page16
sionally,
side-effects may be included within a prepara-
tion record if they are specific to that preparation or if
the preparation is not accompanied by a monograph.
Side-effects are generally listed in order of
frequency
and arranged broadly by body systems.
Occasionally a
rare side-effect might be listed first if it is considered to
be particularly important because of its seriousness. The
frequency of side-effects is described in fig.
1.
An exhaustive list
of
side-effects is not
included for
drugs that are used by specialists (e.g.
cytotoxic drugs
and drugs used in anaesthesia). Recognising that hyper-
sensitivity reactions can occur with virtually all
medi-
cines,
this effect is generally not listed,
unless the drug
carries an increased risk of such reactions. The BNF also
omits effects that
are likely to have little clinical
con-
sequence (e.g.
transient increase in liver enzymes).
The prescribing notes in the BNF may highlight impor-
tant safety concerns and differences between drugs in
their ability to cause certain side-effects.
Safety warn-
ings issued by the Commission on Human Medicines
(CHM) or Medicines and Healthcare products Regula-
tory Agency (MHRA) can also be found here or in the
drug monographs.
Adverse Reactions to Drugs (p.
12) provides advice on
preventing adverse drug reactions,
and guidance on
reporting adverse drug reactions to the MHRA.
The
black triangle symbol T identifies those preparations in
the BNF that are monitored intensively by the MHRA.
Finding significant changes in a new
edition
The BNF is published in March and September each
year and includes lists of changes in a new edition that
are relevant to clinical practice:
.
The print
version includes
an
Insert
that
sum-
marises the background to several
key changes.
A
copy of the Insert can also be found at bnf.org in the
section on Updates under ‘What’s new in BNF?’;
.
Changes for this edition
(p.
xvi),
provides a list of
significant
changes,
dose
changes,
classification
changes,
new names,
and new preparations that
have been incorporated into a new edition,
as well
as a list of preparations that have been discontinued
since the last edition. For ease of identification, the
margins of these pages are marked in blue;
.
Changes
to the Dental
Practitioners’
Formulary
(p.
973),
these are located at the end of the Dental
List;
.
Changes to the Appendices
,
drug entries that have
been amended or
introduced since the previous
edition in Appendix 1 (Drug Interactions) or Appen-
dix 9 (Cautionary and Advisory Labels
for
Dis-
pensed Medicines) are underlined in the print ver-
sions;
.
E-newsletter
, the BNF & BNFC e-newsletter service
is available free of charge.
It alerts healthcare pro-
fessionals to details of
significant
changes in the
clinical content of these publications and to the way
that this information is delivered.
Newsletters also
review clinical
case studies and provide tips on
using these publications effectively.
To sign up for
e-newsletters go to
bnf.org/newsletter.
To visit the
e-newsletter
archive,
go
to
bnf.org/bnf/extra/
current/450066.htm
.
BNF Update
,
an e-learning programme developed
in collaboration with the Centre for Pharmacy Post-
graduate Education (CPPE), enables pharmacists to
identify and assess how significant changes in the
BNF affect their clinical practice. Separate modules
for
primary and secondary care can be found at
www.cppe.ac.uk.
So many changes are made to each new edition of the
BNF,
that not all of them can be accommodated in the
Insert and the Changes section.
We encourage health-
care professionals to review regularly the prescribing
information on drugs that they encounter frequently.
Nutrition
Appendix 7 (p.
903) includes tables of ACBS-approved
enteral feeds and nutritional supplements based on their
energy and protein content.
There are separate tables
for specialised formulae for specific clinical conditions.
Classified sections on foods for special
diets and nutri-
tional
supplements
for
metabolic
diseases
are
also
included.
Wound dressings
A table on wound dressings in Appendix 8 (p.
935)
allows an appropriate dressing to be selected based
on the appearance and condition of the wound. Further
information about the dressing can be found by follow-
ing the cross-reference to the relevant classified section
in the Appendix.
In section (A8.2)
advanced wound
contact
dressings
have
been classified in order
of
increasing absorbency.
Unlicensed medicines
The BNF includes unlicensed use of medicines when the
clinical need cannot be met by licensed medicines; such
use should be supported by appropriate evidence and
experience.
When the BNF recommends an unlicensed
medicine or the ‘off-label’
use of
a licensed medicine,
this is shown in the appropriate place by ‘[unlicensed]’.
Prices in the BNF
Basic net prices are given in the BNF to provide an
indication of
relative cost.
Where there is a choice of
suitable preparations for a particular disease or condi-
tion the relative cost may be used in making a selection.
Cost-effective
prescribing
must,
however,
take
into
account
other
factors
(such as
dose frequency and
duration of
treatment)
that
affect
the total
cost.
The
use of more expensive drugs is justified if it will result in
better treatment
of
the patient,
or a reduction of
the
length of an illness, or the time spent in hospital. Prices
have generally been calculated from the net cost used in
pricing NHS prescriptions in October 2010. Prices gen-
erally reflect whole dispensing packs;
prices for injec-
tions are stated per ampoule, vial, or syringe. The price
for an extemporaneously prepared preparation has been
omitted where the net cost of
the ingredients used to
make it would give a misleadingly low impression of the
final price. In Appendix 8 prices stated are per dressing
or bandage.
BNF prices
are not
suitable for
quoting to patients
seeking private prescriptions
or
contemplating over-
xiv
BNF 61