BNF 82 September 2021 – March 2022

1805 Pages·2021·16.852 MB·English

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BNF
82
September 2021
– March 2022
Publishedjointlyby InScotland,email:
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ISBN:9780857114136 maynotalwaysincludealltheinformationnecessaryfor
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ISBN:9780857114129(NHSEdition) suchasobstetrics,malignantdisease,andanaesthesiasince
ISBN:9780857114112(ePDF) itisexpectedthatthoseundertakingtreatmentwillhave
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BNF82 iii
Preface
TheBNFisajointpublicationoftheBritishMedical BNFPublicationswelcomescommentsfromhealthcare
AssociationandtheRoyalPharmaceuticalSociety.Itis professionals.Commentsandconstructivecriticismshould
publishedundertheauthorityofaJointFormulary besentto:
Committeewhichcomprisesrepresentativesofthetwo
BritishNationalFormulary,
professionalbodies,theUKHealthDepartments,the RoyalPharmaceuticalSociety,
MedicinesandHealthcareproductsRegulatoryAgency,and 66–68EastSmithfield
anationalguidelineproducer.TheDentalAdvisoryGroup
London
overseesthepreparationofadviceonthedrugmanagement E1W1AW
ofdentalandoralconditions;theGroupincludes
[email protected]
representativesoftheBritishDentalAssociationanda
representativefromtheUKHealthDepartments.TheNurse Thecontactemailformanufacturersorpharmaceutical
Prescribers’AdvisoryGroupadvisesonthecontentrelevant companieswishingtocontactBNFPublicationsis
tonursesandincludesrepresentativesfromdifferentparts [email protected]
ofthenursingcommunityandfromtheUKHealth
Departments.
TheBNFaimstoprovideprescribers,pharmacists,and
otherhealthcareprofessionalswithsoundup-to-date
informationabouttheuseofmedicines.
TheBNFincludeskeyinformationontheselection,
prescribing,dispensingandadministrationofmedicines.
MedicinesgenerallyprescribedintheUKarecoveredand
thoseconsideredlesssuitableforprescribingareclearly
identified.Littleornoinformationisincludedonmedicines
promotedforpurchasebythepublic.
Informationondrugsisdrawnfromthemanufacturers’
productliterature,medicalandpharmaceuticalliterature,
UKhealthdepartments,regulatoryauthorities,and
professionalbodies.Adviceisconstructedfromclinical
literatureandreflects,asfaraspossible,anevaluationofthe
evidencefromdiversesources.TheBNFalsotakesaccount
ofauthoritativenationalguidelinesandemergingsafety
concerns.Inaddition,theeditorialteamreceivesadviceon
alltherapeuticareasfromexpertclinicians;thisensuresthat
theBNF’srecommendationsarerelevanttopractice.
TheBNFisdesignedasadigestforrapidreferenceandit
maynotalwaysincludealltheinformationnecessaryfor
prescribinganddispensing.Also,lessdetailisgivenonareas
suchasobstetrics,malignantdisease,andanaesthesiasince
itisexpectedthatthoseundertakingtreatmentwillhave
specialistknowledgeandaccesstospecialistliterature.
Similarly,littleornoinformationisincludedonmedicines
forveryrareconditions.BNFforChildrenshouldbe
consultedfordetailedinformationontheuseofmedicinesin
children.TheBNFshouldbeinterpretedinthelightof
professionalknowledgeandsupplementedasnecessaryby
specialisedpublicationsandbyreferencetotheproduct
literature.Informationisalsoavailablefrommedicines
informationservices,seeMedicinesInformationServices
(seeinsidefrontcover).
ItisimportanttousethemostrecentBNFinformationfor
makingclinicaldecisions.TheprinteditionoftheBNFis
updatedinMarchandSeptembereachyear.Monthly
updatesareprovidedonlineviaMedicinesCompleteandthe
NHSEvidenceportal.Themoreimportantchangesarelisted
underChanges;changeslistedonlinearecumulative(from
oneprinteditiontothenext),andcanbeprintedoffeach
monthtoshowthemainchangessincethelastprintedition
asanaidememoireforthoseusingprintcopies.
