British National Formulary (BNF) 70

1397 Pages·2015·13.51 MB·English

by  Joint Formulary Committee

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BNF
70
September 2015
–March 2016
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BNF70 iii
Preface
TheBNFisajointpublicationoftheBritishMedical BritishNationalFormulary,
AssociationandtheRoyalPharmaceuticalSociety.Itis RoyalPharmaceuticalSociety,
publishedundertheauthorityofaJointFormulary 66-68EastSmithfield,
Committeewhichcomprisesrepresentativesofthetwo London,
professionalbodies,theUKHealthDepartments,the E1W1AW
MedicinesandHealthcareproductsRegulatoryAgency,and [email protected]
anationalguidelineproducer.TheDentalAdvisoryGroup Thecontactemailformanufacturersorpharmaceutical
overseasthepreparationofadviceonthedrugmanagement companieswishingtocontactBNFPublicationsis
ofdentalandoralconditions;theGroupincludes [email protected]
representativesoftheBritishDentalAssociationanda
representativefromtheUKHealthDepartments.TheNurse
Prescribers’AdvisoryGroupadvisesonthecontentrelevant
tonursesandincludesrepresentativesfromdifferentparts
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,anevaluationof
theevidencefromdiversesources.TheBNFalsotakes
accountofauthoritativenationalguidelinesandemerging
safetyconcerns.Inaddition,theeditorialteamreceives
adviceonalltherapeuticareasfromexpertclinicians;this
ensuresthattheBNF’srecommendationsarerelevantto
practice.
TheBNFisdesignedasadigestforrapidreferenceandit
maynotalwaysincludealltheinformationnecessaryfor
prescribinganddispensing.Also,lessdetailisgivenon
areassuchasobstetrics,malignantdisease,andanaesthesia
sinceitisexpectedthatthoseundertakingtreatmentwill
havespecialistknowledgeandaccesstospecialist
literature.BNFforChildrenshouldbeconsultedfordetailed
informationontheuseofmedicinesinchildren.TheBNF
shouldbeinterpretedinthelightofprofessionalknowledge
andsupplementedasnecessarybyspecialisedpublications
andbyreferencetotheproductliterature.Informationis
alsoavailablefrommedicinesinformationservices,see
MedicinesInformationServices.
ItisimportanttousethemostrecentBNFinformationfor
makingclinicaldecisions.TheprinteditionoftheBNFis
updatedinMarchandSeptembereachyear.Monthly
updatesareprovidedonlineviaMedicinesCompleteand
theNHSEvidenceportal.Themoreimportantchangesare
listedunderChanges;changeslistedonlinearecumulative
(fromoneprinteditiontothenext),andcanbeprintedoff
eachmonthtoshowthemainchangessincethelastprint
editionasanaidememoireforthoseusingprintcopies.
TheBNFPublicationswebsite(www.bnf.org)includes
additionalinformationofrelevancetohealthcare
professionals.OtherdigitalformatsoftheBNF—including
versionsformobiledevicesandintegrationintolocal
formularies—arealsoavailable.
iv
BNF70
Contents
Preface pageiii
NOTESONDRUGSANDPREPARATIONS
Acknowledgements v
HowBNFpublicationsareconstructed ix 1 Gastro-intestinalsystem page32
HowtousetheBNF xi 2 Cardiovascularsystem 84
Changes xv 3 Respiratorysystem 209
GuidanceonPrescribing 1 4 Nervoussystem 262
Prescriptionwriting 4 5 Infection 438
Emergencysupplyofmedicines 6 6 Endocrinesystem 574
Controlleddrugsanddrugdependence 7 7 Genito-urinarysystem 667
Adversereactionstodrugs 11 8 Malignantdisease 715
Guidanceonintravenousinfusions 14 9 Bloodandnutrition 822
Prescribingforchildren 16 10 Musculoskeletalsystem 891
Prescribinginhepaticimpairment 17 11 Eye 943
Prescribinginrenalimpairment 17 12 Ear,noseandoropharynx 976
Prescribinginpregnancy 19 13 Skin 998
Prescribinginbreast-feeding 19 14 Vaccines 1059
