Changes
Monthly updates are provided online via Medicines
Complete and the NHS Evidence portal. The changes listed
below are cumulative (from one print edition to the next).
Significant changes
Significant changes that appear in the print edition ofBNF
for Children 2018 – 2019 :
.Side-effects and their futher information sections have
been reviewed against the current product literature and
terms used to define these have been standardised across
all drug monographs in this edition of theBNF for Children.
.Acute porphyrias p. 603 : updated guidance.
.Adalimumab p. 642 for treating plaque psoriasis in
children and young people [NICE guidance].
.Adrenaline/epinephrine auto-injectors p. 136 : updated
advice after European review [MHRA/CHM advice].
.Asthma, chronic p. 146 : updated guidance on
management.
.Attention deficit hyperactivity disorder p. 225 : updated
guidance on management.
.Cerebral palsy and spasticity p. 255 : new guidance on
management.
.Clozapine p. 250 : reminder of potentially fatal risk of
intestinal obstruction, faecal impaction, and paralytic ileus
[MHRA/CHM advice].
.Controlled drugs and drug dependence p. 9 : updated
guidance.
.Corticosteroids [see Corticosteroids, general use p. 434 ]:
rare risk of central serous chorioretinopathy with local and
systemic administration [MHRA/CHM advice].
.Cysticfibrosis p. 184 : updated guidance.
.Daclizumab (Zinbryta®)—marketing authorisation
withdrawn for safety reasons.
.Diabetes, pregnancy and breast-feeding p. 451 : updated
guidance on management.
.Dihydrocodeine with paracetamol p. 278 (co-dydramol):
prescribe and dispense by strength to minimise risk of
medication error (January 2018 ) [MHRA/CHM advice].
.Dihydrocodeine with paracetamol p. 278 [formerly co-
dydramol].
.Drug name confusion: reminder to be vigilant for potential
errors between clobazam and clonazepam, atenolol and
amlodipine, propranolol and prednisolone, risperidone
and ropinirole, sulfadiazine and sulfasalazine, amlodipine
and nimodipine, mercaptamine and mercaptopurine,
zuclopentixol acetate and zuclopentixol decanoate
[MHRA/CHM advice].
.Emergency contraception p. 496 : updated guidance on
management.
.Erythropoietins (epoetin alfa p. 565 , epoetin beta p. 566 ,
epoetin zeta p. 567 , darbepoetin alfa p. 564 ): risk of severe
cutaneous adverse reactions [MHRA/CHM advice].
.Etanercept p. 643 for treating plaque psoriasis in children
and young people [NICE guidance].
.Gabapentin p. 200 (Neurontin®): risk of severe respiratory
depression [MHRA/CHM advice].
.Gentamicin p. 312 : potential for histamine-related adverse
drug reactions with some batches [MHRA/CHM advice].
.Guidance on prescribing p. 1 : updated guidance on
multimorbidity and deprescribing.
.Immunoglobulins p. 770 : updated guidance for Varicella-
zoster immunoglobulin.
.Immunosuppressive therapy for kidney transplant in
children and young people (see antithymocyte
immunoglobulin (rabbit) p. 518 , basiliximab p. 526 ,
mycophenolate mofetil p. 527 , sirolimus p. 521 , and
tacrolimus p. 522 ) [NICE guidance].
.Isotretinoin p. 757 (Roaccutane®): rare reports of erectile
dysfunction and decreased libido [MHRA/CHM advice].
.Loperamide hydrochloride p. 49 : reports of serious cardiac
adverse reactions with high doses of loperamide associated
with abuse or misuse [MHRA/CHM advice].
.Malaria, prophylaxis p. 386 : update to country
recommendations and guidance.
.Methylprednisolone p. 441 : injectable medicine
containing lactose (Solu-Medrone® 40 mg): do not use in
patients with cows’milk allergy [MHRA/CHM advice].
.Mycophenolate mofetil p. 527 , mycophenolic acid:
updated contraception advice for male patients
[MHRA/CHM advice].
.Neural tube defects (prevention in pregnancy) p. 637 :
updated guidance.
.Non-medical prescribing p. 1060 : updated guidance.
.Noradrenaline/norepinephrine 0. 08 mg/mL ( 4 mg in
50 mL) solution for infusion p. 124 association with
potential risk of medication errors.
.Quinine p. 397 : clarification of parenteral dose for the
treatment of malaria [dose reduction necessary if
parenteral treatment is required for more than 48 hours].
.Quinine p. 397 : reminder of dose-dependent QT-
prolonging effects [MHRA/CHM advice].
.Recombinant human erythropoietins (epoetin alfa p. 565 ,
epoetin beta p. 566 , epoetin zeta p. 567 , darbepoetin alfa
p. 564 , methoxy polyethylene glycol-epoetin): very rare
risk of severe cutaneous adverse reactions [MHRA/CHM
advice].
.Skin infections p. 720 : head lice eradication products: risk
of serious burns if treated hair is exposed to openflames or
other sources of ignition [MHRA/CHM advice].
.Sinusitis (acute) p. 697 : updated guidance.
.Terbinafine p. 726 : clarification of hepatic monitoring
advice.
.Tivicay®(dolutegravir p. 411 ),Triumeq®(dolutegravir,
abacavir, lamivudine),Juluca®(dolutegravir, rilpivirine):
neural tube defects reported in infants born to women
exposed to dolutegravir at the time of conception
[MHRA/CHM advice].
.Urinary-tract infections p. 369 : updated guidance on
management in children.
.Ustekinumab p. 748 for treating plaque psoriasis in
children and young people [NICE guidance].
.Vaccines p. 777 : updated guidance for Hepatitis A Vaccine.
.Vaccines: updates to Public Health England’s Green Book
on use of live attenuated vaccines [see updated
MHRA/CHM advice for all vaccines, and PHE advice for
rotavirus vaccine in rotavirus vaccine p. 801 ].
.Vaccines for travel p. 787 : updated guidance on Hepatitis
A.
.Valproic acid p. 213 and sodium valproate p. 208 :
valproate medicines contraindicated in women and girls of
childbearing potential unless conditions of Pregnancy
Prevention Programme are met [MHRA/CHM advice].
Dose changes
Changes in dose statements that appear in the print edition
ofBNF for Children 2018 – 2018 :
.Abatacept p. 641 [update to dosing advice].
.Adalimumab p. 642 [doses for plaque psoriasis,
polyarticular juvenile idiopathic arthritis, enthesitis-
related arthritis].
.Amitriptyline hydrochloride p. 238 [dose for depression
deleted].
.Chloroquine p. 395 [clarification of dose equivalence
statement].
.Co-codamol p. 275 [doses for children aged 12 to 15 years].
.Elvitegravir with cobicistat, emtricitabine and tenofovir
alafenamide p. 418 [age-range extension].
.Ferrous sulfate p. 572 (Ironorm®) [clarification of
maximum daily dose for iron-deficiency anaemiaBNFC 2018 – 2019 xix