BNF 84 (British National Formulary) September 2022 - March 2023

1867 Pages·2022·22.977 MB·English

by  Joint Formulary Committee

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BNF
84
September 2022
– March 2023
Publishedjointlyby InWales,email:
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Copyright©BMJGroupandtheRoyalPharmaceutical
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suchasobstetrics,malignantdisease,andanaesthesiasince
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BNF84 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
BNF84
Contents
Preface pageiii
NOTESONDRUGSANDPREPARATIONS
Acknowledgements v
HowBNFpublicationsareconstructed viii 1 Gastro-intestinalsystem page37
HowtouseBNFPublicationsinprint x 2 Cardiovascularsystem 105
Changes xvi 3 Respiratorysystem 255
GuidanceonPrescribing 1 4 Nervoussystem 325
Prescriptionwriting 4 5 Infection 540
Emergencysupplyofmedicines 6 6 Endocrinesystem 721
Controlleddrugsanddrugdependence 7 7 Genito-urinarysystem 837
Adversereactionstodrugs 10 8 Immunesystemandmalignantdisease 901
Guidanceonintravenousinfusions 14 9 Bloodandnutrition 1095
Medicinesoptimisation 16 10 Musculoskeletalsystem 1186
Antimicrobialstewardship 17 11 Eye 1248
Prescribingforchildren 19 12 Ear,noseandoropharynx 1284
Prescribinginhepaticimpairment 20 13 Skin 1312
Prescribinginrenalimpairment 21 14 Vaccines 1383
Prescribinginpregnancy 24 15 Anaesthesia 1439
Prescribinginbreast-feeding 24 16 Emergencytreatmentofpoisoning 1473
Prescribinginpalliativecare 25
APPENDICESANDINDICES
Prescribingfortheelderly 29
Appendix1
Drugsandsport 31 Interactions 1488
Prescribingindentalpractice 31 Appendix2
Borderlinesubstances 1722
Appendix3
Cautionaryandadvisorylabelsfordispensedmedicines 1764
Appendix4
Woundmanagementproductsandelasticatedgarments 1767
DentalPractitioners’Formulary 1790
NursePrescribers’Formulary 1792
Non-medicalprescribing 1797
Indexofmanufacturers 1798
Special-orderManufacturers 1803
Index 1805
Medicalemergenciesinthecommunity 1842
Lifesupportalgorithm insidebackcover
BNF84 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
OncologyPharmacyAssociation,BritishPainSociety,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.
W.Ahmed,H.Arshad,A.Devanand,H.Iqbal,S.Khan,J.
Kwarteng,C.Lam,A.Mahmood,H.Osman,K.Pradhan,T.
Tahmasi,andH.Tanprovidedconsiderableassistance
duringtheproductionofthisupdateoftheBNF.
vi
BNF84
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LonaMehtaMPharm,MRPharmS JuliaWebbMPharm,PGCertPharmPrac
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