Prescribinginpalliativecare 20 15 Anaesthesia 1093
Prescribingfortheelderly 25 16 Emergencytreatmentofpoisoning 1123
Drugsandsport 26
APPENDICESANDINDICES
Prescribingindentalpractice 27
Appendix1
Interactions 1137
Appendix2
Borderlinesubstances 1260
Appendix3
Cautionaryandadvisorylabelsfordispensedmedicines 1291
Appendix4
Woundmanagementproductsandelasticatedgarments 1294
DentalPractitioners’Formulary 1320
NursePrescribers’Formulary 1322
Non-medicalprescribing 1325
Indexofproprietarymanufacturers 1326
Special-orderManufacturers 1335
Index 1337
Medicalemergenciesinthecommunity insidebackcover
BNF70 v
Acknowledgements
TheJointFormularyCommitteeisgratefultoindividuals
andorganisationsthathaveprovidedadviceand
informationtotheBNF.
Theprincipalcontributorsforthisupdatewere:
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,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,L.P.Ormerod,R.Patel,
W.J.Penny,A.B.Provan,M.M.Ramsay,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,
M.M.Yaqoob.
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.
MembersoftheBritishAssociationofDermatologists’
Therapy&GuidelinesSubcommittee,D.A.Buckley,
M.Cork,E.DuarteWilliams,M.Griffiths,T.Leslie,
E.Mallon,P.McHenry,P.Hunasehally,I.Nasr,C.Saunders,
V.Swale,S.Ungureanu,S.Wakelin,A.Brain(Secretariat),
andM.F.MohdMustapa(Secretariat)haveprovided
valuableadvice.
MembersoftheAdvisoryCommitteeonMalaria
Prevention,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),and
V.Smith(Secretariat)haveprovidedvaluableadvice.
TheUKOphthalmicPharmacyGrouphavealsoprovided
valuableadvice.
TheMHRAhaveprovidedvaluableassistance.
Correspondentsinthepharmaceuticalindustryhave
providedinformationonnewproductsandcommentedon
productsintheBNF.
Numerousdoctors,pharmacists,nurses,andothershave
sentcommentsandsuggestions.
BNFinteractionsareprovidedbyC.L.Preston,S.L.Jones,
H.K.Sandhu,andS.Sutton.
TheBNFhasvaluableaccesstotheMartindaledatabanks
bycourtesyofA.Brayfieldandstaff.
J.Macdonaldandstaffprovidedvaluabletechnical
assistance.
K.K.Cheema,M.E.Elnaeem,H.G.Hesketh,M.Khalid,and
E.Laughtonprovidedconsiderableassistanceduringthe
productionofthisupdateoftheBNF.
InvaluablecontributionstothisnewBNFstructurewere
providedbyE.Boaheng,C.F.Boyle,K.K.Cheema,
J.C.Green,S.Jahangeer,A.R.Javed,P.D.Lee,S.Lynsdale,
H.L.MacKenzie,C.McCahill,S.Murray,M.Muttur,
S.K.Rai,J.Rueben,J.P.Smith,S.Warda,andA.L.Watkins.
vi
BNF70
BNF Staff
BNFDIRECTOR CLINICALWRITER
KarenBaxter SarahMohamad
BSc,MSc,MRPharmS MPharm,MPharmS
HEADOFCONTENT EDITORIALASSISTANT
KateTowers RhiannonHowe
BPharm(AU),GCClinPharm BMedSc
CONTENTMANAGERS
JessicaA.Forrest
BPharm(AU),GradDipHlthEcon(AU)
KristinaFowlie
MPharm,CertPharmPract,MRPharmS
HeenabenPatel
MPharm,DipClinPharm,MRPharmS
QUALITYANDPROCESSMANAGER
AngelaM.G.McFarlane
BSc,DipClinPharm
CLINICALWRITERS
ThomasCorbett
BSc(Pharm),MPharm
JoyceDonnelly
MPharm,MRPharmS
SerenaFrau
MPharm(IT),DipHospPharm(IT),CertScientMethod(IT)
BelénGranellVillén
BSc,DipClinPharm
MaeveA.M.Lynn
MPharm
ClaireMcSherry
BPharm(NZ),PGCertClinPharm(NZ)
KereOdumah
MPharm
KatieL.Page
MPharm,MRPharmS
RoushinPatel
MPharm,MRPharmS
ParidhiK.Prashar
MPharm,MRPharmS
DominiqueShakir
MPharm,MRPharmS,IP,PGDip
JyotiA.Sood
MPharm,MRPharmS,CertPharmPract
CLINICALASSISTANTS
BasmaHossin
MPharm,PhD
ElizabethKing
SENIORBNFADMINISTRATOR
HeidiHomar
BA
MANAGINGDIRECTOR,PHARMACEUTICALPRESS
AlinaLourie
B.Ed,MSc
SENIORMEDICALADVISER
DerekG.Waller
BSc,MB,BS,DM,FRCP
CONTRIBUTORSTOBNF70
SENIORCLINICALWRITER
ManjulaHalai
BScChem,MPharm