page23
toxic syndrome in preterm neonates,
and therefore,
parenteral
preparations
containing
the
preservative
should not
be used in neonates.
Polyoxyl
castor oils,
used as vehicles in intravenous injections,
have been
associated with severe anaphylactoid reactions.
The presence of
propylene glycol
in oral
or parenteral
medicines is indicated in the BNF; it can cause adverse
effects if its elimination is impaired, e.g. in renal failure,
in neonates and young children,
and in slow metaboli-
sers of the substance. It may interact with disulfiram and
metronidazole.
The
lactose
content in most medicines is too small
to
cause
problems
in most
lactose-intolerant
patients.
However in severe lactose intolerance, the lactose con-
tent
should be
determined before
prescribing.
The
amount
of
lactose varies according to manufacturer,
product,
formulation,
and strength.
In the absence of
information on excipients in the
BNF and in the
product
literature
(available
at
www.emc.medicines.org.uk),
contact
the manufac-
turer (see Index of
Manufacturers)
if
it is essential
to check details.
Extemporaneous preparation
A product should be
dispensed extemporaneously only when no product
with a marketing authorisation is available.
The BP direction that
a preparation must
be
freshly
prepared
indicates that it must be made not more than
24 hours before it is issued for use. The direction that a
preparation should be
recently prepared
indicates that
deterioration is likely if
the preparation is stored for
longer than about 4 weeks at 15–258 C.
The term water used without qualification means either
potable water
freshly drawn direct
from the public
supply and suitable for drinking or freshly boiled and
cooled purified water.
The latter should be used if
the
public supply is from a local
storage tank or
if
the
potable water is unsuitable for a particular preparation
(Water for injections,
section 9.2.2).
Drugs and driving
Prescribers and other healthcare
professionals should advise patients if treatment is likely
to affect their ability to perform skilled tasks (e.g.
driv-
ing).
This
applies
especially to drugs
with sedative
effects;
patients should be warned that
these effects
are increased by alcohol.
General
information about a
patient’s fitness to drive is available from the Driver and
Vehicle Licensing Agency at www.dvla.gov.uk.
Patents
In the BNF, certain drugs have been included
notwithstanding the existence of
actual
or
potential
patent rights. In so far as such substances are protected
by Letters
Patent,
their
inclusion in this
Formulary
neither conveys,
nor implies,
licence to manufacture.
Health and safety
When handling chemical
or bio-
logical materials particular attention should be given to
the possibility of
allergy,
fire,
explosion,
radiation,
or
poisoning.
Substances
such as
corticosteroids,
some
antimicrobials,
phenothiazines,
and many cytotoxics,
are irritant or very potent and should be handled with
caution.
Contact
with the skin and inhalation of
dust
should be avoided.
Safety in the home
Patients must be warned to keep
all medicines out of the reach of children. All solid dose
and all
oral
and external
liquid preparations must
be
dispensed
in
a
reclosable
child-resistant
container
unless:
.
the medicine is in an original
pack or patient pack
such as to make this inadvisable;
.
the patient will
have difficulty in opening a child-
resistant container;
.
a specific request is made that the product shall not
be dispensed in a child-resistant container;
.
no suitable child-resistant
container
exists
for
a
particular liquid preparation.
All
patients should be advised to dispose of
unwanted
medicines
by returning them to a supplier for destruc-
tion.
Name of medicine
The name of the medicine should
appear
on the label
unless
the prescriber
indicates
otherwise.
(a)
The strength is also stated on the label in the case of
tablets,
capsules,
and similar preparations that are
available in different strengths.
(b)
If it is the wish of the prescriber that a description
such as ‘The Sedative Tablets’ should appear on the
label,
the
prescriber
should
write
the
desired
description on the prescription form.
(c)
The arrangement
will
extend to approved names,
proprietary names or titles given in the BP,
BPC,
BNF,
DPF,
or NPF.
(d)
The name written on the label
is that used by the
prescriber on the prescription.
(e)
When a prescription is written other
than on an
NHS prescription form the name of the prescribed
preparation will
be stated on the label
of
the dis-
pensed medicine unless
the prescriber
indicates
otherwise.
(f)
The Council
of
the Royal
Pharmaceutical
Society
advises
that
the
labels
of
dispensed medicines
should indicate the total
quantity of
the product
dispensed in the container to which the label refers.
This requirement
applies equally to solid,
liquid,
internal,
and external
preparations.
If
a product is
dispensed in more than one container, the reference
should be to the amount in each container.
Non-proprietary names of compound preparations
which appear in the BNF are those that have been
compiled by the British Pharmacopoeia Commission
or another recognised body; whenever possible they
reflect the names of the active ingredients.
Prescribers should avoid creating their
own com-
pound names
for
the
purposes
of
generic
pre-
scribing;
such names
do not
have an approved
definition and can be misinterpreted.
Special
care should be taken to avoid errors when
prescribing compound preparations;
in particular
the hyphen in the prefix ‘co-’ should be retained.
Special
care should also be taken to avoid creating
generic names for
modified-release preparations
where the use of these names could lead to confu-
sion between formulations with different lengths of
action.
BNF 61
General guidance
3
General guidance