BNF for Children (BNFC) 2018-2019

1142 Pages·2018·29.99 MB·English

by  Paediatric Formulary Committee

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MedicinesInformationServices
Informationondrugtherapy PatientInformationLines
Informationonanyaspectofdrugtherapycanbeobtained NHSUrgentCareServices111
fromRegionalandDistrictMedicinesInformationServices.
Detailsregardingthelocalservicesprovidedwithinyour
Regioncanbeobtainedbytelephoningthefollowing PoisonsInformationServices
numbers. UKNationalPoisonsInformationService(forhealthcare
professionalsonly)
England Tel:[phone]
Birmingham: [phone] www.toxbase.org
Bristol: [phone]
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Leeds: [phone] Up-to-dateinformationontravelimmunisation
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Liverpool: [phone]/7, healthcareprofessionalsonly)08456026712Monday
or(0151)7948118 andFriday:9–11a.m.and1–2p.m,Tuesdayto
London: Thursday:9–11a.m.and1–3:30p.m.
travelhealthpro.org.uk/
.Guy’sHospital (oo0rr2([phone]))877811888887533088,4595, ▶ wT(0rw1aw4v1.et)lraM3v0ae0xd.1inc1hi0ns0.eu(kT2(e–fao4mrpr,.emHgei.sawtletehreekPddruaoystees)rcstioofntShceoNtlHanSd
.NorthwickParkHospital [phone], websiteTravaxonly)
or(020)88693973 ▶ WelshGovernmentSwitchboardEnglishlanguage
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Dundee: [phone], Liverpool(0151)7948206
or(01382)660111Extn32351
Edinburgh: [phone] Sport
Glasgow: [phone] ▶ Informationregardingtheuseofmedicinesinsportis
availablefromUKAnti-Doping:
NorthernIreland www.ukad.org.uk
Belfast: [phone] Tel:[phone]
RepublicofIreland [email protected]
Dublin: [phone], UKAnti-Doping
or(01)4537941Extn2348 F2-le6eStbalainsbkuHryouSsqeuare
London
UnitedKingdomMedicinesInformation(UKMI)website EC4Y8AE
www.sps.nhs.uk/ ▶ Informationabouttheprohibitedstatusofspecific
medicinesbasedonthecurrentWorldAnti-Doping
AgencyProhibitedListisavailablefromGlobalDrug
UKTeratologyInformationService ReferenceOnline:www.globaldro.com/UK/search
Informationondrugandchemicalexposuresin
pregnancy.
03448920909 ProprietaryManufacturers
www.uktis.org Telephonenumbersandemailaddressesofproprietary
manufacturerslistedinBNFPublicationsareshowninthe
Indexofproprietarymanufacturersp.1061
UKDrugsinLactationAdvisoryService(UKDILAS)
Informationonthecompatibilityofdrugswith
ListofRegisteredMedicalPractitioners
breastfeeding.
[phone],or(0121)4247298 Detailsonwhetherdoctorsareregisteredandholda
licencetopractisemedicineintheUKcanbeobtained
Email:[email protected] fromtheGeneralMedicalCouncil.
www.sps.nhs.uk/articles/ukdilas/ Tel:[phone]
www.gmc-uk.org/register
MedicinesforChildreninformationleaflets
Medicinesinformationforparentsandcarers.
www.medicinesforchildren.org.uk
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BNF
for Children
2018
2019
September 2018 – 19
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Publishedjointlyby InScotland,email:
BMJGroup [email protected]
TavistockSquare,London,WC1H9JP,UK InWales,contactNHSWalesSharedServicesPartnership—
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RCPCHPublicationsLtd TheBNFforChildrenisforrapidreferencebyUKhealth
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GreatBritain,andRCPCHPublicationsLtd2018. BNFforChildrenhasbeenconstructedusingrobust
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BNFC2018–2019 iii
Preface
BNFforChildrenaimstoprovideprescribers,pharmacists, ItisimportanttousethemostrecentBNFCinformation
