BNF BNF
British National Formulary
Royal Pharmaceutical Society
1 Lambeth High Street, London SE1 7JN, UK
bnf.org
Dear BNF user
Distribution of BNFs
The UK health departments distribute BNFs to NHS hospitals, doctors, Welcome to BNF 60. We have highlighted below some of the key
dental surgeons, and community pharmacies. In England, BNFs changes you will find in this new edition.
are mailed individually to NHS general practitioners and community
pharmacies; contact the DH Publications Orderline for extra copies or Updated prescribing information
changes relating to mailed BNFs.
Tel: 0300 123 1002 Use of beta-blockers in patients with asthma or chronic obstructive
pulmonary disease
In Wales, contact the Business Services Centre. Guidance on the use of cardioselective beta-blockers to treat co-existing
Tel: 01495 332 000 cardiac conditions in patients with well-controlled asthma or chronic
obstructive pulmonary disease has been updated in section 2.4 (p. 97).
For further information on the supply of copies of the BNF to NHS Beta-blockers can cause bronchospasm and should therefore usually
organisations, see the DH website http://www.library.nhs.uk/orderingbnf be avoided in patients with asthma. The BNF acknowledges that it may
sometimes be necessary to use a beta-blocker in a patient with well-
Alternatively, copies may be obtained through any bookseller or direct controlled asthma or chronic obstructive pulmonary disease (without
from Macmillan Distribution by telephone: +44 (0) 1256 302 699 or by significant reversible airways obstruction) for a co-existing cardiac
email: direct@macmillan.co.uk condition such as heart failure or following a myocardial infarction; in
these circumstances, a cardioselective beta-blocker may be used,
For all bulk orders of more than 20 copies please email the publisher at: initiated at a low dose by a specialist, and the patient monitored closely
pharmpress@rpsgb.org or telephone: +44 (0) 20 7572 2266 for adverse effects.
Print copies of the BNF can also be purchased via a 1 or 2 year Prophylaxis of venous thromboembolism
subscription; please email php@macmillansolutions.com or telephone: Guidance on the prophylaxis of venous thromboembolism has been
+44 (0) 203 318 3141 revised in section 2.8 (p.139) in light of the NICE Clinical Guideline
92 (January 2010): Venous thromboembolism: reducing the risk. All
patients admitted to hospital should undergo a risk assessment for
Pharmaid venous thromboembolism on admission; patients considered to be at
Numerous requests have been received from developing countries high risk should be offered pharmacological prophylaxis. Risk factors
for BNFs. The Pharmaid scheme of the Commonwealth Pharmacists for bleeding should also be assessed, and pharmacological prophylaxis
Association will dispatch old BNFs to Commonwealth countries. BNFs should only be initiated when the risk of bleeding does not outweigh
will be collected from certain community pharmacies in November. For the risk of venous thromboembolism. Advice is provided on choice of
further details check the health press or contact: pharmacological prophylaxis.
Betty Falconbridge Antiplatelet drugs in patients with a coronary stent
Tel: 020 7572 2364 Guidance on the use of antiplatelet drugs in patients following
Email: admin@commonwealthpharmacy.org percutaneous coronary intervention has been included in section 2.9
(p.149). Patients who have had a coronary stent placed will require dual
Feedback antiplatelet therapy. Dual antiplatelet therapy should not be discontinued
prematurely in patients with a drug-eluting stent because there is an
We welcome feedback from you. If you have any comments or increased risk of stent thrombosis as a result of the eluted drug slowing
suggestions please let us know at editor@bnf.org.
BNF60_4PPinsert.indd 1-2 13/8/10 11:00:47
BNF
the re-endothelialisation process. Patients considered to be at high risk of immunocompromised patients over 13 years of age, Pandemrix® should
developing late stent thrombosis with a drug-eluting stent may require a be given 4 weeks before the seasonal influenza vaccine.
longer treatment duration.
Meningococcal A, C, W135, and Y conjugate vaccine
Chronic obstructive pulmonary disease The Joint Committee on Vaccination and Immunisation recommends the
Guidance on the management of chronic obstructive pulmonary meningococcal A, C, W135, and Y conjugate vaccine (Menveo®) in those
disease has been updated in section 3.1 (p.169) to take into account travelling to countries with risk of meningococcal infection. BNF 60 (section
the recommendations of the NICE Clinical Guideline 101 (June 2010): 14.4, p. 750) reflects these recommendations and includes details about
Management of chronic obstructive pulmonary disease in adults in this new vaccine which is likely to provide longer lasting protection than the
primary and secondary care. Significant changes have been made to unconjugated meningococcal polysaccharide vaccine.
the recommendations for regular inhaled therapies. These changes are
illustrated in the Use of inhaled therapies algorithm (p. 172), which has Reorganised sections in BNF 60
been reproduced from the NICE guideline.
Borderline substances
Section A7.6 in the appendix on Borderline substances (Appendix 7) has
Neuropathic pain
been revised. Gluten-free and low-protein food products are now listed
The prescribing notes on the management of neuropathic pain (p. 271)
under separate subheadings, such as bread (including bread rolls and
and the management of diabetic neuropathy (p. 428) have been updated
baguettes), flour mixes, and pasta.
in line with NICE Clinical Guideline 96 (March 2010): Neuropathic pain.
The pharmacological management of neuropathic pain in adults in
non-specialist settings. Additional advice is now provided on the use of Learning with the BNF
combination therapy to treat neuropathic pain or diabetic neuropathy. BNF e-learning modules for pharmacists
The initial dose of amitriptyline (p. 233) for the treatment of neuropathic BNF Update is an e-learning programme developed in collaboration with
pain has been lowered in line with the NICE guideline and following the Centre for Pharmacy Postgraduate Education (CPPE). Using a series
advice from our expert advisers. of clinical case studies, the programme enables pharmacists to identify
and assess how significant changes in the latest BNF affect their clinical
Influenza vaccination practice. There are two e-learning programmes: one for pharmacists
The trivalent seasonal influenza vaccine for 2010–2011 includes working in the community and other primary care settings, and another
components of the H1N1 swine influenza virus. Seasonal influenza aimed at hospital pharmacists. New modules will be released every 6
vaccine should continue to be offered as normal (section 14.4, p. 746). months to complement the publication of each new edition of the BNF.
Additionally, the seasonal influenza vaccine is recommended for pregnant Recognised as an essential component of every pharmacist’s continuing
women who are not in the at-risk groups for influenza, and who have not professional development, BNF Update can be accessed free of charge
received the monovalent influenza A(H1N1)v vaccine previously. by pharmacists and pre-registration pharmacists in England at
http://www.cppe.ac.uk.
The monovalent influenza A(H1N1)v vaccine, Pandemrix®, is
recommended in children aged 6 months–5 years who have not received
the monovalent vaccine previously if they are in the risk groups prioritised
BNF and BNFC e-newsletter
for seasonal influenza vaccine. Pandemrix® is also recommended for The BNF & BNFC free e-newsletter is issued several times a year. To
immunocompromised patients over 6 months of age who have not register for regular updates, case studies, and tips on using these
received the monovalent vaccine previously. Pandemrix® can be given at publications effectively, please sign up at http://bnf.org/newsletter. To visit the
the same time as the first dose of seasonal influenza vaccine; however, in e-newsletter archive, go to http://bnf.org/bnf/extra/current/450066.htm.
BNF60_4PPinsert.indd 3-4 13/8/10 11:00:47
