British National Formulary (BNF)

8th July 2025

British National Formulary

This update contains 12 significant changes and 6 new monographs.

Significant Changes:

• Antibacterials, principles of therapy: updated guidance on notifiable diseases.
• Asthma, acute: update to criteria for severity of acute asthma attacks.
• Immunisation schedule: updated guidance for immunisation against respiratory syncytial virus.
• Ivacaftor with tezacaftor and elexacaftor (Kaftrio®): risk of psychological side effects [MHRA/CHM advice].
• Obstetrics: update to treatment of postpartum haemorrhage.
• Ocular corticosteroids: cautions updated (advice in betamethasone, dexamethasone, fluorometholone, hydrocortisone, loteprednol etabonate, prednisolone; see example in fluorometholone).
• Ocular NSAIDs: cautions updated (advice in bromfenac, diclofenac sodium, flurbiprofen, ketorolac trometamol, nepafenac; see example in bromfenac).
• Posaconazole: update to indications and dose, and important safety information.
• Respiratory syncytial virus immunisation: updated guidance.
• Salbutamol: reminder of the risks from overuse in asthma and to be aware of changes in the SABA prescribing guidelines [MHRA/CHM advice].
• Terbutaline sulfate: reminder of the risks from overuse in asthma and to be aware of changes in the SABA prescribing guidelines [MHRA/CHM advice].
• Thiopurines and intrahepatic cholestasis of pregnancy [MHRA/CHM advice] (advice in azathioprine, mercaptopurine, tioguanine; see example in azathioprine).

New Monographs:

• Abrysvo® [respiratory syncytial virus (RSV) vaccine].
• Andembry® [garadacimab].
• Arexvy® [respiratory syncytial virus (RSV) vaccine].
• Artesunate.
• Lytgobi® [futibatinib].
• Suvexx® [sumatriptan with naproxen].

10th June 2025

British National Formulary

This update contains 8 significant changes, 4 dose changes, 2 new monographs and 4 new preparations.

Significant Changes:

• Bimekizumab: new indication and dose for hidradenitis suppurativa.
• Chloroquine: updated pregnancy and breast-feeding advice when used for rheumatic disease.
• Contraceptives, hormonal: inclusion of guidance for use of combined oral contraceptives for preventive treatment of ovarian cancer in at-risk females.
• Hydroxychloroquine sulfate: updated pregnancy and breast-feeding advice.
• Malaria, prophylaxis: updated guidance.
• Sepsis: updated guidance on management.
• Sympathomimetics: updated guidance for septic shock.
• Tuberculosis: updated guidance for multi-drug resistant tuberculosis.

Dose Changes:

• Colchicine [update to dosing for prophylaxis of familial Mediterranean fever].
• Rilpivirine [update to dosing for HIV-1 infection].
• Sodium hyaluronate with trehalose [update to dosing for dry eye conditions].
• Vocabria® (cabotegravir) [update to dosing for HIV-1 infection].

New Monographs:

• Briumvi® [ublituximab]
• Duvyzat® [givinostat].

New Preparations: Apretude® 30 mg film-coated tablets [cabotegravir]; Apretude® 600 mg prolonged-release suspension for injection [cabotegravir]; Budenofalk® suppositories [budesonide]; Netildex® eye gel [dexamethasone with netilmicin]

13th May 2025

British National Formulary

This update contains 6 significant changes, 4 dose changes, 3 new monographs and 1 deleted preparation.

Significant Changes:

• Amphotericin B: review of indications and dose for liposomal preparations, as well as updates to directions for administration, breast-feeding, pregnancy, cautions, and monitoring advice.
• Asthma, chronic: updated guidance on management.
• Budesonide with formoterol (DuoResp Spiromax® 160 micrograms/4.5 micrograms): new indication and dose for mild asthma, reliever therapy.
• Budesonide with formoterol (Fobumix® 160/4.5 Easyhaler): new indication and dose for mild asthma, reliever therapy.
• Prolonged-release opioids: removal of indication for relief of post-operative pain [MHRA/CHM advice] (advice in all opioids; see example in oxycodone hydrochloride).
• Smoking cessation: updated drug treatment guidance.

