BNF for Children 2019-2020

1173 Pages·2019·11.054 MB·English

by  Paediatric Formulary Committee

MedicinesInformationServices
Informationondrugtherapy MedicinesinDentistrySpecialistAdvisoryService
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fromRegionalandDistrictMedicinesInformationServices. Liverpool:[phone]
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London: NHSUrgentCareServices111
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or(020)71883855
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or(029)20742251 availablefromUKAnti-Doping:
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Scotland
[email protected]
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or(01382)660111Extn32351 2-6SalisburySquare
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NorthernIreland medicinesbasedonthecurrentWorldAnti-Doping
Belfast: [phone] AgencyProhibitedListisavailablefromGlobalDrug
ReferenceOnline:www.globaldro.com/UK/search
RepublicofIreland
Dublin: [phone],
or(01)4537941Extn2348 TravelImmunisation
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UnitedKingdomMedicinesInformation(UKMI)website ▶ NationalTravelHealthNetworkandCentre(for
www.sps.nhs.uk/ healthcareprofessionalsonly)08456026712Monday
andFriday:9–11a.m.and1–2p.m,Tuesdayto
Thursday:9–11a.m.and1–3:30p.m.
Manufacturers ▶ travelhealthpro.org.uk/
Telephonenumbersandemailaddressesofmanufacturers TravelMedicineTeam,HealthProtectionScotland
listedinBNFPublicationsareshownintheIndexof [phone](2–4p.m.weekdays)
manufacturersp.1102 ▶ www.travax.nhs.uk(forregisteredusersoftheNHS
websiteTravaxonly)
▶ WelshGovernmentSwitchboardEnglishlanguage
UKTeratologyInformationService 03000603300(9a.m.–5:30p.m.weekdaysonly)
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UKDrugsinLactationAdvisoryService(UKDILAS) ListofRegisteredMedicalPractitioners
Informationonthecompatibilityofdrugswith Detailsonwhetherdoctorsareregisteredandholda
breastfeeding. licencetopractisemedicineintheUKcanbeobtained
Tel:[phone], fromtheGeneralMedicalCouncil.
or(0121)4247298 Tel:[phone]
Email:[email protected] www.gmc-uk.org/register
www.sps.nhs.uk/ukdilas
70 years supporting you to
make effective decisions
Since 1949 the British National Formulary (BNF) has been
the UK’s most trusted and authoritative healthcare resource,
helping to ensure the safe and effective use of medicines at the
point of care.
Now, as part of our anniversary celebrations, we want to showcase
the rigorous editorial process that goes into creating the content
that you rely on for your everyday practice. We will also go behind
the scenes at the BNF in our ‘A day in the life’ articles. To find out
more visit bnf.org
We really appreciate the support you have given the BNF for our
first 70 years - including the launch of the first edition of the BNF
for Children in 2005, created to meet the needs of healthcare
professionals working with children.
If you have a story to tell about how the BNF has been pivotal in
your healthcare journey, we would love to hear about it on social
media, just use hashtag #BNF70years
Find out more about the BNF’s first 70 years at bnf.org
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BNF
for Children
2019
2020
September 2019 – 20
Publishedjointlyby InWales,email:
BMJGroup [email protected]
TavistockSquare,London,WC1H9JP,UK
InNorthernIreland,email:
and [email protected]
PharmaceuticalPress AboutBNFCcontent
PharmaceuticalPressisthepublishingdivisionoftheRoyal TheBNFforChildrenisforrapidreferencebyUKhealth
PharmaceuticalSociety. professionalsengagedinprescribing,dispensing,and
66-68EastSmithfield,LondonE1W1AW,UK administeringmedicinestochildren.BNFforChildrenhas
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BNFC2019–2020 iii
Preface
BNFforChildrenaimstoprovideprescribers,pharmacists, ItisimportanttousethemostrecentBNFCinformation
andotherhealthcareprofessionalswithsoundup-to-date formakingclinicaldecisions.TheprinteditionofBNFfor
informationontheuseofmedicinesfortreatingchildren. ChildrenisupdatedinSeptembereachyear.Monthlyupdates
AjointpublicationoftheBritishMedicalAssociation,the areprovidedonlineviatheBNFPublicationswebsitewww.
