9 September 2026
September BNF + BNFC Knowledge Updates
British National Formulary
This update contains 12 significant changes, 2 classification changes, 1 new preparation and 3 deleted monographs.
Significant changes
ACE inhibitors: be aware of the distinction between bradykinin- and histamine-mediated angioedema, as treatment strategies differ significantly [MHRA/CHM advice] (see example in lisinopril).
Antihistamines, allergen immunotherapy and allergic emergencies: updated guidance for adrenaline auto-injectors.
Atropine sulfate: information added for Ryjunea® eye drops (licensed for use in children).
Botulinum toxin type A: updated warnings regarding risk of iatrogenic botulism [MHRA/CHM advice].
Botulism antitoxin: updated guidance on iatrogenic botulism.
Cenobamate (Ontozry®): new important safety information on liver monitoring due to reports of severe liver injury.
Chronic obstructive pulmonary disease: updated guidance on the use of mepolizumab.
Domperidone: new contraindication in patients with phaeochromocytoma due to the risk of severe hypertension [MHRA/CHM advice].
Estradiol: existing indication for prophylaxis of recurrent urinary-tract infection in postmenopausal females extended to include perimenopausal and menopausal females.
Estriol: existing indication for prophylaxis of recurrent urinary-tract infection in postmenopausal females extended to include perimenopausal and menopausal females, and to include dosing for vaginal pessaries and gel.
Herpes-zoster vaccine: name change to herpes-zoster vaccine (inactivated) (updated September 2026).
Influenza vaccine: updated guidance for 2026/27 influenza season.
Classification changes
Bupropion hydrochloride [primary classification changed to Antidepressants, other].
Naltrexone with bupropion [primary classification changed to Antidepressants, other].
New Preparations
Meropenem powder and solvent for solution for infusion for Aerobic and anaerobic Gram-positive and Gram-negative infections, Hospital-acquired septicaemia; Exacerbations of chronic lower respiratory-tract infection in cystic fibrosis; Meningitis; Endocarditis (in combination with another antibacterial).
Deleted Monographs
Estramustine phosphate; Lusutrombopag; Pindolol.
BNF for Children
This update contains 6 significant changes and 2 new preparations.
Significant changes
ACE inhibitors: be aware of the distinction between bradykinin- and histamine-mediated angioedema, as treatment strategies differ significantly [MHRA/CHM advice] (see example in lisinopril).
Antihistamines, allergen immunotherapy and allergic emergencies: updated guidance for adrenaline auto-injectors.
Botulinum toxin type A: updated warnings regarding risk of iatrogenic botulism [MHRA/CHM advice].
Botulism antitoxin: updated guidance on iatrogenic botulism.
Domperidone: new contraindication in patients with phaeochromocytoma due to the risk of severe hypertension [MHRA/CHM advice].
Influenza vaccine: updated guidance for 2026/27 influenza season.
New preparations
Meropenem powder and solvent for solution for infusion for Aerobic and anaerobic Gram-positive and Gram-negative infections, Hospital-acquired septicaemia; Severe aerobic and anaerobic Gram-positive and Gram-negative infections; Exacerbations of chronic lower respiratory-tract infection in cystic fibrosis; Meningitis.
Ryjunea® eye drops [atropine sulfate] for Myopia (initiated by a specialist).
