BNF for Children 2020-2021 (British National Formulary for Children)

1221 Pages·2020·11.194 MB·English

by  Paediatric Formulary Committee

MedicinesInformationServices
Informationondrugtherapy MedicinesinDentistrySpecialistAdvisoryService
Informationonanyaspectofdrugtherapycanbeobtained Informationondrugtherapyrelatingtodentaltreatment.
fromRegionalandDistrictMedicinesInformationServices. Liverpool:[phone]
Detailsregardingthelocalservicesprovidedwithinyour
regioncanbeobtainedbytelephoningthefollowing
numbers. DriverandVehicleLicensingAgency(DVLA)
Informationonthenationalmedicalguidelinesoffitness
England todriveisavailablefrom:
Birmingham: [phone] www.gov.uk/government/publications/at-a-glance
Bristol: [phone]
Ipswich: [phone] MedicinesforChildrenInformationLeaflets
Leeds: [phone] Medicinesinformationforparentsandcarers.
Leicester: [phone] www.medicinesforchildren.org.uk
Liverpool: [phone]/7,
or(0151)7948118 PatientInformationLines
London: NHSUrgentCareServices111
.Guy’sHospital [phone],
or(020)71883849, PoisonsInformationServices
or(020)71883855
UKNationalPoisonsInformationService(forhealthcare
.NorthwickParkHospital [phone], professionalsonly)
or(020)88693973 Tel:[phone]
Newcastle: [phone] www.toxbase.org
Southampton: [phone]/9
Wales Sport
Cardiff: (o0r2(90)2290)724072497292,51 ▶ IanvfaoilrambaletifornomregUaKrdAinntgi-tDheopuisnego:fmedicinesinsportis
Scotland Tel:[phone]
Aberdeen: [phone] [email protected]
Dundee: [phone], UKAnti-Doping
or(01382)660111Extn32351 F2-le6eStbalainsbkuHryouSsqeuare
Edinburgh: [phone] London
Glasgow: [phone] EC4Y8AE
▶ Informationabouttheprohibitedstatusofspecific
NorthernIreland
medicinesbasedonthecurrentWorldAnti-Doping
Belfast: [phone] AgencyProhibitedListisavailablefromGlobalDrug
RepublicofIreland ReferenceOnline:www.globaldro.com/UK/search
Dublin: [phone],
or(01)4537941Extn2348 TravelImmunisation
Up-to-dateinformationontravelimmunisation
UnitedKingdomMedicinesInformation(UKMI)website requirementsmaybeobtainedfrom:
www.sps.nhs.uk/ ▶ NationalTravelHealthNetworkandCentre(for
healthcareprofessionalsonly)08456026712Monday
andFriday:9–11a.m.and1–2p.m,Tuesdayto
Manufacturers Thursday:9–11a.m.and1–3:30p.m.
Telephonenumbersandemailaddressesofmanufacturers ▶ travelhealthpro.org.uk/
listedinBNFPublicationsareshownintheIndexof TravelMedicineTeam,HealthProtectionScotland
manufacturersp.1147 (0141)3001100(2–4p.m.weekdays)
▶ www.travax.nhs.uk(forregisteredusersoftheNHS
websiteTravaxonly)
UKTeratologyInformationService ▶ WelshGovernmentSwitchboardEnglishlanguage
Informationondrugandchemicalexposuresin 03000603300(9a.m.–5:30p.m.weekdaysonly)
pregnancy. ▶ WelshGovernmentSwitchboardYrlaithGymraeg
Tel:[phone] 03000604400(9a.m.–5:30p.m.weekdaysonly)
www.uktis.org ▶ D(0e2p8a)r9t0m5e2n2t1o1f8H(ewaeltehkdaanydsS)ocialServices(Belfast)
UKDrugsinLactationAdvisoryService(UKDILAS)
ListofRegisteredMedicalPractitioners
Informationonthecompatibilityofdrugswith
Detailsonwhetherdoctorsareregisteredandholda
breastfeeding.
Torel(:0(102111)64)2245782694891, lfTirceoelm:n(c0teh1et6o1G)pe9rna2ec3rtai6sl6eM0m2eeddiciacilnCeoiunntchile.UKcanbeobtained
Email:[email protected]
www.gmc-uk.org/register
www.sps.nhs.uk/ukdilas
REDUCED RATE SUBSCRIPTION
FOR INDEPENDENT COMMUNITY PHARMACISTS
Essential information to help you
make the right decision
As a community pharmacist, we know you strive to provide safe and eff ective
patient care. That’s why independent community pharmacists can now benefi t
from a reduced rate subscription to essential resources through our trusted
online medicines information platform, MedicinesComplete. Resources include:
Stockley’s Drug Interactions, Stockley’s Interactions Checker,
Martindale: The Complete Drug Reference, Martindale’s ADR Checker,
British National Formulary and BNF for Children.
MedicinesComplete makes it easy for healthcare professionals to access
essential medicines information at the point of care. Providing trusted evidence-
based knowledge for confi dent decision-making and eff ective patient care.
FIND OUT MORE AT
medicinescomplete.com/communitypharmacyoff er
The first choice for concise
medicines information
Trusted by healthcare professionals in the UK and across the world, the British National
Formulary (BNF) and BNF for Children support confident decision-making at the point of care.
BNF and BNF for Children are updated monthly through the online platform
MedicinesComplete and via the BNF app. In print, BNF is updated twice a year and
BNF for Children annually. FormularyComplete enables you to create and manage your own
local formulary online, built on BNF and BNF for Children advice.
How to access the BNF
NHS Eligible Individuals
Eligible healthcare professionals in the UK benefit from a print copy of the BNF and BNF for Children
each September, and online access provided through MedicinesComplete and the BNF app.
(cid:79) For print, refer to page ii, call 01268 495 609 or email [email protected].
(cid:79) To register as an NHS user for access through MedicinesComplete go to
about.medicinescomplete.com/registration.
(cid:79) Download the BNF app from your iOS or Android app store.
Access BNF and BNF for Children alongside other best practice and evidence-based guidance from
NICE at www.evidence.nhs.uk.
Print
Buy single copies or a subscription securely online, at www.pharmpress.com/bnf
Bulk orders: call [phone] or email [email protected]
Online
Subscribe through MedicinesComplete or to FormularyComplete:
call [phone] or email [email protected]
For news on the latest new drugs and significant changes sign up to our newsletter at
www.bnf.org/newsletter
BNF
for Children
2020
2021
September 2020 – 21
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
beenconstructedusingrobustproceduresforgathering,
Copyright©BMJGroup,theRoyalPharmaceuticalSocietyof
GreatBritain,andRCPCHPublicationsLtd2020. assessingandassimilatinginformationonpaediatricdrug
treatment,butmaynotalwaysincludealltheinformation
ISBN:9780857113726 necessaryforprescribinganddispensing.Itisexpectedthat
ISBN:9780857113733(NHSedition) thereaderwillberelyingonappropriateprofessional
ISBN:9780857113740(ePDF) kconnotwelxetdogfetahnedcierxcpuemrtsitsaentcoesinotfetrhpereitntdhievicdounatlecnhtisldin.BtNheFfor
PrintedbyGGPMediaGmbH,Pößneck,Germany Childrenshouldbeusedinconjunctionwithother
TypesetbyDataStandardsLtd,UK appropriateandup-to-dateliteratureand,wherenecessary,
supplementedbyexpertadvice.Informationisalsoavailable
TextdesignbyPeterBurgess fromMedicinesInformationServices.
AcataloguerecordforthisbookisavailablefromtheBritish Specialcareisrequiredinmanagingchildhoodconditions
Library. withunlicensedmedicinesorwithlicensedmedicinesfor
Allrightsreserved.Nopartofthispublicationmaybe unlicenseduses.Responsibilityfortheappropriateuseof
reproduced,storedinaretrievalsystem,ortransmittedin medicinesliessolelywiththeindividualhealthprofessional.
anyformorbyanymeans,withoutthepriorwritten PleaserefertodigitalversionsofBNFforChildrenforthe
permissionofthecopyrightholder. mostup-to-datecontent.BNFforChildrenispublishedin
MaterialpublishedintheBNFforChildren(BNFC)maynot printbutinterimupdatesareissuedandpublishedinthe
beusedforanyformofadvertising,salesorpublicitywithout digitalversionsofBNFforChildren.Thepublishersworkto
priorwrittenpermission.Eachoftheclassificationandthe ensurethattheinformationisasaccurateandup-to-dateas
textareprotectedbycopyrightand/ordatabaseright. possibleatthedateofpublication,butknowledgeandbest
practiceinthisfieldchangeregularly.BNFforChildren’s
RequestingcopiesofBNFpublications accuracyandcurrencycannotbeguaranteedandneitherthe
Papercopiesmaybeobtainedthroughanybookselleror publishersnortheauthorsacceptanyresponsibilityfor
directfrom: errorsoromissions.Whileconsiderableeffortshavebeen
PharmaceuticalPress madetocheckthematerialinthispublication,itshouldbe
treatedasaguideonly.Prescribers,pharmacistsandother
c/oMacmillanDistribution(MDL)
healthcareprofessionalsareadvisedtocheck
HampshireInternationalBusinessPark
www.bnf.orgforinformationaboutkeyupdatesand
LimeTreeWay
corrections.
Basingstoke
Hampshire Pharmaid
RG248YJ Numerousrequestshavebeenreceivedfrom
Tel:[phone] developingcountriesforBNFCs.ThePharmaidscheme
Fax:[phone] oftheCommonwealthPharmacistsAssociation
[email protected] willdispatcholdBNFCstocertainCommonwealth
orviaourwebsitewww.pharmpress.com countries.Formoreinformationonthisschemesee
commonwealthpharmacy.org/what-we-do/pharmaid/.
Forallbulkordersofmorethan20copies: Ifyouwouldliketodonateyourcopy,email:
Tel:[phone] [email protected]
[email protected]
BNFCisavailableasamobileapp,online(bnfc.nice.org.uk/)
andalsothroughMedicinesComplete;aPDAversionisalso
available.Inaddition,BNFCcontentcanbeintegratedintoa
localformularybyusingBNFConFormularyComplete;seewww.
bnf.orgfordetails.
DistributionofprintedBNFCs
InEngland,NICEpurchasesprinteditionsofBNFCfor
distributionwithintheNHS.Fordetailsofwhois
eligibletoreceiveacopyandfurthercontactdetails,please
refertotheNICEwebsite:
www.nice.org.uk/about/what-we-do/evidence-services/british-
national-formulary.Ifyouareentitledtoasharedcopyofthe
BNFC,pleasecall(0)1268495609oremail:
[email protected].
InScotland,email:
[email protected]
BNFC2020–2021 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
BNFC2020–2021
Contents
Preface pageiii
NOTESONDRUGSANDPREPARATIONS
Acknowledgements v
HowBNFpublicationsareconstructed viii 1 Gastro-intestinalsystem page30
HowtouseBNFPublicationsinprint x 2 Cardiovascularsystem 80
Changes xvii 3 Respiratorysystem 153
GuidanceonPrescribing 1 4 Nervoussystem 203
Prescriptionwriting 5 5 Infection 318
Supplyofmedicines 7 6 Endocrinesystem 468
Emergencysupplyofmedicines 8 7 Genito-urinarysystem 526
Controlleddrugsanddrugdependence 9 8 Immunesystemandmalignantdisease 557
Adversereactionstodrugs 13 9 Bloodandnutrition 609
Guidanceonintravenousinfusions 16 10 Musculoskeletalsystem 689
Prescribinginhepaticimpairment 17 11 Eye 717
Prescribinginrenalimpairment 17 12 Ear,noseandoropharynx 741
Prescribinginpregnancy 19 13 Skin 764
Prescribinginbreast-feeding 19 14 Vaccines 821
Prescribinginpalliativecare 21 15 Anaesthesia 862
Drugsandsport 25 16 Emergencytreatmentofpoisoning 891
Medicinesoptimisation 25
APPENDICESANDINDICES
Antimicrobialstewardship 27
Appendix1
Prescribingindentalpractice 29 Interactions 905
Appendix2
Borderlinesubstances 1098
Appendix3
Cautionaryandadvisorylabelsfordispensedmedicines 1138
DentalPractitioners’Formulary 1141
NursePrescribers’Formulary 1143
Non-medicalprescribing 1146
Indexofmanufacturers 1147
Special-orderManufacturers 1152
Index 1154
Medicalemergenciesinthecommunity insidebackcover
BNFC2020–2021 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,BritishPaediatricNeurology
Association,BritishSocietyofGastroenterology,British
SocietyforPaediatricEndocrinologyandDiabetes,British
SocietyofPaediatricGastroenterology,Hepatologyand
Nutrition,CollegeofMentalHealthPharmacy,Facultyof
SexualandReproductiveHealthcare,Neonataland
PaediatricPharmacistsGroup,RoyalCollegeof
Anaesthetists,RoyalCollegeofObstetriciansand
Gynaecologists,RoyalCollegeofPaediatricsandChild
Health,RoyalCollegeofPhysicians,RoyalCollegeof
Psychiatrists,SocietyforEndocrinology,VascularSociety.
TheMHRAhaveprovidedvaluableassistance.
Correspondentsinthepharmaceuticalindustryhave
providedinformationonnewproductsandcommentedon
productsintheBNFC.
Numerousdoctors,pharmacists,nurses,andothershave
sentcommentsandsuggestions.
TheBNFteamaregratefulforthesupportandaccesstoin-
houseexpertiseatPharmaceuticalPressandacknowledge
theassistanceofK.Baxter,A.Naylor,J.Macdonald,
N.Potterandtheirteams.
T.Ali,J.Chen,R.Gupta,E.Kim,O.Komolafe,E.Olaoke,A.
Paul,D.Usopprovidedconsiderableassistanceduringthe
productionofthisupdateoftheBNF.
ThiseditionoftheBNFcarriesarainbowinrecognition
oftheworkanddedicationofallfrontlinehealthcare
workersthroughouttheCOVID-19pandemic.
vi
BNFC2020–2021
BNFStaff
ASSOCIATECONTENTDIRECTOR(BNFPUBLICATIONS)
KateTowersBPharm(AU),GCClinPharm(AU)
SENIOREDITORIALSTAFF
KiriAikmanBPharm(NZ),PGDipClinPharm(NZ),ARPharmS HollyHayneBSc(Pharmacology)(NZ),BPharm(NZ)
AlisonBrayfieldBPharm,MRPharmS RebeccaLuckhurstBSc,MSc
RobertBuckinghamBSc,SRPharmS AlexanderMcPhailMPharm,PGDipClinPharm
CatherineCadartBPharm(AU),BA(Hons), ClaireMcSherryBPharm(NZ),PGCertClinPharm(NZ)
GradDipHospPharm(AU),MRPharmS
ClairePrestonBPharm,PGDipMedMan,MRPharmS
MahinazHarrisonBPharm,DipPharmPract,IP,MRPharmS
EDITORIALSTAFF
MohammedAbouDayaMPharm,PGDipGPP,MRPharmS NalwengaMutamboMPharm
HannahArnoldBPharm(NZ) MerushaNaidooBPharm(NZ),PGCertClinPharm(NZ)
NatashaBell-AsherBPharm(NZ),PGDipClinPharm(NZ) HanaNumanBPharm(NZ),PGDipClinPharm(NZ)
LucíaCamañasSáezMPharm(ESP),PGDipClinPharm, BarbaraOkpalaMPharm,PGDipHospPharm
PGCertPsychTherap,MRPharmS
HeenabenPatelMPharm,PGDipClinPharm,MRPharmS
RochelleChinBPharm(AU) LauraPhamBPharm(Hons)(AU)
KathleenEagerBPharm CatherinePittMPharm,PGDipClinPharm,MRPharmS
EmilyHendersonBPharm(NZ),PGCertClinPharm(NZ) StephaniePowellMBioSci
SueHoBPharm(AU),MRPharmS RebekahRaymondBSc,DipPharmPrac,MRPharmS
ElizabethKingMAPharmT CaralieseRebelloBPharm(NZ),PGDipClinPharm(NZ)
SonalLadaniMPharm,PGDipGPP,MRPharmS SharylRodriguesBPharm(NZ),PGDipClinPharm(NZ)
DavidLipanovicBPharm(NZ),PGCertClinPharm(NZ) JannahRyanBSc(Hons)
JeanMacKershanBSc,PgDip HarpreetSandhuMPharm,MRPharmS
JohnMartinBPharm,PhD,MRPharmS BeejalShahMPharm,PGDipClinPharm,IP
AngelaMcFarlaneBSc,DipClinPharm LucySheedBPharm(NZ)
DeirdreMcGuirkBComm,MPharm TadehTahmasiMPharm,MRPharmS
AnnaMcLachlanBPharm(NZ),PGCertClinPharm(NZ) HannahTanBPharm(AU)
LilianaMoreiraVilasBoasMPharm(PT),PGDipHPS(PT), JuliaWebbMPharm,PGCertPharmPrac
PGCertHSDM(PT),PGCertGPP,MRPharmS
SUPPORTSTAFF
MattBradburyBSc(Hons) OliviaMaskillBSc(Hons)
DarrenChanBSc,MSc TomMathewBSc,MSc
LaurenCheethamBA(Hons) VickyPollingtonBSc(Hons)
FilsaneHajiBSc,MSc CarinaRedigdeCampos
RebeccaHarwoodBSc(Hons) ElisabettaStramiglioBSc,MSc
NickJuddBA(Hons),MA LouiseSymmonsBSc(Hons),MSc
PhilipLeeBSc,PhD NikolaosTsimplisBSc,MRes