British National Formulary
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.
