A more technical document providing details of the links created between the NHS dm+d and BNFC together with the format of the URLs for accessing the interface is available upon request (please contact us).
The NHS dm+d provides a common way of describing and coding all medicines and devices used within the NHS. It is expected to be used with all clinical information systems handling medicines information and is essential to support patient care across all sectors of the health service.
2007-03-09: BNF 53 (March 2007) is published
Information about changes made for this edition is available here.
2005-11-10: Extensions to nurse and pharmacist prescribing were announced today by Health Secretary Patricia Hewitt at the Chief Nursing Officer's conference in London.
Patients will be able to get quicker and more efficient access to medicines thanks to extensions to nurse and pharmacist prescribing announced today by Health Secretary Patricia Hewitt at the Chief Nursing Officer's conference in London.
From spring 2006, qualified Extended Formulary nurse prescribers and pharmacist independent prescribers will be able to prescribe any licensed medicine for any medical condition – with the exception of controlled drugs (see update note below).
Further details are available in a press release (Ref:2005/0395) from the Department of Health.
Update (6 January 2006): Following an amendment to the Prescription Only Medicines (Human Use) Order 1997, Extended formulary nurse prescribers can prescribe, administer or supply certain controlled drugs in defined medical conditions (Pharmaceutical Journal 2006; 276: 21)
2005-10-27: British National Formulary celebrates 50th edition
This week sees the celebration of the 50th edition of the British National Formulary (BNF 50). This significant milestone, representing 25 years of essential prescribing information for health professionals, is marked by a symposium at the Royal College of Physicians.
The BNF as we know it today was born in 1981 to meet the needs of the modern healthcare professional, usually at the point of care, and has quite rightly been dubbed the 'drugs bible' by generations of healthcare professionals.
As well as including details on virtually all prescribed medicines, the first edition also took the bold step of identifying products that were less suitable for prescribing.
More than two decades on, the BNF continues to keep pace with professional needs. Its guidance is continually refined to reflect the latest evidence and to accommodate new medicines, and a new generation of digital products and services is currently in development . The recent launch of BNF for Children sets a new standard in children's medicine.
The latest advice in BNF 50 includes the dangers of using particular antidepressants and changes to the BCG and rabies vaccination programmes.
"We are extremely proud of our achievements so far, but we are also confident that the BNF will continue to build on its success, encouraging sensible, cost-effective and safe use of medicines for many years to come," says Professor Martin Kendall, Chairman of the BNF Joint Formulary Committee.
The next generation of prescribers can turn to the BNF safe in the knowledge that everything they read is based on sound evidence and up to date information."
2005-09-20: The BNF for Children is officially launched today
A new guide which will transform doctors' access to advice on children's medicines is being launched today at the British Medical Association.
The handbook – BNF for Children (BNFC) – is the first comprehensive information resource for doctors, pharmacists, nurses and other healthcare professionals on medicines for children.
The guide covers newborn babies to 18-year olds and gives a range of guidance, from choosing the best available drug to specific doses and formulations—information doctors normally have to research from multiple sources.
Doctors and other prescribers currently use the British National Formulary (BNF) – the 'drugs bible' – as their medicines reference manual. The BNF provides general information on children's medicines but, as prescribing for children has become more complex, healthcare professionals need a source of more specialist information.
Dr George Rylance of the Royal College of Paediatrics and Child Health, who chaired the BNFC formulary committee, commented:
"When treating children dosages must be tailored for each child, calculated by weight and age. Until now the information doctors needed to do this was not easily or readily available when they needed it—during a consultation for instance.
"Most drugs for everyday children's ailments are licensed for paediatric use. But drugs developed for adults are not always tested for use in children. For complicated or more serious conditions doctors often need to use drugs tested in adults which have not been specifically licensed for children (off-label prescribing), or which are not routinely available (unlicensed prescribing).
"The new guide will bring all this information together in one reliable source. It's a great step forward for children's medicine. For the first time, all doctors will have the latest advice at their fingertips."
The BNFC will play a key part in a European initiative, led by the UK, to develop more treatments for children and expand research and information in the field.
Ian Costello, lead editor of BNFC said:
"Updated every year the BNFC will continue to develop, including innovative treatments and new evidence as they become available. This guide will set a new standard—wherever you live in the UK, your doctor will have the latest information on the best treatment for your child."
Health Minister Jane Kennedy said:
"The new BNF for Children is a very exciting development and an important tool in improving the quality of prescribing medicines for children. This is why we are investing £1.8million in this project and ensuring that 175,000 copies of the BNFC are provided free of charge for doctors and other prescribers of paediatric medicines in the NHS."
2005-04-07: EMEA announces voluntary suspension of Bextra® sales and marketing
The European Medicines Agency (EMEA) has today announced a voluntary suspension of valdecoxib (Bextra®) sales and marketing, pending the completion of the review of safety of Cox 2's, which is ongoing.
Professor Gordon Duff, Chairman of the Committee on Safety of Medicines said,
"Today's announcement reinforces our previous advice that Cox 2's should be used after careful consideration of risks and benefits and the lowest effective dose for the shortest duration of time."
The concern about valdecoxib relates to reports of suspected serious skin reactions which are now under review. This action is in line with the voluntary suspension of Bextra® in the USA. The previous advice on cardiovascular risk associated with Cox 2's is unchanged.
