British National Formulary
Welcome to BNF 59. We have highlighted below some of the key changes you will find in this new edition.
BNF Publications is delighted to announce that SGS, one of the world leaders in quality management assessment, has confirmed that the BNF quality management system is ISO 9001:2008 certified.
ISO 9001:2008 certification demonstrates that the procedures that underpin the production of BNF products are robust and carried out to the highest of standards; that we engage with and respond to our users; that we train our staff to promote excellence in performance; and that we are committed to ongoing innovation to meet the needs of healthcare professionals in the future.
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 towards the back of the book. The information can now be read in context with the other prescribing information. The layout is similar to that in BNF for Children, with the messages adjacent to bold headings so that they can easily be found.
General advice on the principles of prescribing in hepatic or renal impairment, and in pregnancy or breast-feeding is now included in the General guidance section.
The table showing equivalent doses of morphine sulphate and diamorphine hydrochloride in Prescribing in palliative care has been revised to improve the clarity of the table. The updated version shows equivalent doses of morphine sulphate and diamorphine hydrochloride over 24 hours.
The marketing authorisation for sibutramine (Reductil®) has been withdrawn by the European Medicines Agency. 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. General practitioners must not issue prescriptions for sibutramine and pharmacists must not dispense prescriptions for sibutramine. Patients who are taking sibutramine must have their treatment reviewed; see section 4.5 for information on the treatment of obesity.
Guidance on the antibacterial treatment of community-acquired pneumonia has been updated in Table 1, section 5.1 to take into account the recommendations of the British Thoracic Society (Thorax 2009; 64 (supp III): iii1–45). 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. Either doxycycline or clarithromycin is recommended as an alternative to amoxicillin for the treatment of low-severity community-acquired pneumonia. A quinolone is included as an alternative to a macrolide if Legionella infection is suspected.
The introductory notes on cytotoxic drugs in section 8.1 have been revised following recommendations made by the National Patient Safety Agency (NPSA) working in collaboration with a multidisciplinary group of specialists. This section now includes additional information on issues concerning the safe use of cytotoxic drugs, particularly by non-cancer specialists in primary care.
Advice on TPMT testing before starting patients on azathioprine has been included in section 8.2.1.
Information on the use of ciclosporin products has been updated in light of advice issued by the Medicines and Healthcare products Regulatory Agency (MHRA) and Commission on Human Medicines (CHM), and the availability of new ciclosporin products in the UK (section 8.2.2).
The prescribing notes on stable and unstable angina have been reorganised and relocated to section 2.10.1, under the revised title ‘Management of stable angina and acute coronary syndromes’. Section 2.10.1 now includes prescribing notes on stable and unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction.
Teaching sessions on Getting the Best Out of Your BNF have revealed that healthcare professionals (from the recently qualified to those who have been practising for many years) and students training to join these professions have much to learn about the BNF. The section on How to Use the BNF has been expanded in this edition to make this information accessible to all those who use the BNF. How to Use the BNF is linked to the main elements of rational prescribing, such as, using the BNF to select drugs that minimise harm in patients with co-morbidities, and writing prescriptions in a way that helps to reduce medication errors. The generic structure of this section means that it can be adapted easily for teaching and learning in different clinical settings.
BNF Update is an e-learning programme developed in collaboration with the Centre for Pharmacy Postgraduate Education (CPPE). Using a series of clinical case studies, the programme enables pharmacists to identify and assess how significant changes in the latest BNF affect their clinical practice. There are two e-learning programmes: one for pharmacists working in the community and other primary care settings, and another aimed at hospital pharmacists. New modules will be released every 6 months to complement the publication of each new edition of the BNF. Recognised as an essential component of every pharmacist’s continuing professional development, BNF Update can be accessed free of charge by pharmacists and pre-registration pharmacists in England at http://www.cppe.ac.uk.
The March 2010 edition of the BNF & BNFC e-newsletter will focus on adverse drug reactions. To register for regular updates, case studies, and tips on using these publications effectively, please sign up at http://bnf.org/newsletter. To visit the e-newsletter archive, go to http://bnf.org/bnf/extra/current/450066.htm.
Numerous changes are made for each edition of the BNF. The most significant changes that have been made for BNF 59 can be reviewed by following the links below:
