How to use the BNF - NHS Education for Scotland

Transcription

How to use the BNF
A CPPE interactive PDF learning programme
E n t er
November 2015
2
Welcome to
How to use the BNF
Contents
This programme contains the following sections:
3
How to use this learning programme
Thank you for downloading this CPPE interactive learning programme.
We hope that you will find it a fun and informative way to help you learn
about this topic.
4
About How to use the BNF
Learning with CPPE
5
Learning objectives
6
Key changes to the BNF
The Centre for Pharmacy Postgraduate Education (CPPE) offers a wide
range of learning opportunities in a variety of formats for pharmacy
professionals from all sectors of practice. We are funded by Health
Education England to offer continuing professional development for all
pharmacists and pharmacy technicians providing NHS services in England.
For further information about our learning portfolio, visit: www.cppe.ac.uk
This document uses interactive features that are supported on most mobile
devices. If you are using this programme on a PC or laptop, please ensure
you are using an up-to-date version of Adobe Reader.
Programme guardians
CPPE has a quality assurance process called programme guardians. A
programme guardian is a recognised expert in an area relevant to the
content of a learning programme who reviews the programme every
six to eight months. Following the regular programme guardian review
we update this programme with any necessary corrections, additions,
deletions or further supporting materials. We recommend that you check
you have the most up-to-date version of this programme if you are using it
more than six months after its initial publication date.
© Copyright Controller HMSO 2015
10 Case studies – introduction
11 Case studies
32 Next steps
33 Programme credits
Click on a title to go directly to that section.
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3
How to use this learning
programme
This programme uses an interactive PDF (iPDF) format. You can navigate
your way through by using the arrows in the bottom right corner of each
page. Where directed, you can also navigate to sections by clicking on text
or images. The programme uses case studies and web links to help you
explore this topic. You will need to be connected to the internet to access
the web links.
You will be able to type, save and view answers to the case studies. You
can save your answers by saving this document to your computer. We would
recommend that you keep notes as you go along as these could be ideal to
generate CPD records.
A note about web links
Where we think it will be helpful we have provided web links to take you
directly to an article or specific part of a website. However, we are aware
that web links can change. If you have difficulty accessing any web links
we provide, please go to the organisation’s home page or your preferred
internet search engine and use appropriate key words to search for the
relevant item.
All web links were accessed on 27 October 2015.
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4
About How to use the BNF
In 2015 the BNF underwent a fundamental change in structure in order to
create purpose-designed digital products. These digital products build on longstanding existing products and sit alongside the familiar print BNF publications.
The redesign of all formats makes the highly valued content in the BNF
publications much more accessible.
In this learning programme you will explore the main changes in structure to
the BNF website (MedicinesComplete), the new BNF app and the latest edition
of the book.
In the following pages we have listed the main changes to the BNF structure.
We have also included case studies to provide you with the opportunity to find
information in the new BNF, and we have provided answers to show you how to
navigate around the BNF.
Please note that at the time of writing this programme the new BNF website
was in development, so although the images in the programme should be very
similar to the new website, particularly in terms of navigation, there might be
some changes to the look and feel of the publication.
You will need about 90 minutes to complete this programme.
Before you start, make sure you have access to BNF 70, the new online version
or the new BNF app.
You can access the BNF online through MedicinesComplete. If you are not
already registered, you will need to do so. Click here to register. UK-based
individuals working for or on behalf of the NHS can register for free and access
the BNF and BNF for Children.
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5
Learning objectives
You can use our programmes to support you in building the evidence that you
need for the different competency frameworks that apply across your career.
These will include building evidence for your Foundation pharmacy framework
(FPF), demonstrating development as your career progresses with the Knowledge
and skills framework (KSF) and supporting your progression through the
membership stages of the Royal Pharmaceutical Society (RPS) Faculty.
As you work through the programme consider which competencies you are
meeting and the level at which you meet these. What extra steps could you take
to extend your learning in these key areas?
After completing this interactive PDF, you should be able to use the BNF to:
n s elect an appropriate choice of treatment for the management of a condition,
taking into account contraindications and cautions
n determine the appropriate dose for a specific indication and patient group
n find information about the unlicensed use of a drug
n find information about a specific preparation and any relevant patient and carer advice
n f ind pre-treatment screening information before starting a medicine and the
appropriate monitoring requirements of a medicine for different indications
n f ind information to make an appropriate choice of treatment for the
management of a condition, taking into account allergy information and
interactions between drugs.
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6
Key changes to the BNF
nW
hen BNF Publications decided to change the structure of their resources, they started out with the aim of consistency
and simplicity. So one of the main changes is that all the information you need about a medicine is now under one
monograph. Information for the systemic use of any given drug has been collated in one place; separate monographs
remain for topical and local uses of the drug.
nT
he number of sections in a drug monograph has been increased, allowing you to more swiftly identify the information
needed.
n Indication and dose has been moved into one section, at the top of the monograph, with the dose now immediately
following the stated indication.
n Age ranges have been changed so wherever possible there is no overlap.
nD
rug class monographs have been created, which follow the same structure as drug monographs and allow a consistency
in presentation.
n Information has been reorganised so it is presented systematically; in print the information is organised by disease state,
with the drug classes and drugs used in the management of that condition following alphabetically.
Click on the headings below to find out more about changes specific to the online version, the new app and the BNF book.
BNF online
BNF app
BNF book
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7
Key changes to the online version of
the BNF and BNF for Children
nW
hen you log into the online version of the BNF you will notice
that the contents page is much more concise and no longer
reflects a book chapter structure.
n If you search a term, you will be presented with search results
and tabs so you can filter your results; the default is to show full
text, but you can filter the search by drugs, treatment summaries,
medicines, interactions or all publications.
n Indications and dose now appear at the top of a monograph.
n Contraindications and cautions now appear as lists.
n There are no changes to the presentation of interactions.
nS
ide-effects now have their own heading and are listed in terms of
incidence, then alphabetically, rather than by body system.
n Search using the search bar top right.
n There are some new sections in monographs including:
• Pre-treatment screening
• Conception and contraception (for male and female patients)
• Monitoring requirements
• Patient and carer advice
• National funding/access decisions
General information on searching BNF publications on
MedicinesComplete
n Switch to BNF for Children using the tab left of the search bar.
n Cautionary and advisory labels are now found in medicinal forms.
nB
rowse through the content and switch between different content
types (drugs, treatment summaries, etc) using the menu on the
BNF home page.
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8
Key changes to the new BNF app
nT
he new BNF app includes an A-Z list of drugs and a section-specific search
function.
nN
avigation allows you to easily switch between drugs, the interactions
checker, treatment summaries, wound care, medical devices and borderline
substances.
n You easily switch between the BNF and the BNF for Children within one app.
n The app is available for use offline.
nT
he app prompts when updates are available and provides reminders when
you need to update the app with the latest information.
General information on searching BNF publications apps
nA
t first use, the screen defaults to adult (BNF) content. Switch to child
content by using the menu (top left).
earch using drug or brand names, or browse using the A-Z listing for drug
nS
names only.
witch between content types (drugs, treatment summaries, etc) using the
nS
icons across the bottom of the screen.
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9
Key changes to print editions: BNF
70 and BNF for Children 2015-16
n Information within the BNF now has a green colour theme, with BNF for Children
retaining its pink colour theme.
n Indications and dose now appear in a green highlighted box in the BNF and a pink
highlighted box in the BNF for Children, allowing for quick and efficient use.
he chapters are organised by disease state, and drug information within each disease
nT
state is in alphabetical order by drug class then by drug.
ithin the chapters there are information summaries on disease states. These do not
nW
include information about drugs; this has been moved to the monographs or drug
class monographs.
white flag in a green circle (BNF) and white flag in a pink circle (BNF for Children)
nA
indicates that the information provided is about a drug class.
green flag (BNF) and pink flag (BNF for Children) indicates that a drug monograph
nA
has a corresponding drug class monograph.
section (eg, monitoring) may appear in both the drug class monograph (eg,
nA
monitoring required by all members of the drug class) and the monograph (eg,
monitoring required for the specific drug); the patient needs to be monitored for both.
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10
Case studies – introduction
This programme contains ten case studies.
In these, there will be space for you to type answers to the questions. You
can save your answers by saving this document to your computer and view
our suggested answers by clicking on the Suggested answer links.
The suggested answers to each case include the answers to the questions
and images of the online version, app or book to help you navigate
around the BNF.
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11
Case studies
The case studies look at the following areas (click on a title to go straight to that case).
You will be able to return to this menu by clicking the link at the bottom of the page at the end of each question.
Treatment choice and dose
Dosing and licensing
Patient and carer advice
Medicinal forms Monograph sections
Screening and monitoring
Monograph structure
Side-effects, cautions, allergy and cross-sensitivity
Interactions Funding
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12
Case study 1 will illustrate key changes relating to:
n choice of treatment
n choice of dose.
Treatment summaries are of three main types:
na
n overview of delivering a drug to a particular body system (eg, skin
conditions, management)
na
comparison between a group or groups of drugs (eg, beta-adrenoceptor
blocking drugs)
na
n overview of the drug management or prophylaxis of common conditions
intended to facilitate rapid appraisal of options (eg, hypertension).
A treatment summary detailing an overview of the drug management of a
condition can be used to aid the choice of an appropriate treatment and
dose.
In order to select safe and effective medicines for individual patients,
information in the treatment summaries must be used in conjunction with
other prescribing details about the drugs and knowledge of the patient’s
medical and drug history.
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13
Mollie Davis is a 13-year-old child with a duodenal ulcer. She also has confirmed Helicobacter pylori
and needs to be prescribed an eradication regimen; however, she is currently completing a course of
clarithromycin that she was prescribed for otitis media.
1. Which eradication regimen should Mollie be prescribed?
Suggested answers
2. What doses are suitable for a 13-year-old child?
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Don’t forget to save your answers
Click to return to the case studies menu
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14
Case study 2 will illustrate key changes relating to searching for:
n the dose for a given indication, route and patient group
n information about the unlicensed use of a drug.
In the new BNF and BNF for Children all of the information for the systemic use of
a drug is contained within one monograph. This carries the advantage of providing
all of the information in one place, so the user does not need to flick back and
forth across several pages to find all of the relevant information for that drug.
The dose of a drug may vary according to different indications, routes of
administration, age, body weight, and body surface area. The right dose should be
selected for the right age and body weight (or body surface area) of the child, as
well as for the right indication, route of administration, and preparation.
One of the most significant changes to the monograph structure is the increased
granularity, with a move from around 9 sections to over 20 sections; sections are
only included when relevant information has been identified.
The Unlicensed use section provides pertinent information about the unlicensed
use of a drug, which can be specific to a patient group, one or more routes of
administration or the indication for which the drug is being used.
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15
David Jones is a 10-year-old boy with asthma who weighs 31 kg. David has had symptoms of a productive
cough for several days and has been needing to use his salbutamol inhaler more frequently. The GP diagnoses
a lower respiratory tract infection and prescribes clarithromycin treatment as David is allergic to penicillin.
1. What oral dose should be prescribed?
Suggested answers
2. Are clarithromycin tablets and intravenous infusion licensed for use in children?
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16
Case study 3 will illustrate key changes relating to finding:
n preparation-specific information
n patient and carer advice.
In previous editions, when a particular preparation had safety information,
dose advice or other clinical information specific to that particular product, it
was contained within the preparations section. This information has now been
moved to the relevant section in the main body of the monograph (now called
Medicinal forms) and placed under a heading of the name of the particular
medicinal form concerned.
The dose panel also contains additional information relevant to indication and
dose, under headings such as Pharmacokinetics, Potency and Dose equivalence
and conversion. This information may affect the choice of dose, especially
when switching between drugs or preparations.
Taking the time to explain to the patient (and carers) the rationale and the
potential adverse effects of treatment may improve adherence. For some
medicines there is a special need for counselling (eg, appropriate posture
during administration of doxycycline); this is shown in a Patient and carer
advice section of the drug monograph.
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17
FIVE
Marsha Dujon is a child aged 13 years who is currently at step 2 in the management of chronic asthma. Her
condition is well-controlled with Salamol Easi-Breathe® and Clenil Modulite® 200 mcg twice daily. However,
Clenil Modulite® device is no longer suitable for Marsha so the GP has decided to trial Qvar Easi-Breathe®.
1. What dose of Qvar Easi-Breathe® is appropriate?
Suggested answers
2. Qvar Easi-Breathe® has been dispensed; what patient and carer advice should be provided?
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18
Medicinal forms
Case study 4 will illustrate key changes relating to information on:
n excipients
n electrolytes
n cautionary and advisory labels.
In the new BNF, the medicinal forms (formerly preparations) record provides
information on the type of formulation (eg, tablet or oral suspension), the
amount of active drug in a solid dosage form, and the concentration of active
drug in a liquid dosage form. Any clinical information relating to a medicinal
form (eg, dose) has been moved to the relevant section within the drug
monograph.
Previously, the BNF only included excipients and electrolyte information for
proprietary medicines. This information is now covered at the level of the dose
form (eg, tablet or oral suspension). As generic products available on the UK
market are constantly changing the information is provided as a reminder to
the healthcare professional that if the presence of a particular excipient is of
concern they should check the product literature for the particular product being
prescribed or dispensed.
Cautionary and advisory labels that pharmacists are recommended to add when
dispensing are now included in the medicinal forms record. In previous editions,
details of these labels could be found in Appendix 3. As these labels have now
been applied at the level of the dose form, a full list of medicinal products with
their relevant labels would be extensive. This list has therefore been removed,
but the information is retained within the monograph. In the case of compound
preparations, the prescribing information for all constituents should be taken
into account.
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19
Paul Osinski, a 65-year-old male with dysphagia, is prescribed Augmentin® suspension to treat
a respiratory tract infection. The patient has known sensitivities, so you are required to check the
preparation for further information.
1. What excipients are included in Augmentin® suspension?
2. What cautionary and advisory label(s) are applicable to Augmentin® suspension?
Suggested answers
The patient is subsequently admitted to hospital and is prescribed Augmentin® injection instead.
3. What electrolytes are contained in this formulation?
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20
The new monograph structure
n monograph structure.
In previous editions of the BNF, information relating to a class of drug sharing the
same properties (eg, tetracyclines on page 496 of BNF 70), was contained within the
prescribing notes. In this new edition, drug class monographs have been created to
contain the common information; this ensures such information is easier to find, and
has a more consistent structure.
Class monographs are indicated by the presence of a white flag in a green circle for
the BNF and in a pink circle for the BNF for Children (eg, systemic beta-blockers on
page 140 of the BNF). If a drug monograph has a corresponding class monograph
that needs to be considered in tandem in order to understand the full information
about a drug, the monograph is indicated by a green flag for the BNF or a pink flag
for the BNF for Children (eg, metoprolol on page 144 of the BNF).
Where the drug monographs run on from a class monograph, no further crossreferencing is given. However, occasionally, due to differences in therapeutic use, the
drug monograph may not directly follow the class monograph. In this situation the
need to consider a class monograph is still indicated by the flag, but a cross reference
is also provided to help you navigate to the class monograph (eg, sotalol on page 93
of the BNF).
In digital formats, the drug class information will be pushed into each drug that it
is relevant to, meaning that all of the relevant drug and drug class information is
displayed within one monograph.
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21
Amy Jones is a 55-year-old with acute angle-closure glaucoma, hypertension and COPD. She has been
newly prescribed ipratropium bromide to treat her COPD.
1. Ipratropium bromide is cautioned in patients with acute angle-closure glaucoma. Are all inhaled antimuscarinics cautioned in patients with acute angle-closure glaucoma?
Amy has been using her inhaler for several weeks and informs you that she is experiencing very dry skin.
2. Is this a possible side-effect of ipratropium bromide when used via the intranasal route?
Suggested answers
3. Is cystic fibrosis a caution for all antimuscarinics (inhaled) or for ipratropium bromide only?
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22
New monograph sections
Case study 6 will illustrate key changes relating to information about:
n conception and contraception
n prescribing and dispensing.
In the BNF, information is provided to enable the prescriber and the patient
to agree on the health outcomes that the patient desires and on the strategy
for achieving them. Conception and contraception advice is therefore an
important aspect of a patient’s health and should always be considered where
appropriate.
The Conception and contraception section within the BNF monograph
contains information relevant to both males and females, covering the
potential for a drug to have harmful effects on an unborn child. In addition,
some drugs can affect the integrity, therefore the efficacy, of latex condoms
and diaphragms and this information is also included within the Conception
and contraception section.
Another new section within the BNF monograph is the Prescribing and
dispensing section. This covers practical information about how a drug can be
prescribed and dispensed. Useful information which may influence the choice
of preparation prescribed or dispensed, such as flavourings, is included, but
also more important information, such as the requirement to check patients
are enrolled in surveillance schemes, may also be present.
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23
Susan Williams is a 32-year-old woman who has recently stopped taking thalidomide. She is no longer
taking any medicines and would like to begin planning to have children. Use the BNF to answer the
following questions.
or how long after stopping thalidomide treatment should women of child-bearing age use
1. F
effective contraception?
Suggested answers
2. What must accompany every prescription when prescribing and dispensing thalidomide?
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24
n pre-treatment screening
n monitoring for different indications.
When selecting the most appropriate drug, it may be necessary to
screen the patient for certain genetic markers or metabolic states. This
information is included within a section called Pre-treatment screening.
This section covers one-off tests required to assess the suitability of a
patient for a particular drug.
After selecting and administering the most appropriate drug by the most
appropriate route, patients should be monitored to ensure they are
achieving the expected benefits from drug treatment without any unwanted
side-effects. The Monitoring section specifies any special monitoring
requirements for that drug.
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25
Amelie Colburn is a 17-year-old girl who is suffering from severe psoriasis, which is unresponsive to
conventional therapy. Under the advice of a specialist, she will be initiated on ciclosporin.
1. What pre-treatment screening, if any, should be undertaken before initiating ciclosporin in psoriasis?
After her pre-treatment screening, Amelie is started on ciclosporin for psoriasis.
2. What monitoring is required for the use of ciclosporin in severe psoriasis?
Suggested answers
James Anson, a 14-year-old boy, attends a dermatology clinic with severe atopic dermatitis. He has
been suffering from severe atopic dermatitis for a number of months, and conventional therapy has not
been successful. The dermatology consultant would now like to try ciclosporin for short-term treatment.
3. What monitoring is required for the use of ciclosporin in severe atopic dermatitis?
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26
Side-effects, cautions, allergy
and cross-sensitivity
n side-effects
n cautions
n allergies and cross-sensitivity.
One key area of change within the restructured BNF publications is side-effects.
Although the section is present as before, it has been restructured so that sideeffects are no longer broadly presented by body system but are presented by
the frequency with which they occur, ordered within each frequency section
alphabetically. In addition, because different routes of administration may be
associated with different frequencies at which side-effects occur, the information
may be further sub-divided by route of administration.
Side-effects are distinct from Allergy and cross-sensitivity, which is presented in its
own section. As hypersensitivity reactions can occur with virtually all medicines,
this effect is generally not listed, unless the drug carries an increased risk of such
reactions.
The Cautions section is also retained from previous editions of the BNF but much
of the information has been removed, for example, monitoring now has its own
dedicated section. This leaves the Cautions section to describe situations where the
use of the drug is known to present a risk of harm that is greater than usual but
where the benefits of the use of that drug are still expected to outweigh the risks.
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27
Emma Hunt is a 48-year-old woman who comes in to the pharmacy with her 17-year-old son George.
Emma wants to buy some ibuprofen to take for her headache, but also to give to her son as he hurt his
ankle from a fall. On taking a medical history, you find out that both Emma and her son George suffer
from ulcerative colitis.
1. Which route is cautioned in the use of ibuprofen in ulcerative colitis?
2. In both adults and children, what allergy and cross-sensitivity contraindicates the use of ibuprofen?
Suggested answers
Emma has suffered from blood disorders in the past and would like to know if blood disorders are a
side-effect of ibuprofen.
3. Are blood disorders a side-effect of ibuprofen? And if so, which route is this side-effect applicable to?
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28
Interactions
n interactions.
A dedicated section for information on interactions is now included in
the restructured BNF monograph. This provides a consistent place for
information that was held variously in Cautions or within notes sections.
In particular, additive side-effects, which are not included within the drug
interactions section of the BNF; however, additive side-effects that result in
measurable clinical signs (eg, QT-interval prolongation are listed within this
new Interactions section).
The Interactions section does not replace Appendix 1 in the book, and the
content of Appendix 1 continues to be displayed in online formats. A new
development for the app is the inclusion of an interactions checker.
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29
FIVE
Sophie Hills is a 26-year-old woman who suffers from epilepsy, which is currently managed on
carbamazepine. She is travelling abroad to Cambodia and Laos, and has a prescription from her GP for
doxycycline for malaria prophylaxis.
1. Is there any interaction between carbamazepine and doxycycline?
Suggested answers
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30
Funding
n national funding and access decisions.
A further section new to the monograph structure is National funding/access
decisions. This section covers information about whether or not a drug is
funded for use within the NHS, based on NICE decisions (NICE TAs) or
Scottish Medicines Consortium (SMC) decisions. In addition, information on
drugs that cannot be prescribed on the NHS is included.
Rarely, national funding/access decisions information is not specific to a
drug or class of drugs, eg, NICE TA10: Inhaler devices for children under 5
years with chronic asthma. In these cases, this information can be found in
the appropriate treatment summary.
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31
Jim Williams is a 65-year-old male with severe chronic spontaneous urticaria. Jim has had an inadequate
response to previous treatment including cetirizine; therefore, his GP would like to trial treatment with Xolair®.
1. Is it appropriate for a GP to be solely responsible for the management of Jim’s treatment with
Xolair®?
Suggested answers
2. What is the maximum number of doses of Xolair® a patient may receive if the condition is
failing to respond?
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32
Next steps
Now that you have completed the case studies, what’s next?
You might like to:
n return to the start of the case studies
n r evisit the learning objectives. Are you confident that you
have achieved these?
n tackle the reflective essay that you can download from your
CPPE record
n complete a CPD record
n email CPPE with any feedback you may have on your
learning experience.
We hope that you have enjoyed your learning.
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33
Credits
CPPE programme manager
Caroline Barraclough, regional manager, East Midlands
Authors
Karen Baxter, director, BNF Publications
Katie Page, clinical writer, BNF Publications
Heenaben Patel, content manager, BNF Publications
Reviewers
Anne Cole, regional manager, South West, CPPE
Editors
Terri Lucas, editor, CPPE
Paddy McLaughlin, assistant editor, CPPE
External websites
CPPE is not responsible for the content of any non-CPPE
websites mentioned in this programme or for the accuracy of
any information to be found there.
Production
Gemini West, 25 Hockeys Lane, Fishponds, Bristol BS16 3HH
T: 0117 965 5252. www.gemini-west.co.uk
Published in October 2015 by the Centre for Pharmacy
Postgraduate Education, Manchester Pharmacy School, The
University of Manchester, Oxford Road, Manchester M13 9PT.
www.cppe.ac.uk
Disclaimer
We have developed this learning programme to support your
practice in this topic area. We recommend that you use it in
combination with other established reference sources. If you are
using it significantly after the date of initial publication, then
you should refer to current published evidence. CPPE does not
accept responsibility for any errors or omissions.
Brand names and trademarks
CPPE acknowledges the following brand names and
registered trademarks mentioned throughout this programme:
Augmentin®, Clenil Modulite®, Easi-Breathe®, Qvar®,
Salamol®, Xolair®.
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Contacting CPPE
For information on your orders or bookings, or any general
enquiries, please contact us by email, telephone or post.
A member of our customer services team will be happy to
help you with your enquiry.
Email [email protected]
Telephone
0161 778 4000
By post
entre for Pharmacy Postgraduate Education (CPPE)
C
Manchester Pharmacy School
1st Floor, Stopford Building
The University of Manchester
Oxford Road
Manchester M13 9PT
Share your learning
experience with us:
email us at [email protected]
Funded by:
For information on all our
programmes and events:
visit our website www.cppe.ac.uk
Developed by:
Suggested answers
Contents
How to find this information in the printed BNF
Step 1: Search the BNF
for Children index for
Helicobacter pylori infection.
Step 2: Locate the relevant
section of the treatment
summary.
Step 3: Read the ‘Recommended regimens for Helicobacter pylori
eradication’ table and find:
• the row for children aged 12-17 years (highlighted in green)
• the recommended antibacterial options available that do not include
clarithromycin (highlighted in yellow)
• the recommended acid suppressant and dose (highlighted in orange).
713
Hepatitis B, chronic, 363
Hepatitis B immunoglobulin, 694
Hepatitis B vaccine, 713
Hepatitis C, chronic, 363
Hepatyrix, 713
Heroin hydrochloride, see
Diamorphine hydrochloride
Herpes labialis, 644
Herpes simplex and varicella–zoster
infection, 366
Herpes simplex infections, 366
Herpesvirus infections, 366
Hexetidine, 628
Hibi, 685
Hibiscrub, 685
HiBiTane Plus, 685
Hidrasec, 43
High-dose inhaled corticosteroids,
133
High lower-limb amputation, 271
Hirudoid, 688
HIV infection, 371
Hizentra, 696
Homatropine hydrobromide, 599
Hormone treatment for acne, 676
How BNF publications are
constructed, ix
How to use BNF publications, xi
H2-receptor antagonists, 48
Humalog, 411
Humalog KwikPen, 411
Humalog Mix25, 408
Humalog Mix50, 408
Humalog Mix25 KwikPen, 408
Humalog Mix50 KwikPen, 408
Human Albumin Solution, see
Albumin solution
Human Chorionic Gonadotrophin,
see Chorionic gonadotrophin
Human Coagulation Factor VIII,
Dried, see Factor VIII fraction,
dried
Hydrotalcite with simeticone, see
Co-simalcite
Hydroxocobalamin, 516
Anaemias, 503
Emergency treatment of
poisoning, 752
Hydroxycarbamide, 495
Sickle-cell disease, 503
Hydroxychloroquine sulfate, 572
1a-Hydroxycholecalciferol, see
Alfacalcidol
Hydroxyethylcellulose, 600
Hydroxypropyl guar with
polyethylene glycol and propylene
glycol, 600
Hydroxyurea, see Hydroxycarbamide
Hydroxyzine hydrochloride, 162
Hylo-Comod, 602
Hy-Opti, 602
Hyoscine butylbromide, 54
Hyoscine hydrobromide, 206
Hyperprolactinaemia, 188
Hypersal, 601
Hypertension, 85
In diabetes, 85
In pregnancy, 85
In renal disease, 85
Hypertensive emergencies, 85
Hypnomidate, 725
Hypnovel, 265
Hypodermic insulin injection pens,
1
l
Oral suspension
▶
I
Ibucalm, 585
Ibuprofen, 584
Drugs affecting the ductus
arteriosus, 129
Ichthammol, 656
Return to case study
MAGNESIUM CARBONATE WITH MAGNESIUM TRISILICATE AND
SODIUM BICARBONATE (Non-proprietary)
Magnesium carbonate light 50 mg per 1 ml, Magnesium
trisilicate 50 mg per 1 ml, Sodium bicarbonate 50 mg per 1
ml Magnesium trisilicate oral suspension | 200 ml G £1.28 DT
price = £1.28
DEFOAMING DRUGS
Simeticone
(Activated dimeticone)
l
DRUG ACTION Simeticone (activated dimeticone) is an
antifoaming agent.
INDICATIONS AND DOSE
INFACOL ®
Colic | Wind pains
BY MOUTH
▶
Neonate: 0.5–1 mL, to be taken before feeds
Child 1 month–1 year: 0.5–1 mL, to be taken before feeds
DENTINOX ®
Colic | Wind pains
Recommended regimens for Helicobacter pylori eradication
BY MOUTH
Acid suppressant
▶
▶
▶
l
l
BY MOUTH
▶
▶
l
l
l
Neonate: 2.5 mL, to be taken with or after each feed;
may be added to bottle feed; maximum 6 doses per
day.
Child 1 month–1 year: 2.5 mL, to be taken with or after
each feed; may be added to bottle feed; maximum
6 doses per day
PATIENT AND CARER ADVICE
INFACOL ®
Patients or carers should be given advice on use of the
Infacol ® dropper.
LESS SUITABLE FOR PRESCRIBING
INFACOL ®
Infacol ® is less suitable for prescribing (evidence of
benefit in infantile colic uncertain).
DENTINOX ®
Dentinox ® colic drops are less suitable for prescribing
(evidence of benefit in infantile colic uncertain).
MEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Oral suspension
▶
Infacol (Forest Laboratories UK Ltd)
Simeticone 40 mg per 1 ml Infacol 40mg/ml oral suspension
(sugar-free) | 50 ml G £2.71 DT price = £2.71
Oral drops
▶
Dentinox Infant (Dendron Ltd)
Simeticone 8.4 mg per 1 ml Dentinox Infant colic drops |
100 ml G £1.73
Aluminium hydroxide with magnesium
hydroxide and simeticone
The properties listed below are those particular to the
combination only. For the properties of the components please
consider, aluminium hydroxide p. 536, simeticone above.
Gastric and duodenal ulceration 47
BNFC 2015–2016
Dyspepsia
Child 2–4 years: 5 mL 3 times a day
Child 5–11 years: 5–10 mL 3–4 times a day
Child 12–17 years: 5–10 mL 4 times a day, to be taken
after meals and at bedtime, or when required
PRESCRIBING AND DISPENSING INFORMATION Maalox
Plus ® is low Na+.
MEDICINAL FORMS
Oral suspension
▶
Maalox Plus (Sanofi)
Aluminium hydroxide gel dried 44 mg per 1 ml, Magnesium
hydroxide 39 mg per 1 ml, Simeticone 5 mg per 1 ml Maalox Plus
oral suspension (sugar-free) | 500 ml G £3.90
4.2 Gastric and duodenal
ulceration
▶
416
Hypoglycaemia, 417
Hypotension and interference with
temperature regulation, 188
Hypovase, 94
Hypromellose, 600
Dry eye, 599
Hypromellose with dexamethasone,
neomycin and polymyxin B
sulfate, see Dexamethasone with
hypromellose, neomycin and
polymyxin B sulphate
Hypromellose with dextran 70, see
Dextran 70 with hypromellose
Hypromol, 600
Hypurin Bovine Isophane, 411
Hypurin Bovine Lente, 411
Hypurin Bovine Neutral, 409
Hypurin Bovine Protamine Zinc, 412
Hypurin Porcine Isophane, 412
Hypurin Porcine 30/70 Mix, 408
Hypurin Porcine Neutral, 409
BNFC 2015–2016
MEDICINAL FORMS
Peptic ulceration
Peptic ulceration commonly involves the stomach,
duodenum, and lower oesophagus; after gastric surgery it
involves the gastro-enterostomy stoma. Healing can be
promoted by general measures, stopping smoking and
taking antacids and by antisecretory drug treatment, but
relapse is common when treatment ceases. Nearly all
duodenal ulcers and most gastric ulcers not associated with
NSAIDs are caused by Helicobacter pylori.
Helicobacter pylori infection
Eradication of Helicobacter pylori reduces the recurrence of
gastric and duodenal ulcers and the risk of rebleeding. The
presence of H. pylori should be confirmed before starting
eradication treatment. If possible, the antibacterial
sensitivity of the organism should be established at the time
of endoscopy and biopsy. Acid inhibition combined with
antibacterial treatment is highly effective in the eradication
of H. pylori; reinfection is rare. Antibiotic-associated colitis
is an uncommon risk.
Treatment to eradicate H. pylori infection in children
should be initiated under specialist supervision. One week
triple-therapy regimens that comprise omeprazole p. 51,
amoxicillin p. 310, and either clarithromycin p. 299 or
metronidazole p. 646 are recommended. Resistance to
clarithromycin or to metronidazole is much more common
than to amoxicillin and can develop during treatment. A
regimen containing amoxicillin and clarithromycin is
therefore recommended for initial therapy and one
containing amoxicillin and metronidazole is recommended
for eradication failure or for a child who has been treated
with a macrolide for other infections. There is usually no
need to continue antisecretory treatment (with a proton
pump inhibitor or H2-receptor antagonist); however, if the
ulcer is large, or complicated by haemorrhage or perforation
then antisecretory treatment is continued for a further 3
weeks. Lansoprazole may be considered if omeprazole is
unsuitable. Treatment failure usually indicates antibacterial
resistance or poor compliance.
Two-week triple-therapy regimens offer the possibility of
higher eradication rates compared to one-week regimens,
but adverse effects are common and poor compliance is
likely to offset any possible gain.
Age range
Child 1–5 years
250 mg twice daily
125 mg 3 times a day
Omeprazole 1–2 mg/kg
(max. 40 mg) once daily
Child 6–11 years
500 mg twice daily
—
—
Omeprazole 40 mg once
daily
Child 12–17 years
1
Antibacterial
Amoxicillin
Omeprazole 1–2 mg/kg
(max. 40 mg) once daily
1 g twice daily
—
Two-week dual-therapy regimens using a proton pump
inhibitor and a single antibacterial produce low rates of H.
pylori eradication and are not recommended.
See under NSAID-associated ulcers for the role of H. pylori
eradication therapy in children starting or taking NSAIDs.
Test for Helicobacter pylori
13
C-Urea breath test kits are available for confirming the
presence of gastro-duodenal infection with Helicobacter
pylori. The test involves collection of breath samples before
and after ingestion of an oral solution of 13C-urea; the
samples are sent for analysis by an appropriate laboratory.
The test should not be performed within 4 weeks of
treatment with an antibacterial or within 2 weeks of
treatment with an antisecretory drug. A specific 13C-Urea
breath test kit for children is available (Helicobacter Test
INFAI for children of the age 3–11 ®). However the
appropriateness of testing for H. pylori infection in children
has not been established. Breath, saliva, faecal, and urine
tests for H. pylori are frequently unreliable in children; the
most accurate method of diagnosis is endoscopy with
biopsy.
Metronidazole
—
100 mg twice daily
—
7.5 mg/kg twice daily
7.5 mg/kg (max. 500 mg)
twice daily
—
7.5 mg/kg (max. 500 mg)
twice daily
500 mg twice daily
—
500 mg twice daily
—
200 mg twice daily
—
400 mg twice daily
GASTROPROTECTIVE COMPLEXES AND
CHELATORS
Chelates and complexes
Sucralfate below is a complex of aluminium hydroxide and
sulfated sucrose that appears to act by protecting the
mucosa from acid-pepsin attack; it has minimal antacid
properties.
Sucralfate
Benign gastric ulceration | Benign duodenal ulceration
BY MOUTH
Child 1 month–1 year: 250 mg 4–6 times a day
Child 2–11 years: 500 mg 4–6 times a day
Child 12–14 years: 1 g 4–6 times a day
Child 15–17 years: 2 g twice daily, dose to be taken on
rising and at bedtime, alternatively 1 g 4 times a day
for 4–6 weeks, or in resistant cases up to 12 weeks,
dose to be taken 1 hour before meals and at bedtime;
maximum 8 g per day
Prophylaxis of stress ulceration in child under intensive
care
▶
▶
▶
▶
NSAID-associated ulcers
Gastro-intestinal bleeding and ulceration can occur with
NSAID use. Whenever possible, NSAIDs should be
withdrawn if an ulcer occurs.
Children at high risk of developing gastro-intestinal
complications with a NSAID include those with a history of
peptic ulcer disease or serious upper gastro-intestinal
complication, those taking other medicines that increase
the risk of upper gastro-intestinal side-effects, or those with
serious co-morbidity. In children at risk of ulceration, a
proton pump inhibitor can be considered for protection
against gastric and duodenal ulcers associated with nonselective NSAIDs; high dose ranitidine p. 48 is an
alternative.
NSAID use and H. pylori infection are independent risk
factors for gastro-intestinal bleeding and ulceration. In
children already taking a NSAID, eradication of H. pylori is
unlikely to reduce the risk of NSAID-induced bleeding or
ulceration. However, in children about to start long-term
NSAID treatment who are H. pylori positive and have
dyspepsia or a history of gastric or duodenal ulcer,
eradication of H. pylori may reduce the overall risk of
ulceration.
If the NSAID can be discontinued in a child who has
developed an ulcer, a proton pump inhibitor usually
produces the most rapid healing; alternatively the ulcer can
be treated with an H2-receptor antagonist.
If NSAID treatment needs to continue, the ulcer is treated
with a proton pump inhibitor.
Clarithromycin
7.5 mg/kg twice daily
Gastro-intestinal system
46 Disorders of gastric acid and ulceration
BNFC 2015–2016
Human Fibrinogen, see Fibrinogen,
dried
Human Fibrin-stabilising Factor,
Dried, see Factor XIII fraction,
dried
Human hemin, see Haem arginate
Human papillomavirus vaccines, 715
Human Prothrombin Complex, see
Dried prothrombin complex
Humatrope, 428
Humira, 575
Humulin I, 411
Humulin I KwikPen, 411
Humulin M3, 408
Humulin M3 KwikPen, 408
Humulin S, 409
Hyabak, 602
Hyaluronidase, 592
Soft-tissue disorders, 592
Hycosan, 602
Hydatid disease, 346
Hydralazine hydrochloride, 102
HydraMed, 602
Hydrea, 496
Hydrex, 685
Hydrocortisone, 397, 631, 666
Airways disease, use of
corticosteroids, 143
Oral ulceration and
inflammation, 630
Soft-tissue disorders, 592
Hydrocortisone and clotrimazole,
see Clotrimazole with
hydrocortisone
Hydrocortisone butyrate, 666
Hydrocortisone with benzalkonium
chloride, dimeticone, and nystatin,
see Benzalkonium chloride with
dimeticone, hydrocortisone and
nystatin
Hydrocortisone with chlorhexidine
hydrochloride and nystatin, see
Chlorhexidine hydrochloride with
hydrocortisone and nystatin
Hydrocortisone with cinchocaine,
see Cinchocaine with
hydrocortisone
Hydrocortisone with
Fusidic acid, 668
Gentamicin, 618
Lidocaine, 62
Miconazole, 668
Oxytetracycline, 668
Ppramocaine, 62
Urea, 668
Hydrocortistab, 398
Hydrogen peroxide, 628, 685
Hydromol Intensive, 644
Hydromoor, 600
Hydromorphone hydrochloride, 224
Index
958 Index
HCU express, 922
HCU Lophlex LQ, 922
Head lice, 644
Heavy metals, 752
Hedrin, 652
Helicobacter pylori infection, 46
Helixate NexGen, 75
Helminth infections, 346
Heparinoid, 688
Heparins, 81
Heparin (unfractionated), 83
Venous thromboembolism, 77
Heparon Junior, 908
Hepatect CP, 694
Hepatitis, 363
Hepatitis A and B vaccine, 712
Hepatitis A vaccine, 712
Hepatitis A with typhoid vaccine,
BY MOUTH
▶
▶
▶
▶
l
l
l
l
▶
▶
Child 1 month–1 year: 250 mg 4–6 times a day
Child 2–11 years: 500 mg 4–6 times a day
Child 12–14 years: 1 g 4–6 times a day
Child 15–17 years: 1 g 6 times a day; maximum 8 g per
day
UNLICENSED USE Not licensed for use in children under
15 years. Tablets not licensed for prophylaxis of stress
ulceration.
CAUTIONS Patients under intensive care (Important:
reports of bezoar formation)
CAUTIONS, FURTHER INFORMATION
Bezoar formation Following reports of bezoar formation
associated with sucralfate, caution is advised in seriously
ill patients, especially those receiving concomitant enteral
feeds or those with predisposing conditions such as
delayed gastric emptying.
INTERACTIONS → Appendix 1 (sucralfate).
SIDE-EFFECTS
Common or very common Constipation
Uncommon Back pain . bezoar formation . diarrhoea .
dizziness . drowsiness . dry mouth . eadache . flatulence .
gastric discomfort . indigestion . nausea . rash
continue to
answers part 2
Answers
1. Omeprazole, amoxicillin or metronidazole.
2. Omeprazole 40 mg once daily.
Amoxicillin 500 mg three times daily.
Metronidazole 400 mg three times daily.
How to find this information in the app
• Ensure you have selected child content in the app.
• Switch to treatment summaries using the icons.
• Search the name of the relevant disease state or browse through treatment summaries, by body system (similar to
book chapters), then alphabetically.
• Select relevant sections of the treatment summary and review the Helicobacter pylori table, as with book content.
How to find this information online (MedicinesComplete)
•S
earch the name of the relevant disease state or browse through treatment summaries, by body system (similar to
book chapters), then alphabetically.
• Select relevant sections of the treatment summary and review the Helicobacter pylori table, as with book content.
return to
answers part 1
How to find this information in the app
Step 1: Ensure you have
selected child content in
the app.
Step 2: Switch to drugs using
the icons.
Step 3: Search ‘clarithromycin’.
continue to
answers part 2
Answers
1. 250 mg twice daily.
2. Clarithromycin tablets and intravenous infusion are not licensed for use in children under 12 years.
How to find this information in print
•Search the BNF for Children index for the page number of the clarithromycin monograph.
• Use the Indications and dose section of the clarithromycin monograph to find the correct dose.
• Pass down the monograph to find the Unlicensed use section in order to find information about the unlicensed use of
clarithromycin in children.
• Search ‘clarithromycin’.
• Scroll down the monograph or jump through the section headings using the navigation pane on the left to find the
relevant monograph sections.
return to
answers part 1
Step 1: Ensure you are in BNF for
Children, or search and select BNF for
Children from the available options.
Step 4: Scroll through the monograph
(or use the navigation tab) to locate
the relevant monograph sections (Dose
equivalence and conversion and Potency,
and Patient and carer advice).
Step 2: Search ‘Qvar’.
Step 3: Too many results?
Select the drugs tab.
Step 5: Move down the monograph to
find Patient and carer advice.
continue to
answers part 2
Answers
1. 100 mcg twice daily.
2. Patients on long-term corticosteroid treatment should carry a Steroid Treatment Card which gives guidance on
minimising the risks of treatment and provides details of prescriber, drug, dosage and duration of treatment. A
Medicines for children information leaflet is available at the web address provided in the monograph. This can be
used to provide further advice about the use of beclomethasone inhalers for the control of asthma in children.
•Search the BNF for Children index for ‘Qvar Easi-Breath’.
• Locate information relating to Dose equivalence and conversion and Potency.
• Move down the monograph to find Patient and carer advice.
How to find the information on the app
• Ensure you have selected child content in the app.
• Search ‘Qvar’ within the drugs section – results will indicate Qvar® appears as a medicine in the beclomethasone
monograph.
• Select the beclomethasone monograph and choose the relevant sections (Dose equivalence and conversion and
Potency; and Patient and carer advice) from the menu.
return to
answers part 1
Medicinal forms
Bacterial infection 485
BNF 70
▶
l
▶
▶
l
l
l
l
With intravenous use in children Co-amoxiclav injection: use
normal initial dose and then use half normal dose every
12 hours if estimated glomerular filtration rate
10–30 mL/minute/1.73 m2; use normal initial dose and
then use half normal dose every 24 hours if estimated
glomerular filtration rate less than 10 mL/minute/1.73 m2.
Accumulation of electrolytes contained in parenteral
preparations can occur in patients with renal failure.
DIRECTIONS FOR ADMINISTRATION
With intravenous use in adults For intravenous infusion
(Augmentin ®), give intermittently in Sodium chloride
0.9%. Reconstitute 600 mg initially with 10 mL water for
injections, then dilute with 50 mL infusion fluid;
reconstitute 1.2 g initially with 20 mL water for injections,
then dilute with 100 mL infusion fluid; give over 30–40
minutes via drip tubing in Sodium chloride 0.9%.
With intravenous use in children For intravenous infusion,
dilute reconstituted solution to a concentration of
10 mg/mL with Sodium Chloride 0.9%; give intermittently
over 30–40 minutes.
PRESCRIBING AND DISPENSING INFORMATION Doses are
expressed as co-amoxiclav: a mixture of amoxicillin (as
the trihydrate or as the sodium salt) and clavulanic acid
(as potassium clavulanate); the proportions are expressed
in the form x/y where x and y are the strengths in
milligrams of amoxicillin and clavulanic acid respectively.
Flavours of oral liquid formulations may include raspberry
and orange.
Medicines for Children leaflet: Co-amoxiclav for bacterial
infections www.medicinesforchildren.org.uk/
co-amoxiclav-bacterial-infections-0
PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary Co-amoxiclav 250/125
Tablets may be prescribed. Co-amoxiclav 125/31
Suspension may be prescribed. Co-amoxiclav 250/62
Suspension may be prescribed.
MEDICINAL FORMS
containing the same drug. Forms available from special-order
manufacturers include: infusion
Tablet
CAUTIONARY AND ADVISORY LABELS 9
CO-AMOXICLAV (Non-proprietary)
Amoxicillin (as Amoxicillin trihydrate) 250 mg, Clavulanic acid
(as Potassium clavulanate) 125 mg Co-amoxiclav 250mg/125mg
tablets | 21 tablet P £7.00 DT price = £4.87 | 100 tablet P
£35.00
tablets | 21 tablet P £15.00 DT price = £4.23
▶ Augmentin (GlaxoSmithKline UK Ltd)
(as Potassium clavulanate) 125 mg Augmentin 375mg tablets |
21 tablet P £5.03 DT price = £4.87
▶
Oral suspension
EXCIPIENTS: May contain Aspartame
▶
Amoxicillin (as Amoxicillin trihydrate) 25 mg per 1 ml, Clavulanic
acid (as Potassium clavulanate) 6.2 mg per 1 ml Co-amoxiclav
125mg/31mg/5ml oral suspension | 100 ml P £4.20
Co-amoxiclav 125mg/31mg/5ml oral suspension sugar free (sugarfree) | 100 ml P £25.00 DT price = £1.81
Amoxicillin (as Amoxicillin trihydrate) 80 mg per 1 ml,
Clavulanic acid (as Potassium clavulanate) 11.4 mg per 1 ml Coamoxiclav 400mg/57mg/5ml oral suspension sugar free (sugarfree) | 35 ml P £4.13 DT price = £4.13 (sugar-free) | 70 ml P
£5.79 DT price = £5.79
acid (as Potassium clavulanate) 6.2 mg per 1 ml Augmentin
125/31 SF oral suspension (sugar-free) | 100 ml P £3.54 DT price
= £1.81
= £1.89
▶ Augmentin-Duo (GlaxoSmithKline UK Ltd)
Clavulanic acid (as Potassium clavulanate) 11.4 mg per
1 ml Augmentin-Duo 400/57 oral suspension (sugar-free) |
35 ml P £4.13 DT price = £4.13 (sugar-free) | 70 ml P £5.79
DT price = £5.79
Powder for solution for injection
5
l
▶
▶
l
ELECTROLYTES: May contain Potassium, sodium
Amoxicillin (as Amoxicillin sodium) 500 mg, Clavulanic acid (as
Potassium clavulanate) 100 mg Co-amoxiclav 500mg/100mg
powder for solution for injection vials | 10 vial P £14.90
▶ Augmentin Intravenous (GlaxoSmithKline UK Ltd)
Potassium clavulanate) 100 mg Augmentin Intravenous 600mg
Potassium clavulanate) 200 mg Augmentin Intravenous 1.2g
▶
Co-fluampicil
BY MOUTH
▶
▶
▶
Child 1 month–9 years: 125/125 mg every 6 hours
Child 10–17 years: 250/250 mg every 6 hours
Adult: 250/250 mg every 6 hours
BY INTRAMUSCULAR INJECTION OR BY SLOW INTRAVENOUS
INJECTION OR BY INTRAVENOUS INFUSION
Severe mixed infections involving beta-lactamase-producing
staphylococci
▶
BY MOUTH
▶
▶
▶
▶
Important safety information
HEPATIC DISORDERS
Cholestatic jaundice and hepatitis may occur very
rarely, up to two months after treatment with
flucloxacillin has been stopped. Administration for
more than 2 weeks and increasing age are risk factors.
Healthcare professionals are reminded that:
. flucloxacillin should not be used in patients with a
history of hepatic dysfunction associated with
flucloxacillin;
. flucloxacillin should be used with caution in patients
with hepatic impairment;
l
l
F
Mixed infections involving beta-lactamase-producing
staphylococci
BNF 70
▶
l
and orange.
MEDICINAL FORMS
Tablet
£35.00
▶
Oral suspension
▶
Step 4: Locate Powder for
solution for injection.
£5.79 DT price = £5.79
= £1.81
= £1.89
DT price = £5.79
5
l
▶
▶
l
▶
Co-fluampicil
BY MOUTH
▶
▶
▶
staphylococci
▶
BY MOUTH
▶
▶
▶
▶
HEPATIC DISORDERS
flucloxacillin;
l
l
F
staphylococci
BNF 70
▶
l
and orange.
MEDICINAL FORMS
Tablet
£35.00
▶
Oral suspension
▶
£5.79 DT price = £5.79
= £1.81
= £1.89
DT price = £5.79
▶
Co-fluampicil
F
staphylococci
BY MOUTH
▶
▶
▶
staphylococci
▶
BY MOUTH
▶
▶
▶
▶
HEPATIC DISORDERS
flucloxacillin;
continue to
answers part 2
5
Infection
Atarax, 248
Atazanavir, 567
Atenolol, 141
Atenolol with chlortalidone, see Cotenidone
Atenolol with nifedipine, 141
Atimos Modulite, 221
Ativan, 414
Atomoxetine, 272
Atonic and tonic seizures, 383
Atorvastatin, 179
Atosiban, 708
Atovaquone, 523
Pneumocystis pneumonia, 522
Atovaquone with proguanil
hydrochloride, 536
Atracurium besilate, 1103
Atracurium besylate, see Atracurium
besilate
Atrial fibrillation, 84
Atrial flutter, 84
Atriance, 764
Atripla, 565
Atrolak XL, 319
Atropine sulfate, 950, 1099
Cardiopulmonary resuscitation, 195
Emergency treatment of poisoning,
1123
Atropine sulfate with diphenoxylate
hydrochloride, see Co-phenotrope
Atrovent, 218
Atrovent UDV, 218
Attention deficit hyperactivity disorder,
270
Attia, 107
Aubagio, 734
Audavate, 1023
Audmonal, 75
Augmentin, 485
Augmentin-Duo, 485
Augmentin Intravenous, 485
Aureocort, 1032
Avamys, 985
Avanafil, 698
Avastin, 737
Avaxim, 1082
Avelox, 493
Aviticol, 886
Avloclor, 537
Avoca, 1057
Avodart, 676
Avomine, 252
Avonex, 730
Axitinib, 802
Axorid, 932
Axsain, 383
Aymes Shake, 1266
Azacitidine, 757
Azactam, 474
Azapress, 717
Azarga, 966
Azathioprine, 716
Inflammatory bowel disease, 32
Azelaic acid, 1043
Rosacea and Acne, 1041
Azelastine hydrochloride, 945
Azelastine with fluticasone, 985
Azidothymidine, see Zidovudine
Azilect, 340
Azilsartan medoxomil, 132
Azithromycin, 469, 955
Genital system infections, bacterial,
445
Azopt, 966
Aztreonam, 474
AZT, see Zidovudine
Index
Arava, 895
Arcoxia, 925
Aredia, 624
Argatroban monohydrate, 116
Aricept, 263
Aricept Evess, 263
Arimidex, 792
Aripiprazole, 312
Psychoses and related disorders, 300
Arixtra, 109
Arjun, 1041
Arkolamyl, 316
Arlevert, 343
Aromasin, 792
Aromatic inhalations, cough preparations
and systemic nasal decongestants, 258
Arpicolin, 326
Arrangements for supplying oxygen, 214
Arrhythmias, 84
Arrhythmias after myocardial infarction,
84
Arsenic trioxide, 776
Artelac, 952
Artelac Nighttime, 951
Artelac Rebalance, 953
Artelac Splash, 953
Artemether with lumefantrine, 534
Artenimol with piperaquine phosphate,
535
Arthritis, 891
Arthrotec, 924
Articaine hydrochloride with adrenaline,
see Adrenaline with articaine
hydrochloride
Artificial saliva products, 987
Arythmol, 93
Arzerra, 740
Asacol, 36
Asacol MR, 36
Asasantin Retard, 107
Ascaricides (common roundworm
infections), 524
Ascorbic acid, 884
Anaemias, 822
Ascorbic acid with ferrous sulfate, 835
Ascorbic acid with vitamin B substances,
see Vitamin b substances with ascorbic
acid
Ascur, 884
Asenapine, 276
Asmabec Clickhaler, 228
Asmanex Twisthaler, 232
Asmasal Clickhaler, 224
Asmavent, 224
Aspirin
Drug monograph, 104
Acute coronary syndromes, 186
Antiplatelet drugs, 103
Arrhythmias, 84
Emergency treatment of poisoning,
1123
Gout, 908
Hypertension, 121
Management of stroke, 101
Aspirin with codeine, 354
Aspirin with dipyridamole, 107
Aspirin with metoclopramide, 381
Asplenia, 528
Asthma
Treatment summary, 210
Asymptomatic contacts of patients with
infectious syphilis, 445
AT10, 887
Step 3: Locate Oral
suspension.
Infection
Index 1339
BNF 70
Sinusitis, 446
Throat infections, 995
Typhoid fever, 445
Uncomplicated genital chlamydial
infection, non-gonococcal
urethritis, and non-specific genital
infection, 445
Upper urinary-tract infections, 510
Anticholinesterases, 912
Anticoagulants, 102, 104, 529
Antidepressants, 1127
Antidiarrhoeals, 83
Anti-d (rh0) immunoglobulin, 1061
Antiepileptic drugs, 383
Antiepileptic hypersensitivity syndrome,
384
Anti-lymphocyte monoclonal antibodies,
731
Antimalarials, 1123
Antimicrobial dressings, 1305
Antimotility drugs, 54
Antimuscarinic drugs used in
parkinsonism, 324
Antimuscarinics (eye), 949
Antimuscarinics (inhaled), 217
Antimuscarinics (systemic), 668
Antiplatelet drugs, 103
Antiplatelet drugs and coronary stents,
103
Antipsychotic depot injections, 300
Antipsychotic drugs, 300
Class monograph, 303
Antiseptic mouthwashes, 992
Antispasmodics, 54
Antithymocyte immunoglobulin (rabbit),
723
Antituberculosis drugs
Table, 501
Tuberculosis, 501
Antivaricella-zoster Immunoglobulin, see
Varicella-zoster immunoglobulin
Apercap, 40
Apidra, 606
Apidra SoloStar, 606
Apixaban, 108
Apodespan PR, 331
APO-go, 333
APO-go Pen, 333
APO-go PFS, 333
Apomorphine hydrochloride, 332
Parkinson’s disease and related
disorders, 324
Approximate Conversions and Units,
inside back cover
Apraclonidine, 963
Glaucoma, 962
Aprepitant, 351
Apresoline, 158
Aprinox, 159
Aprokam, 955
Aprovel, 134
Aptivus, 571
Aqua-cool, 1041
Aquadrate, 1005
Aquamol, 1004
AquaSoothe, 1041
Arachis oil, 51
Arachis oil extract of coal tar with cade
oil, coal tar, light liquid paraffin and
tar, 1035
Arachis oil with chlorobutanol, 980
Arachis oil with extract of coal tar, 1036
Aragam, 1064
Aranesp, 826
Aranesp SureClick, 826
Step 2: Locate Medicinal
forms in the monograph.
Infection
Step 1: Search index for
Augmentin®.
Medicinal forms
Answers
1. May contain aspartame.
2. Cautionary and advisory labels 9: Space the doses evenly
throughout the day. Keep taking this medicine until the
course is finished, unless you are told to stop.
3. May contain potassium, sodium.
How to find the information in the app or online
avigate to the relevant drug (co-amoxiclav) by searching
•N
‘Augmentin’ or ‘co-amoxiclav’.
• Follow the same steps as for print.
return to
answers part 1
Isovorin, 782
Ispaghula husk, 45
Ispaghula husk with mebeverine, 75
Ispaghula husk with senna, 54
Isradipine, 152
Isteranda, 694
Istin, 149
Itching, 1007
Itraconazole, 519
Oropharyx infections, fungal, 996
Ivabradine, 185
Stable angina, 182
Ivacaftor, 257
Ivemend, 351
Ivermectin, 525, 1015
Helminth infections, 524
Skin infections, 1006
Ixiaro, 1087
ANTIMUSCARINICS
Antimuscarinics (inhaled)
l
l
l
▶
▶
J
Jakavi, 816
Janumet, 598
Januvia, 598
Japanese encephalitis vaccine, 1086
Jardiance, 611
Javlor, 775
Jaydess, 694
Jentadueto, 597
Jet nebulisers, 209
Jetrea, 975
Jevity, 1262, 1264, 1265
Jevtana, 770
Jext, 198
Joint Formulary Committee 2015–2016,
vii
Joint prostheses and dental treatment,
442
Joint replacement including hip and
knee, 441
Joy-Rides, 345
K
Kadcyla, 744
Kalcipos-D, 886
Kaletra, 570
Kalspare, 204
Kalydeco, 257
Kaolin, 57
Kaolin with morphine, 55
Kapake, 359
Katya, 687
Kay-Cee-L, 864
Keflex, 457
Keftid, 456
Kelo-cote, 1309, 1310
Kemadrin, 326
Kemicetine, 453
Kenalog, 587
Kentera, 670
Kentipine MR, 154
Kenzem SR, 151
Kepivance, 783
Keppra, 397
Keral, 920
Kerstipon, 264
Ketalar, 1111
Ketamine, 1110
General anaesthesia, 1093
KetoCal, 1271
Ketoconazole, 587, 713, 1011
Scalp and hair conditions, 1048
Ketoprofen, 930
Ketoprofen with omeprazole, 932
Ketorolac trometamol, 961
Ketotifen, 249, 945
▶
l
f
CAUTIONS Bladder outflow obstruction . prostatic
hyperplasia . susceptability to angle-closure glaucoma
INTERACTIONS See Appendix 1 (antimuscarinics).
However, note that interactions do not generally apply to
antimuscarinics used by inhalation.
SIDE-EFFECTS
Common or very common Constipation . cough . diarrhoea .
dry mouth . gastro-intestinal motility disorder . headache
Uncommon Angle-closure glaucoma . atrial fibrillation .
blurred vision . bronchospasm . dysphagia . dysphonia .
gastro-oesophageal reflux disease . mydriasis .
nasopharyngitis . nausea . palpitation . paradoxical
bronchospasm . pharyngitis . tachycardia . throat irritation
. urinary retention
Rare Dental caries . dry skin
Aclidinium bromide
F
l
l
l
l
l
l
▶
▶
F
l
BY INHALATION OF NEBULISED SOLUTION
Adult: 250–500 micrograms 3–4 times a day
Acute bronchospasm
▶
Child 1 month–4 years: 125–250 micrograms as required;
maximum 1 mg per day
Child 6–11 years: 250 micrograms as required; maximum
1 mg per day
Child 12–17 years: 500 micrograms as required
Adult: 500 micrograms as required
Severe or life-threatening acute asthma
▶
▶
▶
▶
▶
Eklira (AstraZeneca UK Ltd) A
Aclidinium bromide 375 microgram per 1 dose Eklira
322micrograms/dose Genuair | 60 dose P £28.60
▶
Child 1 month–11 years: 250 micrograms every
20–30 minutes for the first 2 hours, then
250 micrograms every 4–6 hours as required
Child 12–17 years: 500 micrograms every 4–6 hours as
required
Adult: 500 micrograms every 4–6 hours as required
PHARMACOKINETICS
The maximal effect of inhaled ipratropium occurs 30–60
minutes after use; its duration of action is 3 to 6 hours
and bronchodilation can usually be maintained with
treatment 3 times a day.
l
▶
F
Maintenance treatment of chronic obstructive pulmonary
disease
BY INHALATION OF POWDER
▶ Adult: 50 micrograms once daily
Dose equivalence and conversion
For inhalation of powder, each 50 microgram capsule of
glycopyrronium delivers 44 micrograms of
glycopyrronium.
CAUTIONS Arrhythmia (excluding chronic stable atrial
fibrillation) . history of myocardial infarction . history of
Child 6–11 years: 1–2 drops 1–2 times a day as required
for maximum duration of 5 days, 0.05% solution to be
administered into each nostril
Child 12–17 years: 2–3 drops 2–3 times a day as required
for maximum duration of 7 days, 0.1% solution to be
Adult: 2–3 drops 2–3 times a day as required for
maximum duration of 7 days, 0.1% solution to be
CAUTIONS Cystic fibrosis
Glaucoma Acute angle-closure glaucoma has been reported
with nebulised ipratropium, particularly when given with
nebulised salbutamol (and possibly other beta2 agonists);
care needed to protect the patient’s eyes from nebulised
drug or from drug powder.
l SIDE-EFFECTS
▶ Common or very common Dizziness . nausea (in children)
▶ Uncommon Laryngospasm . pharyngeal oedema (in
children) . pruritus . stomatitis . vomiting
▶ Rare Atrial fibrillation (in children) . ocular
accommodation disorder (in children)
Child 12–17 years: 1 spray 1–3 times a day as required
for maximum duration of 7 days, to be administered
into each nostril
Adult: 1 spray 1–3 times a day as required for
maximum duration of 7 days, to be administered into
each nostril
The CHM/MHRA has stated that non-prescription cough
and cold medicines containing ephedrine,
oxymetazoline, or xylometazoline can be considered for
up to 5 days’ treatment in children aged 6–12 years
after basic principles of best care have been tried; these
medicines should not be used in children under 6 years
of age.
BY INHALATION OF AEROSOL
(Glycopyrrolate)
l
▶
Child 1 month–5 years: 20 micrograms 3 times a day
▶ Child 6–11 years: 20–40 micrograms 3 times a day
▶ Child 12–17 years: 20–40 micrograms 3–4 times a day
Reversible airways obstruction, particularly in chronic
obstructive pulmonary disease
Inhalation powder
▶
BY INTRANASAL ADMINISTRATION USING NASAL DROPS
BY INTRANASAL ADMINISTRATION USING NASAL SPRAY
Adult: 20–40 micrograms 3–4 times a day
Otrivine Adult Metered Dose 0.1% nasal spray | 10 ml G £3.31 DT
price = £2.10
Sudafed Mucus Relief (McNeil Products Ltd)
Xylometazoline hydrochloride 1 mg per 1 ml Sudafed Mucus Relief
0.1% nasal spray | 15 ml G £2.37
▶ Sudafed Non-Drowsy Decongestant (xylometazoline) (McNeil
Products Ltd)
Xylometazoline hydrochloride 1 mg per 1 ml Sudafed Blocked
Nose 0.1% spray | 15 ml G £2.38
DRUG ACTION Xylometazoline is a sympathomimetic.
▶
▶
▶
Nasal inﬂammation, nasal polyps and rhinitis 983
Nasal congestion
BY INHALATION OF AEROSOL
MEDICINAL FORMS
Glycopyrronium bromide
l
Reversible airways obstruction
CAUTIONS Hospitalisation with moderate or severe heart
failure within last 12 months . myocardial infarction
within last 6 months . newly diagnosed arrhythmia within
last 3 months . unstable angina
SIDE-EFFECTS Sinusitis
PREGNANCY Manufacturer advises use only if potential
benefit outweighs risk.
BREAST FEEDING Manufacturer advises avoid.
PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer aclidinium bromide
powder inhalation.
▶
3
Seebri Breezhaler (Novartis Pharmaceuticals UK Ltd) A
Glycopyrronium bromide 55 microgram Seebri Breezhaler
44microgram inhalation powder capsules with device |
6 capsule P £5.50 | 30 capsule P £27.50
Ipratropium bromide
Adult: 375 micrograms twice daily
Each 375 microgram inhalation of aclidinium bromide
delivers 322 micrograms of aclidinium.
l
BNF 70
Xylometazoline hydrochloride
▶
▶
l
MEDICINAL FORMS
▶
BY INHALATION OF POWDER
l
QT-interval prolongation . left ventricular failure .
unstable ischaemic heart disease
PREGNANCY Manufacturer advises use only if potential
benefit outweighs risk.
BREAST FEEDING Manufacturer advises use only if
potential benefit outweighs risk.
RENAL IMPAIRMENT Use with caution if eGFR less than
30 mL/minute/1.73 m2.
PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer glycopyrronium for
inhalation.
Inhalation powder
Maintenance treatment of chronic obstructive pulmonary
disease
l
Step 4: Locate Ipratropium
monograph (intranasal).
Airways disease, obstructive 217
BNF 70
Index
Invodol SR, 374
Invokana, 609
Iodide with iodine, 665
Iodine, 1306
Iodine with iodide, see Iodide with iodine
Iopidine, 963
Ipilimumab, 739
Ipocol, 36
Ipramol, 218
Ipratropium bromide, 217, 983
Ipratropium with salbutamol, 218
Irbesaran with hydrochlorothiazide, see
Hydrochlorothiazide with irbesartan
Irbesartan, 133
Iressa, 809
Irinotecan hydrochloride, 772
Iron-deficiency anaemias, 830
Iron dextran, 832
Iron (injectable), 831
Iron isomaltoside 1000, 832
Iron (oral), 833
Iron overload, 838
Iron preparations, 83
Iron salts, 1123
Iron sucrose, 832
Irriclens, 1053
Irrigation fluids, 1309
Irrigation solutions, 1053
Irritable bowel syndrome, 40
Ischaemic stroke, 101
Isentress, 558
Isib XL, 192
Ismo, 192
Ismo Retard, 192
Isocarboxazid, 282
Iso D3, 886
Isodur XL, 193
Isoflurane, 1098
General anaesthesia, 1093
Isoket, 192
Isoket Retard, 191
Isolated systolic hypertension, 121
Isoniazid
Drug monograph, 506
Antibacterials, use for prophylaxis,
439
Tuberculosis, 501
Isoniazid with ethambutol with
pyrazinamide and rifampicin, see
Ethambutol with isoniazid,
pyrazinamide and rifampicin
Isoniazid with pyrazinamide and
rifampicin, 510
Isoniazid with rifampicin, 510
Isophane insulin, 607
Isophane Insulin Injection, see Isophane
insulin
Isophane Insulin (NPH)—intermediate
acting, see Isophane insulin
Isophane Protamine Insulin Injection, see
Isophane insulin
Isoplex, 854
Isopropyl alcohol with chlorhexidine
gluconate, see Chlorhexidine gluconate
with isopropyl alcohol
Isopto Alkaline, 952
Isopto Plain, 952
Isosorbide dinitrate, 191
Isosorbide mononitrate, 192
Isotard XL, 193
Isotretinoin, 1045
Rosacea and Acne, 1041
Isotretinoin with erythromycin, see
Erythromycin with isotretinoin
Isotrex, 1046
Isotrexin, 1047
Step 3: Locate Ipratropium
monograph (inhaled).
l
l
l
l
CAUTIONS Angle-closure glaucoma . avoid excessive or
prolonged use . cardiovascular disease (in children) .
diabetes mellitus . elderly . hypertension .
hyperthyroidism . ischaemic heart disease (in adults) .
prostatic hypertrophy (risk of acute retention) (in adults) .
rebound congestion
Rebound congestion Sympathomimetic drugs are of
limited value in the treatment of nasal congestion
because they can, following prolonged use (more than
7 days), give rise to a rebound congestion (rhinitis
medicamentosa) on withdrawal, due to a secondary
vasodilatation with a subsequent temporary increase in
nasal congestion. This in turn tempts the further use of
the decongestant, leading to a vicious cycle of events.
SIDE-EFFECTS Cardiovascular effects . hallucinations in
small children . headache . local irritation . nausea .
rebound congestion . restlessness in small children . sleep
disturbances in small children . tolerance with diminished
effect (after excessive use) . transient visual disturbances
SIDE-EFFECTS, FURTHER INFORMATION
Hallucinations (in small children) Discontinue treatment if
the hallucinations occur.
PREGNANCY Manufacturer advises avoid.
BREAST FEEDING Manufacturer advises caution—no
information available.
MEDICINAL FORMS
Spray
▶
Otrivine (Novartis Consumer Health UK Ltd)
Xylometazoline hydrochloride 1 mg per 1 ml Otrivine Congestion
Relief 0.1% nasal spray | 10 ml G £2.93 DT price = £2.10
Otrivine Adult Measured Dose Sinusitis spray | 10 ml G £2.55 DT
price = £2.10
Otrivine Allergy Relief 0.1% nasal spray | 10 ml G £2.55 DT price
= £2.10
Otrivine Adult nasal spray | 10 ml G £2.10 DT price = £2.10
Nasal drops
▶
Otrivine (Novartis Consumer Health UK Ltd)
Xylometazoline hydrochloride 500 microgram per 1 ml Otrivine
Child nasal drops | 10 ml p £1.91 DT price = £1.91
Xylometazoline hydrochloride 1 mg per 1 ml Otrivine Adult 0.1%
nasal drops | 10 ml G £2.10 DT price = £2.10
12
2.2 Nasal inflammation, nasal
polyps and rhinitis
Ear, nose and oropharynx
Index 1351
BNF 70
Inflectra, 908
Infliximab, 906
Influenza, 571
Influenza vaccine, 1085
Influvac Sub-unit, 1086
Ingenol mebutate, 1039
Inhalational anaesthetics, 1093
Inhaled corticosteroids
Inhaler devices, 209
Inlyta, 803
Innohep, 115
Innovace, 127
Innozide, 127
Inosine acedoben dimepranol, see
Inosine pranobex
Inosine pranobex, 550
Herpesvirus infections, 549
Inositol nicotinate, 206
Peripheral vascular disease, 205
Inovelon, 403
Insect stings, 1130
Inspra, 168
Instant Carobel, 1279
Instanyl, 366
Instillagel, 679
Insulatard, 607
Insulatard InnoLet, 607
Insulatard Penfill, 607
Insulin aspart, 604
Insulin degludec, 604
Insulin degludec with liraglutide, 605
Insulin delivery systems, needle free, see
Needle free insulin delivery systems
Insulin detemir, 605
Insulin glargine, 605
Insulin glulisine, 605
Insulin injection pens, hypodermic, see
Hypodermic insulin injection pens
Insulin Injection, see Insulin
Insulin lispro, 606
Insulins, 602
Insulin zinc suspension, 607
Insulin Zinc Suspension (Mixed)—long
acting, see Insulin zinc suspension
Insuman Basal, 607
Insuman Comb, 603
Insuman Rapid, 604
Intal, 235
Intanza, 1086
Integrilin, 183
Intelence, 560
Interferon alfa, 794
Interferon beta, 729
Interferon gamma-1b, 795
Intermediate-acting insulin, see Biphasic
insulin aspart
Intermediate-acting insulin, see Biphasic
insulin lispro
Intracerebral haemorrhage, 101
Intralipid, 874
Intratect, 1064
Intra-uterine contraceptive devices
(copper), 689
Intravenous anaesthetics, 1093
Intravenous glucose, 845
Intravenous potassium, 845
Intravenous sodium, 845
IntronA, 795
Invanz, 453
Invega, 318
Invirase, 571
InVita D3, 886
Step 2: Locate the class
monograph.
Respiratory system
Step 1: Search index for
ipratropium bromide.
Drugs used for Nasal inflammation, nasal polyps and
rhinitis not listed below; Desloratadine, p. 247 .
Fexofenadine hydrochloride, p. 247 . Ketotifen, p. 249
ANTIMUSCARINICS
Ipratropium bromide
Rhinorrhoea associated with allergic and non-allergic
rhinitis
BY INTRANASAL ADMINISTRATION
Child 12–17 years: 2 sprays 2–3 times a day, dose to be
sprayed into each nostril
Adult: 2 sprays 2–3 times a day, dose to be sprayed
into each nostril
1 metered spray of nasal spray = 21 micrograms.
▶
▶
l
l
▶
▶
▶
l
CAUTIONS Avoid spraying near eyes . bladder outflow
obstruction . cystic fibrosis . prostatic hyperplasia (in
adults) . risk of glaucoma (in children) . susceptability to
angle-closure glaucoma (in adults)
SIDE-EFFECTS
Common or very common epistaxis . nasal dryness . nasal
irritation
Uncommon headache . nausea . pharyngitis (in children)
Very rare gastro-intestinal motility disturbances .
palpitations . urinary retention
MEDICINAL FORMS
Spray
EXCIPIENTS: May contain Benzalkonium chloride, disodium edetate
▶
Rinatec (Boehringer Ingelheim Ltd)
Ipratropium bromide 21 microgram per 1 dose Rinatec
21micrograms/dose nasal spray | 180 dose P £6.54 DT price =
£6.54
CORTICOSTEROIDS
Corticosteroids (intranasal)
l
f
CAUTIONS Avoid after nasal surgery (until healing has
occurred) . avoid in pulmonary tuberculosis . avoid in the
presence of untreated nasal infections . patients
transferred from systemic corticosteroids may experience
exacerbation of some symptoms
continue to
answers part 2
Answers
1. All inhaled antimuscarinics (check both drug (inhaled) and class monograph).
2. No. It is listed as a rare side-effect in the antimuscarinic (inhaled) class monograph for
inhaled route only. Intranasal ipratropium (Chapter 12) does not inherit the class monograph
information. Note that there is no flag. Check both drug and class monographs, if applicable,
to obtain the full information about a drug.
3. Ipratropium bromide only. Not listed in antimuscarinic (inhaled) class monograph which
means that this caution does not apply to all inhaled antimuscarinics.
Finding the information in the app or online (MedicinesComplete)
• Navigate to the relevant drug by searching ‘ipratropium’.
• Note that the information, including the class information, will be contained within the drug
monograph – class information is automatically included within drug monograph in the app
and online.
return to
answers part 1
Step 1: Ensure the app is
displaying adult content.
Step 2: Search thalidomide in
the drugs section.
Step 3: Select Conception and
contraception from the menu
options.
Step 4: Go back to the menu,
(tap on drug name, top left).
Step 5: Select Prescribing and
dispensing information.
continue to
answers part 2
Answers
1. W
omen of child-bearing age must practise effective contraception at least one month before, during,
and for at least one month after treatment, including during dose interruptions (oral combined
hormonal contraceptives and copper-releasing intrauterine devices are not recommended).
2. Every prescription must be accompanied by a complete prescription authorisation form.
Question 1
• Search index for thalidomide.
• Locate monograph and locate Conception and contraception heading within monograph.
Question 2
• Locate monograph (as in Question 1) and locate Prescribing and dispensing heading within monograph.
How to find the information online (MedicinesComplete)
• Search ‘thalidomide’.
• Scroll through the monograph (or use the navigation tab) to locate the relevant monograph sections.
return to
answers part 1
628
Chlorhexidine with neomycin, 625
Chlorhexidine with nystatin, 651
Chlorobutanol and arachis oil, see
Arachis oil with chlorobutanol
Chlorobutanol with chlorhexidine,
see Chlorhexidine with
chlorobutanol
Chloromycetin, 604
Chloroquine, 358
Malaria, prophylaxis, 350
Malaria, treatment, 351
Chloroquine with proguanil, 359
Chlorothiazide, 104
Hypoglycaemia, 417
Chlorphenamine maleate, 160
Chlorpheniramine maleate, see
Chlorphenamine maleate
Chlorpromazine hydrochloride, 191
Chlortalidone, 129
Chlortetracycline with
triamcinolone, 669
Chlorthalidone, see Chlortalidone
Cholecalciferol, see Colecalciferol
Cholera vaccine, 710
Cholesterol, 58
Cholestyramine, see Colestyramine
Choline salicylate, 632
Oral ulceration and
inflammation, 630
Choragon, 427
Chorionic gonadotrophin, 427
Chronic bowel disorders, 23
Chronic constipation, 33
Step 3: Locate monograph and Monitoring
requirements.
It is important to note that the index will
take you to the main monograph for
ciclosporin. Although not listed in the
Skin chapter, there is an indication listed
for severe psoriasis.
This is the main monograph for ciclosporin;
therefore, all information about the drug
will be located here. There will be general
monitoring requirements and monitoring
requirements specific to certain diseases,
and the monitoring specific to psoriasis/
dermatitis will need to be chosen.
443
Citrulline, 550
Clairette, 678
Clamelle, 299
Clarelux, 662
Clarie XL, 300
Clarithromycin, 299
Antibacterials, use for
prophylaxis, 271
infections, bacterial, 276
Clarityn, 164
Clasteon, 422
Clavulanic acid with amoxicillin, see
Co-amoxiclav
Clavulanic acid with ticarcillin, see
Ticarcillin with clavulanic acid
Clenil Modulite, 145
Cleosensa, 451
Clexane, 83
Clindamycin 297, 463
MRSA, 325
Oral bacterial infections, 278
Vaginal and vulval conditions,
BNFC 2015–2016
Index
Chronic facial pain, 233
Chronic hypoglycaemia, 417
Chronic otitis media, 616
Ciclesonide, 147
Ciclosporin, 468
Cidomycin, 282
Cilastatin with imipenem, see
Imipenem with cilastatin
Cilest, 453
Ciloxan, 604
Cimizt, 450
Cinchocaine hydrochloride with
fluocortolone caproate and
fluocortolone pivalate, 61
Cinchocaine with hydrocortisone, 61
Cinchocaine with prednisolone, 62
Cinnarizine, 204
Cinryze, 168
Cipramil, 183
Ciprofloxacin, 320, 604
Anthrax, 325
Antibacterials, use for
prophylaxis, 271
Ear, 616
infections, bacterial, 276
Ciproxin, 320
Circadin, 266
Cisatracurium, 735
Cisplatin, 494
Citalopram, 183
Citanest, 750
Citanest with Octapressin, 750
Citramag, 31
Citric acid, 170
Citric acid with magnesium
carbonate, 31
Citric acid with potassium citrate,
462
Clindamycin with benzoyl peroxide,
see Benzoyl peroxide with
clindamycin
Clindamycin with tretinoin, 682
Clinitas, 602
Clinitas Carbomer, 599
Clioquinol with betamethasone, see
Betamethasone with clioquinol
Clioquinol with flumetasone
pivalate, 617
Clioquinol with fluocinolone
acetonide, 665
ClobaDerm, 663
Clobavate, 663
Clobazam, 258
Epilepsy, 234
Clobetasol propionate, 662
Clobetasol propionate with
neomycin sulfate and nystatin, 663
Clobetasone butyrate, 663
Clobetasone butyrate with nystatin
and oxytetracycline, 663
Clofarabine, 487
Clonazepam, 259
Epilepsy, 234
Clonidine hydrochloride, 94
Clostridium difficile infection, 23
Closure of the ductus arteriosus, 129
Clotrimazole, 464, 618, 648
Ear, 616
Clotrimazole with betamethasone,
see Betamethasone with
clotrimazole
Clotrimazole with hydrocortisone,
l
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▶
▶
▶
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667
Clozapine, 196
Psychoses and related disorders,
188
Clozaril, 197
Coal tar, 670
Psoriasis, 654
Coal tar with arachis oil extract of
coal tar, cade oil, light liquid
paraffin and tar, see Arachis oil
extract of coal tar with cade oil,
coal tar, light liquid paraffin and
tar
Coal tar with coconut oil and
salicylic acid, 671
Coal tar with dithranol and salicylic
acid, 671
Coal tar with lecithin, 671
Coal tar with salicylic acid and
precipitated sulfur, 671
Coal tar with zinc oxide, 672
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Immune system disorders and transplantation 469
indications) . uncontrolled hypertension (in nontransplant indications) . uncontrolled infections (in nontransplant indications) . use with tacrolimus specifically
contraindicated
CAUTIONS Hyperuricaemia . in atopic dermatitis
Staphylococcus aureus skin infections—not absolute
contra-indication providing controlled (but avoid
erythromycin unless no other alternative) . in atopic
dermatitis allow herpes simplex infections to clear before
starting (if they occur during treatment withdraw if
severe) . in atopic dermatitis and psoriasis discontinue if
lymphoproliferative disorder develops . in psoriasis treat
patients with malignant or pre-malignant conditions of
skin only after appropriate treatment (and if no other
option)
INTERACTIONS → Appendix 1 (ciclosporin).
For patients other than transplant recipients, preferably
avoid other immunosuppressants (increased risk of
infection and malignancies, including lymphoma and skin
cancer).
SIDE-EFFECTS
Common or very common Abdominal pain . anorexia .
diarrhoea . fatigue . gingival hyperplasia . headache .
hepatic dysfunction . hypercholesterolaemia .
hyperkalaemia . hyperlipidaemia . hypertension .
hypertrichosis . hyperuricaemia . hypomagnesaemia .
muscle cramps . myalgia . nausea . paraesthesia . renal
dysfunction (renal structural changes on long-term
administration) . tremor . vomiting
Uncommon Anaemia . oedema . signs of encephalopathy .
thrombocytopenia . weight gain
Rare Gynaecomastia . haemolytic uraemic syndrome .
hyperglycaemia . menstrual disturbances . microangiopathic haemolytic anaemia . motor polyneuropathy .
muscle weakness . myopathy . pancreatitis . visual
disturbances secondary to benign intracranial
hypertension
Frequency not known ▶ With intravenous use Anaphylaxis
Visual disturbances Discontinue if visual disturbances
secondary to benign intracranial hypertension occur.
PREGNANCY Crosses placenta. There is less experience of
ciclosporin in pregnancy but it does not appear to be any
more harmful than azathioprine. The use of ciclosporin
during pregnancy needs to be supervised in specialist
units.
BREAST FEEDING Present in milk—manufacturer advises
avoid.
HEPATIC IMPAIRMENT Dosage adjustment based on
bilirubin and liver enzymes may be needed.
RENAL IMPAIRMENT In patients with nephrotic syndrome
and renal impairment initially 2.5 mg/kg daily. Reduce
dose by 25–50% if serum creatinine more than 30% above
baseline on more than one measurement.
In psoriasis and atopic dermatitis, reduce dose by 25–50%
if serum creatinine increases more than 30% above
baseline (even if within normal range) and discontinue if
reduction not successful within 1 month.
PRE-TREATMENT SCREENING In psoriasis, exclude
malignancies (including those of skin and cervix) before
starting (biopsy any lesions not typical of psoriasis).
MONITORING REQUIREMENTS
Monitor whole blood ciclosporin concentration (trough
level dependent on indication—consult local treatment
protocol for details).
Dermatological and physical examination, including blood
pressure and renal function measurements required at
least twice before starting treatment for psoriasis or
atopic dermatitis.
Monitor liver function.
▶
▶
▶
▶
▶
▶
▶
▶
l
▶
▶
l
l
l
l
Monitor serum potassium especially in renal dysfunction
(risk of hyperkalaemia).
Monitor serum magnesium.
Measure blood lipids before treatment and after the first
month of treatment.
In psoriasis and atopic dermatitis monitor serum
creatinine every 2 weeks for first 3 months then every
month.
Investigate lymphadenopathy that persists despite
improvement in atopic dermatitis.
Monitor kidney function—dose dependent increase in
serum creatinine and urea during first few weeks may
necessitate discontinuation (exclude rejection of kidney
transplant).
Monitor blood pressure—discontinue if hypertension
develops that cannot be controlled by antihypertensives.
In long-term management of nephrotic syndrome,
perform renal biopsies every 1–2 years.
With oral use Mix solution with orange juice (or squash) or
apple juice (to improve taste) or with water immediately
before taking (and rinse with more to ensure total dose).
Do not mix with grapefruit juice. With capsules and oral
solution, total daily dose should be taken in 2 divided
doses.
With intravenous use For intermittent intravenous infusion,
dilute to a concentration of 0.5–2.5 mg/mL with Glucose
5% or Sodium Chloride 0.9%; give over 2–6 hours; not to
be used with PVC equipment. Observe patient for signs of
anaphylaxis for at least 30 minutes after starting infusion
and at frequent intervals thereafter.
PRESCRIBING AND DISPENSING INFORMATION
Brand name prescribing Prescribing and dispensing of
ciclosporin should be by brand name to avoid inadvertent
switching. If it is necessary to switch a patient to a different
brand of ciclosporin, the patient should be monitored closely
for changes in blood-ciclosporin concentration, serum
creatinine, blood pressure, and transplant function.
Sandimmun ® capsules and oral solution are available
direct from Novartis for patients who cannot be
transferred to a different oral preparation.
HANDLING AND STORAGE Keep medicine measure away
from other liquids (including water).