andotherhealthcareprofessionalswithsoundup-to-date formakingclinicaldecisions.TheprinteditionofBNFfor
informationontheuseofmedicinesfortreatingchildren. ChildrenisupdatedinSeptembereachyear.Monthlyupdates
AjointpublicationoftheBritishMedicalAssociation,the areprovidedonlineviatheBNFPublicationswebsitewww.
RoyalPharmaceuticalSociety,theRoyalCollegeof bnf.org,MedicinesCompleteandtheNHSEvidenceportal.
PaediatricsandChildHealth,andtheNeonataland ThemoreimportantchangeslistedunderChangesp.xixare
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).
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iv
BNFC2018–2019
Contents
Preface pageiii
NOTESONDRUGSANDPREPARATIONS
Acknowledgements v
HowBNFpublicationsareconstructed ix 1 Gastro-intestinalsystem page25
HowtouseBNFPublicationsinprint xii 2 Cardiovascularsystem 75
Changes xix 3 Respiratorysystem 145
GuidanceonPrescribing 1 4 Nervoussystem 191
Prescriptionwriting 5 5 Infection 300
Supplyofmedicines 7 6 Endocrinesystem 432
Emergencysupplyofmedicines 8 7 Genito-urinarysystem 488
Controlleddrugsanddrugdependence 9 8 Immunesystemandmalignantdisease 517
Adversereactionstodrugs 13 9 Bloodandnutrition 562
Guidanceonintravenousinfusions 16 10 Musculoskeletalsystem 638
Prescribinginhepaticimpairment 17 11 Eye 665
Prescribinginrenalimpairment 17 12 Ear,noseandoropharynx 688
Prescribinginpregnancy 19 13 Skin 712
Prescribinginbreast-feeding 19 14 Vaccines 770
Prescribinginpalliativecare 20 15 Anaesthesia 803
Drugsandsport 24 16 Emergencytreatmentofpoisoning 832
Prescribingindentalpractice 24
APPENDICESANDINDICES
Appendix1
Interactions 845
Appendix2
Borderlinesubstances 1012
Appendix3
Cautionaryandadvisorylabelsfordispensedmedicines 1053
DentalPractitioners’Formulary 1056
NursePrescribers’Formulary 1057
Non-medicalprescribing 1060
Indexofproprietarymanufacturers 1061
Special-orderManufacturers 1066
Index 1068
Medicalemergenciesinthecommunity insidebackcover
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BNFC2018–2019 v
Acknowledgements
ThePaediatricFormularyCommitteeisgratefulto
individualsandorganisationsthathaveprovidedadviceand
informationtotheBNFforChildren(BNFC).
Theprincipalcontributorsforthisupdatewere:
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,M.M.Yaqoob,Z.Zaiwalla,and
S.M.Zuberi.
MembersoftheBritishAssociationofDermatologists’
Therapy&GuidelinesSubcommittee,D.A.Buckley,
N.Chiang,M.Cork,K.Gibbon,R.Y.P.Hunasehally,
G.A.Johnston,T.A.Leslie,E.C.Mallon,P.M.McHenry,
J.Natkunarajah,C.Saunders,S.Ungureanu,S.Wakelin,
F.S.Worsnop,A.G.Brain(Secretariat),andM.F.Mohd
Mustapa(Secretariat)haveprovidedvaluableadvice.
MembersoftheAdvisoryCommitteeonMalariaPrevention,
R.H.Behrens,D.Bell,P.L.Chiodini,V.Field,F.Genasi,
L.Goodyer,A.Green,J.Jones,G.Kassianos,D.G.Lalloo,
D.Patel,H.Patel,M.Powell,D.V.Shingadia,N.O.Subair,
C.J.M.Whitty,M.Blaze(Secretariat),andV.Smith
(Secretariat)haveprovidedvaluableadvice.
TheMHRAhaveprovidedvaluableassistance.
Correspondentsinthepharmaceuticalindustryhave
providedinformationonnewproductsandcommentedon
productsinBNFC.
Numerousdoctors,pharmacists,nurses,andothershave
sentcommentsandsuggestions.
TheBNFChasvaluableaccesstotheMartindaledatabanks
bycourtesyofA.Brayfieldandstaff.
TheBNFteamaregratefulforthesupportandaccesstoin-
houseexpertiseatPharmaceuticalPressandacknowledge
theassistanceofA.Lourie,J.Macdonald,N.Potter,H.Sondh
andtheirteams.
E.Hagos,A.Pryde,M.SmithandK.Sprostonprovided
considerableassistanceduringtheproductionofthisupdate
ofBNFC.
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