British National Formulary 79 (BNF) March 2020

1749 Pages·2020·16.245 MB·English

by  Joint Formulary Committee

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websiteTravaxonly)
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BNF
79
March –
September 2020
Publishedjointlyby InScotland,email:
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BNF79 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).
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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
BNF79
Contents
Preface pageiii
NOTESONDRUGSANDPREPARATIONS
Acknowledgements v
HowBNFpublicationsareconstructed viii 1 Gastro-intestinalsystem page37
HowtouseBNFPublicationsinprint x 2 Cardiovascularsystem 102
Changes xvi 3 Respiratorysystem 242
GuidanceonPrescribing 1 4 Nervoussystem 308
Prescriptionwriting 6 5 Infection 519
Emergencysupplyofmedicines 8 6 Endocrinesystem 686
Controlleddrugsanddrugdependence 9 7 Genito-urinarysystem 800
Adversereactionstodrugs 13 8 Immunesystemandmalignantdisease 862
Guidanceonintravenousinfusions 17 9 Bloodandnutrition 1046
Prescribingforchildren 19 10 Musculoskeletalsystem 1127
Prescribinginhepaticimpairment 20 11 Eye 1194
Prescribinginrenalimpairment 20 12 Ear,noseandoropharynx 1231
Prescribinginpregnancy 24 13 Skin 1257
Prescribinginbreast-feeding 24 14 Vaccines 1326
Prescribinginpalliativecare 25 15 Anaesthesia 1368
Prescribingfortheelderly 30 16 Emergencytreatmentofpoisoning 1399
Drugsandsport 31
APPENDICESANDINDICES
Prescribingindentalpractice 32
Appendix1
Interactions 1413
Appendix2
Borderlinesubstances 1606
Appendix3
Cautionaryandadvisorylabelsfordispensedmedicines 1637
Appendix4
Woundmanagementproductsandelasticatedgarments 1640
DentalPractitioners’Formulary 1664
NursePrescribers’Formulary 1666
Non-medicalprescribing 1669
Indexofmanufacturers 1670
Special-orderManufacturers 1675
Index 1677
Medicalemergenciesinthecommunity insidebackcover
BNF79 v
Acknowledgements
TheJointFormularyCommitteeisgratefultoindividualsand
organisationsthathaveprovidedadviceandinformationto
theBNF.
Contributorsforthisupdatewere:
K.W.Ah-See,M.N.Badminton,A.K.Bahl,P.R.J.Barnes,
D.Bilton,S.L.Bloom,M.F.Bultitude,I.F.Burgess,D.J.Burn,
C.E.Dearden,D.W.Denning,P.N.Durrington,
D.A.C.Elliman,P.Emery,M.D.Feher,A.Freyer,
B.G.Gazzard,A.M.Geretti,N.J.L.Gittoes,P.J.Goadsby,
M.Gupta,T.L.Hawkins,B.G.Higgins,S.P.Higgins,
S.H.D.Jackson,A.Jones,D.M.Keeling,J.R.Kirwan,
P.G.Kopelman,T.H.Lee,A.Lekkas,D.N.J.Lockwood,
A.M.Lovering,M.G.Lucas,L.Luzzatto,P.D.Mason,
D.A.McArthur,K.E.L.McColl,L.M.Melvin,E.Miller,
R.M.Mirakian,P.Morrison,S.M.S.Nasser,C.Nelson-Piercy,
J.M.Neuberger,D.J.Nutt,R.Patel,W.J.Penny,A.B.Provan,
A.S.C.Rice,D.J.Rowbotham,J.W.Sander,J.A.T.Sandoe,
M.Schacter,S.E.Slater,J.Soar,S.C.E.Sporton,M.D.Stewart,
S.Thomas,J.P.Thompson,A.D.Weeks,A.Wilcock,
A.P.R.Wilson.
Expertadviceonthemanagementoforalanddental
conditionswaskindlyprovidedbyM.Addy,P.Coulthard,
A.Crighton,M.A.O.Lewis,J.G.Meechan,N.D.Robb,
C.Scully,R.A.Seymour,R.Welbury,andJ.M.Zakrzewska.
S.Kaurprovidedvaluableadviceondentalprescribing
policy.
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
productsintheBNF.
Numerousdoctors,pharmacists,nurses,andothershave
sentcommentsandsuggestions.
TheBNFteamaregratefulforthesupportandaccesstoin-
houseexpertiseatPharmaceuticalPressandacknowledge
theassistanceofA.Lourie,J.Macdonald,N.Potterandtheir
teams.
vi
BNF79
BNFStaff
BNFDIRECTOR
KarenBaxterBSc,MSc,FRPharmS
SENIOREDITORIALSTAFF
KiriAikmanBPharm(NZ),PGDipClinPharm(NZ),ARPharmS RebeccaLuckhurstBSc,MSc
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RobertBuckinghamBSc,SRPharmS ClaireMcSherryBPharm(NZ),PGCertClinPharm(NZ)
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EDITORIALSTAFF
MohammedAbouDayaMPharm,PGDipGPP,MRPharmS AnnaMcLachlanBPharm(NZ),PGCertClinPharm(NZ)
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NatashaBell-AsherBPharm(NZ),PGDipClinPharm(NZ) PGCertHSDM(PT),PGCertGPP,MRPharmS
LucíaCamañasSáezMPharm(ESP),PGDipClinPharm, MerushaNaidooBPharm(NZ),PGCertClinPharm(NZ)
PGCertPsychTherap,MRPharmS HanaNumanBPharm(NZ),PGDipClinPharm(NZ)
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JeanMacKershanBSc,PgDip HarpreetSandhuMPharm,MRPharmS
JohnMartinBPharm,PhD,MRPharmS BeejalShahMPharm,PGDipClinPharm,IP,MRPharmS
AngelaMcFarlaneBSc,DipClinPharm LucySheedBPharm(NZ)
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SUPPORTSTAFF
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