Using the BNF
Introduction
BNF and separate BNFc for children are authority
for medicine selection in the UK
BNF published biannually (March and Sept)
BNFc published annually (Sept)
Guidance
Online versions updated monthly
(recommended resource for use)
Differences
BNF but not BNFc
BNFc but not BNF
General guidance specific for adults
e.g. elderly care
Appendix on wound management
Drugs used in adults but not children
Appendix on BSA
Developed by Royal Pharmaceutical Society, BMA,
plus Royal College of Pediatrics
Prescription writing
Controlled drugs
ADRs
Prescribing in special groups
Dose and administration
Off licence use
Basic principles
Drug monograph
Contents
Organised by body system or specific condition (e.g. ID)
Appendices - drug interactions, dental and nurse prescribing, community management of emergencies, BSA tables
16 chapters on clinical conditions and drug treatments
Abbreviations, symbols and E numbers in back cover
CIs and cautions
Interactions (signposts to Appendix)
Licencing
SEs
Indication
Pregnancy and breastfeeding
Hepatic and renal impairment
Monitoring requirements
Directions for administration
Prescribing and dispensing
Patient/carer advice
Profession specific info
National funding/access
Legal category
(prescription only, etc.)
Medicinal forms
Pre-treatment screening
Excipients/ingredients
Symbols
POM: prescription only medication
CD2/3/4-1/4-2: controlled drug and their schedule
(Misuse of Drug Regulations 2012)
Half shaded box/crossed out 'NHS': less suitable for prescribing/not prescribable on the NHS (will be rejected by the pharmacy)
Prescribing
information
Black triangle: close monitoring by MHRA for SEs
(all new biologics or new active substance, all needing more monitoring after licencing, those subject to restrictions on safe use)
General guidance
Prescription writing requirements
Unlicenced meds
General info for day to day practice
How BNF made, changes since last
Controlled drugs
Supply of meds
AEs
IV infusions
Prescribing in special groups
Pregnancy and
breastfeeding
Electrolytes and
excipients
Hepatic and
renal impairment
IV administration
Indication
and dosing
Drug interactions
Licencing
ADRs
Unlicenceed: no market authorisation
Off label: market authorisation granted
for a different indication/route/patient group
Licenced: market authorisation
granted by MHRA
Correct indication
Correct route (PO, SC, IM, etc.)
Correct dose (age, BSA, weight, IBW)
found via searching condition or drug itself
Cockroft and Gault equation not suitable for children;
use Schwartz equation (provided in BNFc)
General guidance information
Specific information in each drug monograph
Queries to local pharmacy staff
E.g. alcohol, artificial preservatives, dilutents/vehicles,
electrolytes, lactose, sesnitising agents
Na content will be given
Found in each drug monograph
BNF books: Appendix 1
BNF online: interactions tab
General guidance details when to report,
how to prevent, and special reactions
Yellow cards for reporting inside BNF
and can also be filed online
MHRA (2014): in children <18 years.Yellow Card should be submitted for all serious ADRs to new drugs and vaccines that result in harm (fatal/life-threatening/disabling/incapacitating, congenital abnormality, or result in hospitalisation)
Unlicenced prescribing must satisify:
No suitable licenced alternative for pt need
Sufficient evidence/experience to support use
Take responsibility for pt care and monitoring
Document decision with rationaile and prescription
Suitability
Specific requirements
Absence of info does not indicate it is safe,
rather that expert opinion is needed