Dose Changes:

• Fobumix® 80/4.5 Easyhaler (budesonide with formoterol) [update to dosing for asthma, maintenance therapy].
• Fobumix® 160/4.5 Easyhaler (budesonide with formoterol) [update to dosing for asthma, maintenance therapy].
• Fobumix® 320/9 Easyhaler (budesonide with formoterol) [update to dosing for asthma, maintenance therapy].
• Rosuvastatin [update to dose adjustments due to interactions].

New Monographs:

• Anzupgo® [delgocitinib].
• Imdylltra® [tarlatamab].
• Winlevi® [clascoterone].

Deleted Preparations:

• Ambisome® [amphotericin B].

8th April 2025

British National Formulary

This update contains 11 significant changes, 2 dose changes, 3 new monographs, and 8 new preparations.

Significant Changes:

• Apixaban: update to structure of dosing for prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation and at least one risk factor.
• Bempedoic acid: new indication and dose for established or at high-risk of atherosclerotic cardiovascular disease.
• Cardiovascular disease risk assessment and prevention: updated guidance.
• Dupilumab: new indication and dose for chronic obstructive pulmonary disease.
• Emtricitabine with tenofovir alafenamide: new indication and dose for pre-exposure prophylaxis of HIV-1.
• Fezolinetant: risk of drug-induced liver injury and new recommendations on monitoring of liver function before and during treatment [MHRA/CHM advice].
• GLP-1 and dual GIP/GLP-1 receptor agonists: potential risk of pulmonary aspiration during general anaesthesia or deep sedation [MHRA/CHM advice] (advice in dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, tirzepatide; see example in liraglutide).
• Immunisation schedule: updated guidance for immunisation against diphtheria, tetanus, pertussis and poliomyelitis in children aged 3 years and 4 months.
• Naltrexone hydrochloride: new indication and dose for gambling-related harm.
• Sodium valproate: new advice for male patients already taking sodium valproate [MHRA/CHM advice].
• Valproic acid: new advice for male patients already taking valproic acid [MHRA/CHM advice].

Dose Changes:

• Ferrous fumarate [update to dosing for iron-deficiency anaemia using oral solution].
• Sodium feredetate [update to dosing for iron-deficiency anaemia using oral solution].

New Monographs:

• Agamree® [vamorolone].
• Joenja® [leniolisib].
• Lunivia® [eszopiclone].

New Preparations: Abilify Maintena® 720 mg or 960 mg prolonged-release suspension for injection [aripiprazole]; Bibecfo® 100/6 [beclometasone with formoterol]; Bibecfo® 200/6 [beclometasone with formoterol]; Luforbec® 200/6 [beclometasone with formoterol]; Proxor® 100/6 [beclometasone with formoterol]; Proxor® 200/6 [beclometasone with formoterol]; Vivaire® 100/6 [beclometasone with formoterol]; Vivaire® 200/6 [beclometasone with formoterol].

11th March 2025

British National Formulary

This update contains 3 significant changes, 3 new monographs and 3 new preparations.

Significant Changes:

• Andexanet alfa [therapeutic use changed to reversal of anticoagulation].
• Idarucizumab [therapeutic use changed to reversal of anticoagulation].
• Pneumococcal polysaccharide conjugate vaccine (adsorbed): name change of Apexxnar® to Prevenar 20®.

New Monographs:

• Balversa® [erdafitinib].
• Vafseo® [vadadustat].
• Wainzua® [eplontersen].

New Preparations: Cequa® [ciclosporin]; Hyftor® [sirolimus]; Verorab® [rabies vaccine].

11th February 2025

British National Formulary

This update contains 1 significant change, 3 dose changes, 4 new monographs and 2 deleted monographs.

Significant Changes:

• Wegovy® (semaglutide): new indication and dose for cardiovascular risk reduction.

Dose Changes:

• Glyceryl trinitrate [update to dosing for treatment of angina using sublingual tablets or spray].
• Medical emergencies in the community [update to dosing of glyceryl trinitrate for acute coronary syndromes].
• Ozempic® (semaglutide) [update to indications and dosing].

New Monographs:

• Fruzaqla® [fruquintinib].
• Kisunla® [donanemab].
• Loargys® [pegzilarginase].
• Yorvipath® [palopegteriparatide].

Deleted Monographs: Co-flumactone; Co-simalcite.