RoyalPharmaceuticalSociety,theRoyalCollegeof bnf.org,MedicinesCompleteandtheNHSEvidenceportal.
PaediatricsandChildHealth,andtheNeonataland ThemoreimportantchangeslistedunderChangesp.xviiare
PaediatricPharmacistsGroup,BNFforChildren(‘BNFC’)is cumulative(fromoneprinteditiontothenext),andcanbe
publishedundertheauthorityofaPaediatricFormulary printedoffeachmonthtoshowthemainchangessincethe
Committeewhichcomprisesrepresentativesofthesebodies, lastprinteditionasanaidememoireforthoseusingprint
theDepartmentofHealthforEngland,andtheMedicines copies.
andHealthcareproductsRegulatoryAgency. Thewebsite(www.bnf.org)includesadditionalinformation
Manyareasofpaediatricpracticehavesufferedfrom ofrelevancetohealthcareprofessionals.Otherdigital
inadequateinformationoneffectivemedicines.BNFC formatsofBNFC—includingversionsformobiledevicesand
addressesthissignificantknowledgegapbyproviding integrationintolocalformularies—arealsoavailable.
practicalinformationontheuseofmedicinesinchildrenof BNFPublicationswelcomescommentsfromhealthcare
allagesfrombirthtoadolescence.InformationinBNFChas
professionals.Commentsandconstructivecriticismshould
beenvalidatedagainstemergingevidence,best-practice
besentto:
guidelines,andcrucially,advicefromanetworkofclinical
experts. BritishNationalFormulary,
Drawinginformationfrommanufacturers’literaturewhere RoyalPharmaceuticalSociety,
appropriate,BNFCalsoincludesagreatdealofadvicethat 66–68EastSmithfield
goesbeyondmarketingauthorisations(productlicences). London
Thisisnecessarybecauselicensedindicationsfrequentlydo E1W1AW
notcovertheclinicalneedsofchildren;insomecases, [email protected]
productsforuseinchildrenneedtobespecially Thecontactemailformanufacturersorpharmaceutical
manufacturedorimported.Carefulconsiderationhasbeen companieswishingtocontactBNFPublicationsis
giventoestablishingtheclinicalneedforunlicensed [email protected]
interventionswithrespecttotheevidenceandexperienceof
theirsafetyandefficacy;localpaediatricformularies,clinical
literatureandnationalinformationresourceshavebeen
invaluableinthisprocess.
BNFChasbeendesignedforrapidreferenceandthe
informationpresentedhasbeencarefullyselectedtoaid
decisionsonprescribing,dispensingandadministrationof
medicines.Lessdetailisgivenonareassuchasmalignant
diseaseandtheveryspecialistuseofmedicinesgenerally
undertakenintertiarycentres.BNFCshouldbeinterpreted
inthelightofprofessionalknowledgeanditshouldbe
supplementedasnecessarybyspecialisedpublications.
InformationisalsoavailablefromMedicinesInformation
Services(seeinsidefrontcover).
iv
BNFC2019–2020
Contents
Preface page
NOTESONDRUGSANDPREPARATIONS
Acknowledgements v
HowBNFpublicationsareconstructed viii 1 Gastro-intestinalsystem page27
HowtouseBNFPublicationsinprint x 2 Cardiovascularsystem 76
Changes xvii 3 Respiratorysystem 147
GuidanceonPrescribing 1 4 Nervoussystem 195
Prescriptionwriting 6 5 Infection 309
Supplyofmedicines 8 6 Endocrinesystem 448
Emergencysupplyofmedicines 9 7 Genito-urinarysystem 506
Controlleddrugsanddrugdependence 10 8 Immunesystemandmalignantdisease 535
Adversereactionstodrugs 14 9 Bloodandnutrition 583
Guidanceonintravenousinfusions 17 10 Musculoskeletalsystem 661
Prescribinginhepaticimpairment 18 11 Eye 689
Prescribinginrenalimpairment 18 12 Ear,noseandoropharynx 712
Prescribinginpregnancy 20 13 Skin 736
Prescribinginbreast-feeding 21 14 Vaccines 793
Prescribinginpalliativecare 22 15 Anaesthesia 830
Drugsandsport 26 16 Emergencytreatmentofpoisoning 859
Prescribingindentalpractice 26
APPENDICESANDINDICES
Appendix1
Interactions 872
Appendix2
Borderlinesubstances 1054
Appendix3
Cautionaryandadvisorylabelsfordispensedmedicines 1094
DentalPractitioners’Formulary 1097
NursePrescribers’Formulary 1098
Non-medicalprescribing 1101
Indexofmanufacturers 1102
Special-orderManufacturers 1107
Index 1109
Medicalemergenciesinthecommunity insidebackcover
BNFC2019–2020 v
Acknowledgements
ThePaediatricFormularyCommitteeisgratefulto
individualsandorganisationsthathaveprovidedadviceand
informationtotheBNFforChildren(BNFC).
Contributorsforthisupdatewere:
M.N.Badminton,S.Bailey,G.D.L.Bates,H.Bedford,
M.W.Beresford,R.M.Bingham,L.Brook,K.G.Brownlee,
I.F.Burgess,A.Cant,R.Carr,T.D.Cheetham,A.G.Cleary,
A.J.Cotgrove,J.B.S.Coulter,B.G.Craig,J.H.Cross,
A.Dhawan,P.N.Durrington,A.B.Edgar,J.A.Edge,
D.A.C.Elliman,N.D.Embleton,A.Freyer,P.J.Goadsby,
J.Gray,J.W.Gregory,P.Gringras,J.P.Harcourt,C.Hendriksz,
R.F.Howard,R.G.Hull,H.R.Jenkins,S.Jones,B.A.Judd,
E.Junaid,P.T.Khaw,J.M.W.Kirk,E.G.H.Lyall,P.S.Malone,
S.D.Marks,D.F.Marsh,P.McHenry,P.J.McKiernan,
L.M.Melvin,E.Miller,S.Moledina,R.E.Morton,
P.Mulholland,C.Nelson-Piercy,J.M.Neuberger,
K.K.Nischal,C.Y.Ng,J.Y.Paton,G.A.Pearson,J.Puntis,
J.Rogers,K.E.Rogstad,J.W.Sander,N.J.Scolding,
M.R.Sharland,N.J.Shaw,O.F.WStumper,A.G.Sutcliffe,
E.A.Taylor,S.Thomas,M.A.Thomson,J.A.Vale,S.Vijay,
J.O.Warner,N.J.A.Webb,A.D.Weeks,R.Welbury,
W.P.Whitehouse,A.Wright,Z.Zaiwalla,andS.M.Zuberi.
Valuableadvicehasbeenprovidedbythefollowingexpert
groups:AdvisoryCommitteeonMalariaPrevention,
AssociationofBritishNeurologists,BritishAssociationof
Dermatologists’Therapy&GuidelinesSub-committee,
BritishGeriatricsSociety,BritishSocietyof
Gastroenterology,BritishSocietyofPaediatric
Gastroenterology,HepatologyandNutrition,Facultyof
SexualandReproductiveHealthcare,Neonataland
PaediatricPharmacistsGroup,RoyalCollegeof
Anaesthetists,RoyalCollegeofObstetriciansand
Gynaecologists,RoyalCollegeofPsychiatrists,Vascular
Society.
TheMHRAhaveprovidedvaluableassistance.
Correspondentsinthepharmaceuticalindustryhave
providedinformationonnewproductsandcommentedon
productsintheBNFC.
Numerousdoctors,pharmacists,nurses,andothershave
sentcommentsandsuggestions.
TheBNFteamaregratefulforthesupportandaccesstoin-
houseexpertiseatPharmaceuticalPressandacknowledge
theassistanceofA.Lourie,J.Macdonald,N.Potterandtheir
teams.
M.D'Souza,D.Isaacson,A.Iqbal,N.Kaur,R.K.Khonsoorkh,
I.Lowings,E.RichardsonandT.T.Shamprovided
considerableassistanceduringtheproductionofthisupdate
ofBNFC.
vi
BNFC2019–2020
BNFStaff
BNFDIRECTOR
KarenBaxterBSc,MSc,MRPharmS
SENIOREDITORIALSTAFF
KiriAikmanBPharm(NZ),PGDipClinPharm(NZ),ARPharmS MahinazHarrisonBPharm,DipPharmPract,IP,MRPharmS
RebeccaBloorBPharm(NZ) RebeccaLuckhurstBSc,MSc
AlisonBrayfieldBPharm,MRPharmS AlexanderMcPhailMPharm,PGDipClinPharm
RobertBuckinghamBSc,SRPharmS ClaireMcSherryBPharm(NZ),PGCertClinPharm(NZ)
CatherineCadartBPharm(AU),BA(Hons), ClairePrestonBPharm,PGDipMedMan,MRPharmS
GradDipHospPharm(AU),MRPharmS
KateTowersBPharm(AU),GCClinPharm(AU)
EDITORIALSTAFF
LucíaCamañasSáezMPharm(ESP),PGDipClinPharm, AnnaMcLachlanBPharm(NZ),PGCertClinPharm(NZ)
PGCertPsychTherap,MRPharmS LilianaMoreiraVilasBoasMPharm(PT),PGDipHPS(PT),
JackyChanBPharm(Hons)(NZ),PGDipClinPharm(NZ) PGCertHSM(PT),PGCertGPP,MRPharmS
KiranCheemaMPharm MerushaNaidooBPharm(NZ),PGCertClinPharm(NZ)
KathleenEagerBPharm HanaNumanBPharm(NZ),PGDipClinPharm(NZ)
HannahGilesBPharm(NZ) KereOdumahMPharm,PGCertClinPharm
HollyHayneBSc(Pharmacology)(NZ),BPharm(NZ) BarbaraOkpalaMPharm,PGDipHospPharm
SueHoBPharm(AU),MRPharmS CatherinePittMPharm,PGDipClinPharm,MRPharmS
StephanieJonesMPharm,MSc(GenomicMedicine), StephaniePowellMBioSci
MRPharmS
RebekahRaymondBSc,DipPharmPrac,MRPharmS
ElizabethKingMAPharmT HarpreetSandhuMPharm,MRPharmS
MartaLeon-AlonsoMPharm(ESP),MRes(ESP),MSc BeejalShahMPharm,PGDipClinPharm,IP,MRPharmS
ClinPharm,MRPharmS
TadehTahmasiMPharm,MRPharmS
DavidLipanovicBPharm(NZ),PGCertClinPharm(NZ)
HannahTanBPharm(AU)
JeanMacKershanBSc,PgDip
JacobWarnerBPharm(AU)
JohnMartinBPharm,PhD,MRPharmS
JuliaWebbMPharm,PGCertPharmPrac
AngelaMcFarlaneBSc,DipClinPharm
HansYuBPharm(Hons)(NZ),PGDipClinPharm(NZ)"
DeirdreMcGuirkBComm,MPharm,MRPharmS
SUPPORTSTAFF
MattBradburyBSc(Hons) PhilipLeeBSc,PhD
DarrenChanBSc,MSc VickyPollingtonBSc(Hons)
LaurenCheethamBA(Hons) CarinaRedigdeCampos
FilsaneHajiBSc,MSc JannahRyanBSc(Hons)
HannahKittBSc(Hons) NikolaosTsimplisBSc,MRes