Patients and carers should be counselled on the
administration of ciclosporin capsules and oral solution.
Avoid excessive exposure to UV light, including sunlight.
In psoriasis and atopic dermatitis, avoid use of UVB or
PUVA.
Medicines for Children leaflet: Ciclosporin for nephrotic
syndrome www.medicinesforchildren.org.uk/ciclosporinnephrotic-syndrome-0
BNFC 2015–2016
l
8
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▶
▶
▶
l
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l
MEDICINAL FORMS
Capsule
EXCIPIENTS: May contain Ethanol, ethyl lactate, propylene glycol
CICLOSPORIN (Non-proprietary)
Ciclosporin 25 mg Ciclosporin 25mg capsules | 30 capsule P no
price available
price available
Ciclosporin 100 mg Ciclosporin 100mg capsules |
30 capsule P no price available
▶ Capimune (Mylan Ltd)
Ciclosporin 25 mg Capimune 25mg capsules | 30 capsule P
£13.05
£25.50
£48.50
▶
l
l
▶
▶
▶
Immune system disorders and transplantation 469
indications) . uncontrolled hypertension (in nontransplant indications) . uncontrolled infections (in nontransplant indications) . use with tacrolimus specifically
contraindicated
CAUTIONS Hyperuricaemia . in atopic dermatitis
Staphylococcus aureus skin infections—not absolute
contra-indication providing controlled (but avoid
erythromycin unless no other alternative) . in atopic
dermatitis allow herpes simplex infections to clear before
starting (if they occur during treatment withdraw if
severe) . in atopic dermatitis and psoriasis discontinue if
lymphoproliferative disorder develops . in psoriasis treat
patients with malignant or pre-malignant conditions of
skin only after appropriate treatment (and if no other
option)
INTERACTIONS → Appendix 1 (ciclosporin).
For patients other than transplant recipients, preferably
avoid other immunosuppressants (increased risk of
infection and malignancies, including lymphoma and skin
cancer).
SIDE-EFFECTS
Common or very common Abdominal pain . anorexia .
diarrhoea . fatigue . gingival hyperplasia . headache .
hepatic dysfunction . hypercholesterolaemia .
hyperkalaemia . hyperlipidaemia . hypertension .
hypertrichosis . hyperuricaemia . hypomagnesaemia .
muscle cramps . myalgia . nausea . paraesthesia . renal
dysfunction (renal structural changes on long-term
administration) . tremor . vomiting
Uncommon Anaemia . oedema . signs of encephalopathy .
thrombocytopenia . weight gain
Rare Gynaecomastia . haemolytic uraemic syndrome .
hyperglycaemia . menstrual disturbances . microangiopathic haemolytic anaemia . motor polyneuropathy .
muscle weakness . myopathy . pancreatitis . visual
disturbances secondary to benign intracranial
hypertension
Frequency not known ▶ With intravenous use Anaphylaxis
Visual disturbances Discontinue if visual disturbances
secondary to benign intracranial hypertension occur.
PREGNANCY Crosses placenta. There is less experience of
ciclosporin in pregnancy but it does not appear to be any
more harmful than azathioprine. The use of ciclosporin
during pregnancy needs to be supervised in specialist
units.
BREAST FEEDING Present in milk—manufacturer advises
avoid.
HEPATIC IMPAIRMENT Dosage adjustment based on
bilirubin and liver enzymes may be needed.
RENAL IMPAIRMENT In patients with nephrotic syndrome
and renal impairment initially 2.5 mg/kg daily. Reduce
dose by 25–50% if serum creatinine more than 30% above
baseline on more than one measurement.
In psoriasis and atopic dermatitis, reduce dose by 25–50%
if serum creatinine increases more than 30% above
baseline (even if within normal range) and discontinue if
reduction not successful within 1 month.
PRE-TREATMENT SCREENING In psoriasis, exclude
malignancies (including those of skin and cervix) before
starting (biopsy any lesions not typical of psoriasis).
MONITORING REQUIREMENTS
Monitor whole blood ciclosporin concentration (trough
level dependent on indication—consult local treatment
protocol for details).
Dermatological and physical examination, including blood
pressure and renal function measurements required at
least twice before starting treatment for psoriasis or
atopic dermatitis.
Monitor liver function.
▶
▶
▶
▶
▶
▶
▶
▶
l
▶
▶
l
l
l
l
Monitor serum potassium especially in renal dysfunction
(risk of hyperkalaemia).
Monitor serum magnesium.
Measure blood lipids before treatment and after the first
month of treatment.
In psoriasis and atopic dermatitis monitor serum
creatinine every 2 weeks for first 3 months then every
month.
Investigate lymphadenopathy that persists despite
improvement in atopic dermatitis.
Monitor kidney function—dose dependent increase in
serum creatinine and urea during first few weeks may
necessitate discontinuation (exclude rejection of kidney
transplant).
Monitor blood pressure—discontinue if hypertension
develops that cannot be controlled by antihypertensives.
In long-term management of nephrotic syndrome,
perform renal biopsies every 1–2 years.
With oral use Mix solution with orange juice (or squash) or
apple juice (to improve taste) or with water immediately
before taking (and rinse with more to ensure total dose).
Do not mix with grapefruit juice. With capsules and oral
solution, total daily dose should be taken in 2 divided
doses.
With intravenous use For intermittent intravenous infusion,
dilute to a concentration of 0.5–2.5 mg/mL with Glucose
5% or Sodium Chloride 0.9%; give over 2–6 hours; not to
be used with PVC equipment. Observe patient for signs of
anaphylaxis for at least 30 minutes after starting infusion
and at frequent intervals thereafter.
PRESCRIBING AND DISPENSING INFORMATION
Brand name prescribing Prescribing and dispensing of
ciclosporin should be by brand name to avoid inadvertent
switching. If it is necessary to switch a patient to a different
brand of ciclosporin, the patient should be monitored closely
for changes in blood-ciclosporin concentration, serum
creatinine, blood pressure, and transplant function.
Sandimmun ® capsules and oral solution are available
direct from Novartis for patients who cannot be
transferred to a different oral preparation.
HANDLING AND STORAGE Keep medicine measure away
from other liquids (including water).
Patients and carers should be counselled on the
administration of ciclosporin capsules and oral solution.
Avoid excessive exposure to UV light, including sunlight.
In psoriasis and atopic dermatitis, avoid use of UVB or
PUVA.
Medicines for Children leaflet: Ciclosporin for nephrotic
syndrome www.medicinesforchildren.org.uk/ciclosporinnephrotic-syndrome-0
8
Malignant disease
Index 951
BNFC 2015–2016
Cetrimide with chlorhexidine, 687
Cetrimide with undecenoic acid, 683
Changes, xvi
Charcoal, activated, 759
Emergency treatment of
poisoning, 752
Charcodote, 759
Chenodeoxycholic acid, 57
Biliary disorders, 56
Chirocaine, 745
Chloral hydrate, 265
Chlorambucil, 481
Chloramphenicol, 284, 604, 617
Ear, 616
ChloraPrep, 685
Chlorhexidine, 628, 684
Mouthwashes and other
preparations for oropharyngeal
use, 627
Chlorhexidine gauze dressing, 1094
Chlorhexidine gluconate with
isopropyl alcohol, 685
Chlorhexidine hydrochloride with
hydrocortisone and nystatin, 667
Chlorhexidine with cetrimide, see
Cetrimide with chlorhexidine
Chlorhexidine with chlorobutanol,
Step 2: Locate monograph and Pretreatment screening.
Malignant disease
Step 1: Search the BNF
for Children index for
ciclosporin.
MEDICINAL FORMS
Capsule
EXCIPIENTS: May contain Ethanol, ethyl lactate, propylene glycol
CICLOSPORIN (Non-proprietary)
price available
price available
Ciclosporin 100 mg Ciclosporin 100mg capsules |
30 capsule P no price available
▶ Capimune (Mylan Ltd)
£13.05
£25.50
£48.50
▶
continue to
answers part 2
Answers
1. In psoriasis, exclude malignancies (including skin and cervix malignancies) before starting.
2. General monitoring requirements and monitoring requirements specific to dermatitis/psoriasis:
• Monitor whole blood ciclosporin concentration (through level dependent on indication – consult local
treatment protocol for details).
•Dermatological and physical examination, including blood pressure and renal function measurements,
required at least twice before starting treatment for psoriasis or atopic dermatitis.
• Monitor liver function.
• Monitor serum potassium especially in renal dysfunction (risk of hyperkalaemia).
• Monitor serum magnesium.
• Measure blood lipids before treatment and after the first month of treatment.
• In psoriasis and atopic dermatitis monitor serum creatinine every two weeks for first three months then
every month.
• Investigate lymphadenopathy that persists despite improvement in atopic dermatitis.
• Monitor kidney function – dose dependent increase in serum creatinine and urea during first few weeks
may necessitate discontinuation (exclude rejection of kidney transplant).
• Monitor blood pressure – discontinue if hypertension develops that cannot be controlled by
antihypertensives.
Finding the information in the app or online
• Ensure the correct content set (adult or child) is selected in the app.
• Navigate to the relevant drug by searching ‘ciclosporin’.
• Navigate to the relevant monograph sections Pre-treatment screening and Monitoring requirements.
return to
answers part 1
How to find the information online
Step 1: Search ‘ibuprofen’.
Step 2: Use the navigation pane to jump between section titles or scroll down
to the relevant sections (Cautions, Allergy and cross-sensitivity, Side-effects).
continue to
answers part 2
Answers
1. Oral use is cautioned in ulcerative colitis.
2. Ibuprofen is contraindicated in adults and children with a history of hypersensitivity to aspirin or any
other non-steroidal anti-inflammatory drug (NSAID).
3. Blood disorders are a side-effect of ibuprofen. Blood disorders can be a side-effect of oral use but the
frequency is not known.
How to find the information in print
•
•
•
•
Search the BNF index for ibuprofen.
Locate Cautions in the monograph.
In the monograph, locate Allergy and cross-sensitivity information.
Locate Side-effects in the monograph.
• Search ‘ibuprofen’ from within the drugs section.
• Select the ibuprofen monograph and choose the relevant sections (Cautions and Potency, Allergy and
cross-sensitivity, and Side-effects) from the menu.
return to
answers part 1
Interactions
The app has an interactions checker, which allows you to add multiple drugs and check for pairwise interactions.
Step 1: Select the
interactions icon to
enter the checker.
Step 2: Add the
relevant drugs.
Step 3: Click to
see interactions
information.
Step 4: The
interactions information
is also listed in the
Interactions section of
the monograph, which
allows you to browse all
of the interactions for
one drug.
Step 5: When in a
drug monograph,
drugs may be added
to the interactions
checker using the
symbol top right.
continue to
answers part 2
Interactions
Answers
1. C
arbamazepine reduces the effect of doxycycline, as it accelerates metabolism. It is not a ‘black
dot’ interaction.
• Search for Appendix 1 Interactions in the BNF.
• Drugs in Appendix 1 are listed alphabetically. Searching under antiepileptics directs you to go to
single monographs.
• Search for carbamazepine, check interaction with antibacterials and find doxycycline.
How to find this information online
• Search either drug.
• Use the navigation pane to jump to the Interactions section.
• Click on the hyperlinked drug name.
return to
answers part 1
Funding
How to find this information online
Step 1: Navigate to the relevant drug by
searching ‘omalizumab’.
Step 2: Navigate to the relevant
monograph section National funding/
access decisions.
continue to
answers part 2
Funding
Answers
1. It is not appropriate for a GP to solely manage treatment with Xolair®. NICE technology appraisal
Omalizumab for previously treated chronic spontaneous urticarial (TA339) recommends that
treatment with omalizumab (Xolair®) should be administered under the management of a
secondary care specialist in dermatology, immunology or allergy for the treatment of previously
treated chronic spontaneous urticaria.
2. Omalizumab is stopped at or before the fourth dose if the condition has not responded.
• Search index for omalizumab.
• Locate monograph and National funding/access decisions.
How to find the information in the app
• Navigate to the relevant drug by searching ‘omalizumab’.
• Navigate to the relevant monograph section National funding/access decisions.
return to
answers part 1

How to use the BNF - NHS Education for Scotland

Transcription

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