TheBNFPublicationswebsite(www.bnf.org)includes
additionalinformationofrelevancetohealthcare
professionals.OtherdigitalformatsoftheBNF—including
versionsformobiledevicesandintegrationintolocal
formularies—arealsoavailable.
iv
BNF82
Contents
Preface pageiii
NOTESONDRUGSANDPREPARATIONS
Acknowledgements v
HowBNFpublicationsareconstructed viii 1 Gastro-intestinalsystem page40
HowtouseBNFPublicationsinprint x 2 Cardiovascularsystem 107
Changes xvi 3 Respiratorysystem 252
GuidanceonPrescribing 1 4 Nervoussystem 319
Prescriptionwriting 5 5 Infection 531
Emergencysupplyofmedicines 7 6 Endocrinesystem 708
Controlleddrugsanddrugdependence 8 7 Genito-urinarysystem 821
Adversereactionstodrugs 12 8 Immunesystemandmalignantdisease 885
Guidanceonintravenousinfusions 16 9 Bloodandnutrition 1063
Medicinesoptimisation 18 10 Musculoskeletalsystem 1149
Antimicrobialstewardship 20 11 Eye 1211
Prescribingforchildren 22 12 Ear,noseandoropharynx 1246
Prescribinginhepaticimpairment 23 13 Skin 1274
Prescribinginrenalimpairment 23 14 Vaccines 1342
Prescribinginpregnancy 27 15 Anaesthesia 1396
Prescribinginbreast-feeding 28 16 Emergencytreatmentofpoisoning 1430
Prescribinginpalliativecare 28
APPENDICESANDINDICES
Prescribingfortheelderly 33
Appendix1
Drugsandsport 34 Interactions 1445
Prescribingindentalpractice 35 Appendix2
Borderlinesubstances 1654
Appendix3
Cautionaryandadvisorylabelsfordispensedmedicines 1696
Appendix4
Woundmanagementproductsandelasticatedgarments 1699
DentalPractitioners’Formulary 1723
NursePrescribers’Formulary 1725
Non-medicalprescribing 1730
Indexofmanufacturers 1731
Special-orderManufacturers 1736
Index 1738
Medicalemergenciesinthecommunity insidebackcover
BNF82 v
Acknowledgements
TheJointFormularyCommitteeisgratefultoindividualsand
organisationsthathaveprovidedadviceandinformationto
theBNF.
Contributorsforthisupdatewere:
K.W.Ah-See,M.N.Badminton,A.K.Bahl,D.Bilton,
M.F.Bultitude,I.F.Burgess,C.E.Dearden,D.W.Denning,
D.A.C.Elliman,P.Emery,A.Freyer,N.J.L.Gittoes,M.Gupta,
T.L.Hawkins,S.P.Higgins,T.H.Lee,A.Lekkas,
D.N.J.Lockwood,A.M.Lovering,M.G.Lucas,P.D.Mason,
D.A.McArthur,L.M.Melvin,R.M.Mirakian,P.Morrison,
S.M.S.Nasser,C.Nelson-Piercy,D.J.Nutt,R.Patel,
A.B.Provan,A.S.C.Rice,D.J.Rowbotham,S.E.Slater,J.Soar,
M.D.Stewart,S.Thomas,A.D.Weeks,A.Wilcock.
Expertadviceonthemanagementoforalanddental
conditionswaskindlyprovidedbyA.Crighton,C.Scully,
R.A.Seymour,andR.Welbury.S.Kaurprovidedvaluable
adviceondentalprescribingpolicy.
Valuableadvicehasbeenprovidedbythefollowingexpert
groups:AdvisoryCommitteeonMalariaPrevention,
AssociationofBritishNeurologists,BritishAssociationof
Dermatologists’Therapy&GuidelinesSub-committee,
BritishGeriatricsSociety,BritishMenopauseSociety,British
SocietyforAllergy&ClinicalImmunology,BritishSociety
forAntimicrobialChemotherapy,BritishSocietyof
Gastroenterology,BritishSocietyofRheumatology,College
ofMentalHealthPharmacy,ENTUK,FacultyofSexualand
ReproductiveHealthcare,NationalPoisonsInformation
Service&TOXBASE,PublicHealthEngland,Renal
Association,RoyalCollegeofAnaesthetists,RoyalCollegeof
ObstetriciansandGynaecologists,RoyalCollegeof
Ophthalmologists,RoyalCollegeofPathologists,Royal
CollegeofPhysicians,RoyalCollegeofPsychiatrists,Society
forEndocrinology,UKTeratologyInformationService,
VascularSociety.
TheMHRAhaveprovidedvaluableassistance.
Correspondentsinthepharmaceuticalindustryhave
providedinformationonnewproductsandcommentedon
productsintheBNF.