In line with the European action, the MHRA is today issuing updated advice to health professionals and patients on valdecoxib and advise that patients should see their doctor at the next convenient appointment to arrange alternative pain relieving treatment.
Most suspected adverse reactions have occurred in the USA where valdecoxib has been used more extensively. Professor Kent Woods, MHRA Chief Executive says,
"We support the EMEA action in advising health professionals and patients of this new safety concern. There is no immediate new risk and it is important that we review all available data before reaching a final position."
2004-10-06: The British National Formulary has issued the following advice in response to a new study1 on medication use during pregnancy:
Women need to take special care about their entire lifestyle during pregnancy: this means taking care with eating, drinking, exercising and, indeed, taking medicines. Women should consult their doctor or pharmacist before embarking on any treatment with medicines or herbal remedies during pregnancy.
Some maternal illnesses if unchecked may be harmful to the fetus and in such cases taking a medicine might be a safer option. For example, inhaled medicines used for asthma are highly unlikely to harm the baby but untreated asthma might endanger both the mother and the baby.
Iron and folic acid are used during pregnancy in women who are suffering from iron or folic acid deficiency or who are at high risk of developing such deficiency. To guard against neural tube defects (e.g. spina bifida) in babies, women planning to become pregnant are advised to take folic acid; folic acid is started before pregnancy and given until week 12 of pregnancy.
Certain antacids are considered safe for use during pregnancy when conservative measures have failed to control symptoms such as heartburn.
As Dr Headley states, relatively few medicines have been associated with harm. However, the BNF advice that medicines should be avoided during pregnancy as far as possible is a very wise precaution. The BNF goes on to say that drugs which have been extensively used in pregnancy and appear to be usually safe should be prescribed in preference to new or untried drugs; and the smallest effective dose should be used.
Given that occasionally the potential for harm might be overstated, it is important to bear in mind that pregnant women can become worried and anxious if they are told that they should not have taken a medicine (even though the evidence for that medicine doing harm is weak).
It is important to understand how many women have taken medicines during pregnancy, but it is even more important to determine the clinical outcome of their pregnancy. Studies such as the Avon longitudinal study are extremely important in understanding the consequences of medicine taking.
Before we get too concerned about the level of medicine taking during pregnancy, we need to have a clearer idea of whether the clinical outcome of the pregnancy in women who have taken medicines is statistically different from those who have not.
The ALSPAC press release that reports the study findings is available on the ALSPAC website.
2004-10-01: he manufacturer of Vioxx® and Vioxx® Acute (rofecoxib) has withdrawn the products with immediate effect.
Merck Sharp & Dohme have informed the Committee on Safety of Medicines of the immediate voluntary worldwide withdrawal of rofecoxib. This follows new clinical trial results showing an increased risk of confirmed serious thrombotic events (including myocardial infarction and stroke) compared to placebo, following long-term use.
Patients taking Vioxx® or Vioxx® Acute should contact their doctor by telephone or at the next convenient appointment to arrange an alternative prescription.
The new data and advice is specific to rofecoxib.
Additional information is available from the Department of Health.
2004-09-01: The BNF website has undergone a complete makeover
Welcome to the new-look BNF website.
Frequent visitors to this site cannot have failed to notice the changes to its appearance. The new design and arrangement of content will, we hope, ease access to the material, both in terms of reducing download times, and navigation around the site.
The new design incorporates:
The other significant change is that visitors need to register with us to view the BNF. Until 20 September 2004, visitors will have the option to skip registration but we strongly recommend that you register now to minimise disruption to access when registration becomes mandatory on 20 September. To find out more about registration see the Registration page.
2004-08-17: BNF response to Government initiative to develop medicines for children
The British National Formulary (BNF) welcomes the announcement today by Health Minister, Lord Warner of a new initiative to develop medicines designed specifically for use in children.
The BNF particularly welcomes his commitment to provide funding for a BNF for Children, the first ever version of the doctors' handbook devoted entirely to the needs of children.
Publication in print and electronic formats is planned for June 2005 with a new edition produced every year thereafter. Online updates will also ensure that the latest information is always available.
Ian Costello, Editor of BNF for Children said:
"The use of medicines in children is particularly complex. Because many medicines are not licensed for use in children, healthcare professionals currently have to rely on a variety of non-standard information resources. Selecting the right medicine and calculating the right dose for a child can be particularly problematic and make treatment more difficult. Healthcare professionals need clear, reliable and up-to-date information to inform prescribing decisions. The BNF for Children is a crucial step towards helping them make the best decisions for their younger patients."
Ends
Notes to editors:
BNF for Children is being produced in collaboration with the Royal College of Paediatrics and
Child Health and the Neonatal and Paediatric Pharmacists Group.
The BNF, a joint publication of the British Medical Association and Royal Pharmaceutical Society of Great Britain, is used daily by 200,000 health professionals, with an updated version published every six months. It is an up-to-date pocket book, for rapid reference by practising healthcare professionals, which encourages sensible, cost-effective and safe use of medicines.
For further information, please contact Emma Dickinson, Press Officer on Tel: 020 7383 6529 or Email: edickinson@bma.org.uk
2004-07-14: BNF prescribing excellence conference 2004
The third BNF conference took place on 18 May 2004. The conference theme was, 'Good medicine for children'.
Presentations from the conference are available on the Talks and presentations page.