Numerousdoctors,pharmacists,nurses,andothershave
sentcommentsandsuggestions.
TheBNFteamaregratefulforthesupportandaccesstoin-
houseexpertiseatPharmaceuticalPressandacknowledge
theassistanceofK.Baxter,A.Naylor,J.Macdonald,
N.Potterandtheirteams.
H.Bulman,Z.Dildar,K.EstifanosBiru,D.Gutu,A.Healy,
K.Inderaraj,N.Khatibi-Jah,andM.Sohaibprovided
considerableassistanceduringtheproductionofthisupdate
oftheBNF.
vi
BNF82
BNFStaff
ASSOCIATECONTENTDIRECTOR(BNFPUBLICATIONS)
KateTowersBPharm(AU),GCClinPharm(AU)
SENIOREDITORIALSTAFF
KiriAikmanBPharm(NZ),PGDipClinPharm(NZ),ARPharmS HollyHayneBSc(Pharmacology)(NZ),BPharm(NZ)
AlisonBrayfieldBPharm,MRPharmS JeanMacKershanBSc,PgDip
RobertBuckinghamBSc,SRPharmS AngelaMcFarlaneBSc,DipClinPharm
CatherineCadartBPharm(AU),BA(Hons), AlexanderMcPhailMPharm,PGDipClinPharm
GradDipHospPharm(AU),MRPharmS ClairePrestonBPharm,PGDipMedMan,MRPharmS
MahinazHarrisonBPharm,DipPharmPract,IP,MRPharmS
EDITORIALSTAFF
HannahArnoldBPharm(NZ) NalwengaMutamboMPharm
NatashaBell-AsherBPharm(NZ),PGDipClinPharm(NZ) MerushaNaidooBPharm(NZ),PGCertClinPharm(NZ)
LucíaCamañasSáezMPharm(ESP),PGDipClinPharm, HanaNumanBPharm(NZ),PGDipClinPharm(NZ)
PGCertPsychTherap,MRPharmS
BarbaraOkpalaMPharm,PGDipHospPharm
RochelleChinBPharm(AU) HeenabenPatelMPharm,PGDipClinPharm,MRPharmS
KathleenEagerBPharm LauraPhamBPharm(Hons)(AU)
EmilyHendersonBPharm(NZ),PGCertClinPharm(NZ) CatherinePittMPharm,PGDipClinPharm,MRPharmS
SueHoBPharm(AU),MRPharmS CaralieseRebelloBPharm(NZ),PGDipClinPharm(NZ)
EmmaJonesMPharm SharylRodriguesBPharm(NZ),PGDipClinPharm(NZ)
ElizabethKingMAPharmT JannahRyanBSc(Hons)
SonalLadaniMPharm,PGDipGPP,IP,MRPharmS BeejalShahMPharm,PGDipClinPharm,IP
DavidLipanovicBPharm(NZ),PGCertClinPharm(NZ) LucySheedBPharm(NZ)
JohnMartinBPharm,PhD,MRPharmS TadehTahmasiMPharm,MRPharmS
SorchaMcCannMPharm,PGDip HarpreetTakharMPharm,MRPharmS
DeirdreMcGuirkBComm,MPharm HannahTanBPharm(AU)
AnnaMcLachlanBPharm(NZ),PGCertClinPharm(NZ) JuliaWebbMPharm,PGCertPharmPrac
LilianaMoreiraVilasBoasMPharm(PT),PGDipHPS(PT),
PGCertHSDM(PT),PGCertGPP,MRPharmS
SUPPORTSTAFF
SophiaAldwinckleBSc(Hons) PhilipLeeBSc,PhD
RosalindBarkerBMus,MA RebeccaLuckhurstBSc(Hons),MSc
MattBradburyBSc(Hons) OliviaMaskillBSc(Hons)
DarrenChanBSc,MSc LonaMehtaMPharm,MRPharmS
LaurenCheethamBA(Hons) IbrahimMohammed-AliBSc(Hons),MSc
ElainaCrehanMChem(Hons) ChristineParryBSc(Hons),MSc
HarrietFiddimore-HicksBSc(Hons),MSc VickyPollingtonBSc(Hons)
FilsaneHajiBSc(Hons),MSc CarinaRedigdeCampos
RebeccaHarwoodBSc(Hons) LeahRichardsonBPharm(NZ)
NickJuddBA(Hons),MA ElisabettaStramiglioBSc,MSc
LouiseSymmonsBSc(Hons),MSc